Pediatric Advance Life Support: Pulseless Electrical Activity (PEA)

Exhaled or End-Tidal CO2 Monitoring

·         Recommended as confirmation of tracheal tube position

·         Confirms tube position in the airway but does not rule out right main stem bronchus intubation

·         During cardiac arrest the absence of CO2 may reflect very low pulmonary blood

·         Persistently low PETCO2 values (<10 mm Hg) during CPR in intubated patients suggest that ROSC is unlikely

·         If PETCO2 is <10 mm Hg, it is reasonable to consider trying to improve CPR quality by optimizing chest compression parameters

Note:  Although a PETCO2 value of <10 mm Hg in intubated patients indicates that cardiac output is inadequate to achieve ROSC, a specific target PETCO2 value that optimizes the chance of ROSC has not been established. Monitoring PETCO2 trends during CPR has the potential to guide individual optimization of compression depth and rate and to detect fatigue in the provider performing compressions

End-tidal CO2 detector may be altered by the following:

·         Detector is contaminated with gastric contents or acidic

·         An intravenous (IV) bolus of epinephrine may transiently reduce pulmonary blood flow and exhaled CO2 below the limits of detection

·         Severe airway obstruction and pulmonary edema may impair CO2

·         Large glottic air leak may reduce exhaled tidal volume

Broweslow 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