Pediatric Advance Life Support: Asystole Part 4
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
Broweslow Tape
IV Access
· Peripheral IV
· Central line
· Intraosseous
· Intratracheal
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
Peripheral IVs
· Placement may be difficult in a critically ill child
· Central venous placement requires procedure can be time consuming
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
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
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