Elegard - Pediatric: Difference between revisions

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(Created page with "==Procedure Guidelines== ===Elegard - Pediatric=== '''Therapeutic Goal''' To recognize the pediatric patient requiring cardiopulmonary resuscitation and to restore a stable cardiac rhythm with adequate cardiac output and perfusion leading to neurologically intact survival. '''Assessment / Pathophysiology''' * Most cardiac arrest in infants and children is secondary to other causes (respiratory insult, illness, congenital heart defect, drowning, etc.) rather than corona...")
 
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'''This policy is for medical cardiac arrest and does not apply to hemorrhagic traumatic arrest. For the pediatric patient EleGARD use is appropriate for anyone who is of adult size  based on the pediatric protocol criteria for cardiac arrest; [[Pediatric Asystole|7.01 PEDIATRIC ASYSTOLE]], [[Pediatric Pulseless Electrical Activity PEA|7.02 PEDIATRIC PULSELESS ELECTRICAL ACTIVITY (PEA)]], [[Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia|7.03 PEDIATRIC VENTRICULAR FIBRILLATION /PULSELESS VENTRICULAR TACHYCARDIA]]'''
'''This policy is for medical cardiac arrest and does not apply to hemorrhagic traumatic arrest. For the pediatric patient EleGARD use is appropriate for anyone who is of adult size  based on the pediatric protocol criteria for cardiac arrest; [[Pediatric Asystole|7.01 PEDIATRIC ASYSTOLE]], [[Pediatric Pulseless Electrical Activity PEA|7.02 PEDIATRIC PULSELESS ELECTRICAL ACTIVITY (PEA)]], [[Pediatric Ventricular Fibrillation or Pulseless Ventricular Tachycardia|7.03 PEDIATRIC VENTRICULAR FIBRILLATION /PULSELESS VENTRICULAR TACHYCARDIA]]'''


General Care
'''General Care'''
    • Ensure the patient is pulseless and that resuscitation is indicated. If there is doubt whether  
*Ensure the patient is pulseless and that resuscitation is indicated. If there is doubt whether or not to start a resuscitation, start the process.
            or not to start a resuscitation, start the process.
*Perform a rapid scene survey for any evidence of a valid DNR order and or directive.
    • Perform a rapid scene survey for any evidence of a valid DNR order and or directive.
*Apply cardiac monitor and reassess rhythm and pulse every 2 minutes.
    • Apply cardiac monitor and reassess rhythm and pulse every 2 minutes.
*Utilize time in-between procedures to optimize care and trouble shoot any H’s and T’s.
    • Utilize time in-between procedures to optimize care and trouble shoot any H’s and T’s.
*Ensure high quality compressions are performed continuously throughout the code.
    • Ensure high quality compressions are performed continuously throughout the code.
*Compressions should be delivered at a rate of 100-120 compression per minute.
    • Compressions should be delivered at a rate of 100-120 compression per minute.
*Compress ≥ 1/3 anterior-posterior diameter of chest (infants 1.5”, children 2”).
    • Compress ≥ 1/3 anterior-posterior diameter of chest (infants 1.5”, children 2”).
*If two rescuers are on scene utilize the 15 compressions to 2 ventilations ratio until an advanced airway is established. Single rescuers should use the 30 compressions to 2 ventilations ratio until additional personnel arrives on scene. Provide adequate appropriately timed ventilations
    • If two rescuers are on scene utilize the 15 compressions to 2 ventilations ratio until an  
*Airway is a more important intervention in pediatric arrests. This should be accomplished quickly with a BVM with OPA/NPA or Supraglottic airway.
            advanced airway is established. Single rescuers should use the 30 compressions to 2  
*It is preferred to place a supraglottic airway as the first line attempt when placing an advanced airway.
            ventilations ratio until additional personnel arrives on scene. Provide adequate  
*Do not hyperventilate: Once an advanced airway is placed, ventilate 8-10 bpm (i.e. 1 breath: 6 seconds) with continuous, uninterrupted compressions.
            appropriately timed ventilations
*Attach ETCO2 filter line once advanced airway is placed. ETCO2 goal in cardiac arrest is >10mmHg.
    • Airway is a more important intervention in pediatric arrests. This should be accomplished  
*Continually reassess for proper airway placement. Targeted treatment and appropriately timed medications.
            quickly with a BVM with OPA/NPA or Supraglottic airway.
*Initiate IV/IO for medication administration. Humeral IO placement is preferred in older children as the initial access point. In younger children tibial IO placement is preferred.
    • It is preferred to place a supraglottic airway as the first line attempt when placing an
*Recording the time that a medication is given is of paramount importance, so that medications are being given at the appropriate interval. The team leader should be responsible for this task, unless delegated to another team member.
          advanced airway.
*Reassess rhythm and pulse every 2 min.
Cardiac Arrest (Ped)


 
'''The optimal airway technique for cardiac arrest is unknown and is likely to depend on the skills of the operator, the anticipated prehospital time and patient-dependent factors, therefore it is acceptable to place a supraglottic airway as the first go to airway if deemed difficult. This is preferred over multiple time-consuming attempts at intubation while delaying compressions.'''
 
    • Do not hyperventilate: Once an advanced airway is placed, ventilate 8-10
            bpm (i.e. 1 breath: 6 seconds) with continuous, uninterrupted compressions.
    • Attach ETCO2 filter line once advanced airway is placed. ETCO2 goal in cardiac
            arrest is >10mmHg.
    • Continually reassess for proper airway placement. Targeted treatment and
            appropriately timed medications.
    • Initiate IV/IO for medication administration. Humeral IO placement is preferred in
            older children as the initial access point. In younger children tibial IO placement is 
            preferred.
    • Recording the time that a medication is given is of paramount importance, so that
            medications are being given at the appropriate interval. The team leader should be 
            responsible for this task, unless delegated to another team member.
    • Reassess rhythm and pulse every 2 min.
 
VFIB / VTACH:
              Defibrillate at 2 J/KG as soon as possible.
• If AED is already in place, defibrillate as indicated. Otherwise, place patient on the monitor/defibrillator as soon as practical.
• Continue to defibrillate at 2 min intervals in a step wise fashion: 4 J/KG, 10 J/KG, 
until ROSC or the rhythm changes to a non-shockable rhythm.
• Compressions should be continued while the defibrillator is charging and should
resume immediately following any defibrillation.
Medication Administration: Administer as indicated.
• EPINEPHRINE 0.01 MG/KG (0.1 ML/KG) 1:10,000 IV/IO. Repeat every 3-5 min 
• AMIODARONE 5 MG/KG IV/IO (Max: 300 MG), repeat once in 3-5 min (Max repeat dose 150MG).
• MAGNESIUM SULFATE 50 MG/KG IV/IO (Max: 2G) for: Polymorphic VT, suspected hypomagnesemia, or refractory VF/VT.
• SODIUM BICARB 1 MEQ/KG IV/IO for: known pre-existing bicarbonate responsive acidosis, Tricyclic antidepressant (TCA) overdose, barbiturate overdose, or after a prolonged resuscitation. Bicarb can be repeated in 20 mins if cardiac arrest persists.
 
ASYSTOLE / PEA:
• Administer EPINEPHRINE 0.01 MG/KG (0.1 ML/KG) 1:10,000 IV/IO. Repeat every 5 minutes for continued Asystole/PEA.
• Consider SODIUM BICARB 1 MEQ/KG IV/IO for conditions listed above.
• Consider CALCIUM CHLORIDE 20 MG/KG slow IV/IO (Max: 1G) for suspected hyperkalemia (e.g. dialysis patients).
 
 
 
The optimal airway technique for cardiac arrest is unknown and is likely to depend on the skills of the operator, the anticipated prehospital time and patient-dependent factors, therefore it is acceptable to place a supraglottic airway as the first go to airway if deemed difficult. This is preferred over multiple time-consuming attempts at intubation while delaying compressions.

Latest revision as of 18:45, 4 March 2025

Procedure Guidelines

Elegard - Pediatric

Therapeutic Goal To recognize the pediatric patient requiring cardiopulmonary resuscitation and to restore a stable cardiac rhythm with adequate cardiac output and perfusion leading to neurologically intact survival.

Assessment / Pathophysiology

  • Most cardiac arrest in infants and children is secondary to other causes (respiratory insult, illness, congenital heart defect, drowning, etc.) rather than coronary artery disease. Respiratory problems are common in infants and children, and can quickly progress to respiratory failure, then cardiopulmonary arrest. Dysrhythmias are rare, except as an agonal event.
  • Treatment should aim to achieve ROSC with good neurological outcome. Efforts should be directed at high quality and continuous compressions with limited interruptions and early defibrillation when indicated. Beginning compressions first is recommended in pediatric patients during CPR. Compressions should be coupled with ventilations, early attention to airway management and oxygenation. Patient survival is often dependent on proper airway management.
  • Consider early IO placement if available and/or difficult IV access anticipated. Consider the secondary causes that lead to hypoventilation/apnea and treat accordingly.
  • Success is based on proper planning and execution. Procedures require space and patient access. Make room to work.

This policy is for medical cardiac arrest and does not apply to hemorrhagic traumatic arrest. For the pediatric patient EleGARD use is appropriate for anyone who is of adult size based on the pediatric protocol criteria for cardiac arrest; 7.01 PEDIATRIC ASYSTOLE, 7.02 PEDIATRIC PULSELESS ELECTRICAL ACTIVITY (PEA), 7.03 PEDIATRIC VENTRICULAR FIBRILLATION /PULSELESS VENTRICULAR TACHYCARDIA

General Care

  • Ensure the patient is pulseless and that resuscitation is indicated. If there is doubt whether or not to start a resuscitation, start the process.
  • Perform a rapid scene survey for any evidence of a valid DNR order and or directive.
  • Apply cardiac monitor and reassess rhythm and pulse every 2 minutes.
  • Utilize time in-between procedures to optimize care and trouble shoot any H’s and T’s.
  • Ensure high quality compressions are performed continuously throughout the code.
  • Compressions should be delivered at a rate of 100-120 compression per minute.
  • Compress ≥ 1/3 anterior-posterior diameter of chest (infants 1.5”, children 2”).
  • If two rescuers are on scene utilize the 15 compressions to 2 ventilations ratio until an advanced airway is established. Single rescuers should use the 30 compressions to 2 ventilations ratio until additional personnel arrives on scene. Provide adequate appropriately timed ventilations
  • Airway is a more important intervention in pediatric arrests. This should be accomplished quickly with a BVM with OPA/NPA or Supraglottic airway.
  • It is preferred to place a supraglottic airway as the first line attempt when placing an advanced airway.
  • Do not hyperventilate: Once an advanced airway is placed, ventilate 8-10 bpm (i.e. 1 breath: 6 seconds) with continuous, uninterrupted compressions.
  • Attach ETCO2 filter line once advanced airway is placed. ETCO2 goal in cardiac arrest is >10mmHg.
  • Continually reassess for proper airway placement. Targeted treatment and appropriately timed medications.
  • Initiate IV/IO for medication administration. Humeral IO placement is preferred in older children as the initial access point. In younger children tibial IO placement is preferred.
  • Recording the time that a medication is given is of paramount importance, so that medications are being given at the appropriate interval. The team leader should be responsible for this task, unless delegated to another team member.
  • Reassess rhythm and pulse every 2 min.

The optimal airway technique for cardiac arrest is unknown and is likely to depend on the skills of the operator, the anticipated prehospital time and patient-dependent factors, therefore it is acceptable to place a supraglottic airway as the first go to airway if deemed difficult. This is preferred over multiple time-consuming attempts at intubation while delaying compressions.

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