Pediatric Advance Life Support: Aystole Part 2

Mnemonic for Treating Asystole:  CAVE

C- CPR

A-assess rhythm in another lead

V-vasoconstrictors

E- evaluate reversible causes

CPR:  Primary Survey

·         Assess patient

·         Support ABCs

·         CPR

·         Attach defibrillator/monitor

·         Assess rhythm

The effectiveness of PALS is dependent on high-quality CPR

·         Adequate compression rate (at least 100 compressions/min)

·         Adequate compression depth (at least one third of the AP diameter of the chest or approximately

·         1 1⁄2 inches [4 cm] in infants and approximately 2inches [5 cm] in children)

·         Allowing complete recoil of the chest after each compression

·         Minimizing interruptions in compression

·         Avoiding excessive ventilation

Assess Rhythm in Another Lead

·         Make sure correct lead is displayed on the monitor

·         Make sure cables are connected to the monitor

·         Check gain on monitor

·         Check for loose leads

·         Confirm that the rhythm is not fine VF

Asystole Confirmed in Two Leads

Fine ventricular fibrillation may look like asystole

Secondary Survey

·         Intubate

·         Oxygenate

·         IV access

·         Treat reversible causes

Note: Once the patient is intubated, continue CPR with asynchronous ventilations and chest compressions.

Formula for Estimating Endotracheal tube size: 

Uncuffed ET tube:  mm ID = (age in years/4) + 4

Cuffed ET tube:  mm ID = (age in years/4) + 3