Pediatric Advance Life Support: Pulseless Electrical Activity (PEA)

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