Pediatric PEA Part 4

Pediatric PEA

Length based color-coded tape.

Medication Dose Calculation

·         Use the child’s weight if it is known

·         If the child’s weight is unknown, it is reasonable to use a body length tape

·         No data regarding the safety or efficacy of adjusting the doses for obese patients

IV Access

·         Peripheral IV

·         Central line

·         Intraosseous

·         Endotratracheal

Peripheral IVs

·         Placement may be difficult in a critically ill child

·         Central venous placement requires procedure can be time consuming

Central IV Drug Delivery

•                    Peak drug concentrations are higher and drug circulation times shorter

•                    Central line placement can interrupt CPR.

•                    A central line extending into the superior vena cava can be used to monitor ScvO2 and estimate CPP during CPR, both of which are predictive of ROSC

Intraosseous (IO) Access

·         All intravenous medications can be administered intraosseously

·         Onset of action and drug levels are comparable to venous administration

·         IO access can be used to obtain blood samples for analysis

·         Use manual pressure or an infusion pump to administer viscous drugs or rapid fluid boluses

·         Follow each medication with a saline flush

Endotracheal Drug Administration

·         Lipid-soluble drugs, such as lidocaine, epinephrine, atropine, and naloxone (mnemonic “LEAN”)

·         Effects may not be uniform with tracheal as compared with intravenous administration

·         Expert consensus recommends doubling or tripling the dose of lidocaine, atropine or naloxone

·         Epinephrine 0.1 mg/kg or 0.1 mL/kg of 1:1000 concentration is recommended

ET tube Medication Administration

·         Dilute the dose in 2 to 5 mL saline

·         Remove ambu bag from ET tube

·         Inject it into the ET tube

·         Replace ambu bag on ET tube

·         Administer 2 to 3 breaths with the ambu bag

Vasoconstrictors

Epinephrine 0.01mg/kg (0.1ml/kg of a 1:10,100 solution) IV or IO

Epinephrine 0.1mg/kg (0.1ml of a 1:1000 solution) via ET tube

May repeat dose every 3-5 minutes

Note:  Epinephrine increases the heart rate and myocardial contractility more effectively than atropine through its alpha- and beta-adrenergic receptor stimulation. Its direct chronotropic effects (beta-agonist) and vasoconstrictor effects (alpha-agonist) increase mean arterial blood pressure, coronary perfusion pressure, and myocardial oxygen delivery. While epinephrine does increase myocardial oxygen consumption, it poses no significant risk of causing myocardial infarction in children as it does in adults.