Pediatric Advanced Life Support

Pediatric Bradycardia (HR _ 60 bpm)

Asymptomatic

■ Observe—Support ABCs—Admission to PICU

Symptomatic—severe cardiopulmonary compromise (Poor perfusion, low BP, dyspnea, ALOC despite O2 and ventilation)

■ Chest compressions: 100/min (ratio 30:2)

■ Epinephrine*: IV or IO—0.01 mg/kg of 1:10,000 strength

(0.1 mL/kg) q 3–5 minutes. ET—0.1 mg/kg of 1:1,000 strength

(0.1 mL/kg) q 3–5 minutes.

■ Atropine*: 0.02 mg/kg (min dose 0.1 mg) may repeat one time.

Max total dose is 1 mg.

■ Consider cardiac pacing: Same as for adults, but use pediatric pads, placed anterior-to-posterior, and set rate to 100 bpm.

*Note: If bradycardia due to suspected increased vagal tone or primary AV block, give atropine as first-line drug.

Pediatric Tachycardia-Poor Perfusion*

Narrow-Complex (0.08 sec or less)

■ 12-lead to evaluate tachycardia if clinically practical.

■ Consider vagal maneuvers.ERG

TRAUMA

*Note: When the tachycardia is associated with adequate perfusion, consider

pharmacological cardioversion first, then consider electrical cardioversion.

■ Immediate cardioversion: 0.5–1 J/kg (repeat at 2 J/kg); or

■ Adenosine: (if IV or IO established) 0.1 mg/kg rapid IV or IO push. Max 1st dose of 6 mg. May repeat 2nd dose at 12 mg.

Wide-Complex (> 0.08 sec)

■ 12-lead to evaluate tachycardia if clinically practical.

■ Immediate cardioversion: 0.5–1 J/kg, (repeat at 2 J/kg)

Consider one of the following antiarrhythmic medications:

■ Amiodarone: 5 mg/kg IV over 20–60 min; or

■ Procainamide: 15 mg/kg IV over 30–60 min; or

Cardiac Arrest (ABCs-CPR-O2-Monitor-Intubate-IV) V-Fib-Pulseless VT

■ Defibrillate: 2 J/kg, CPR for 5 cycles while recharging, 4 J/kg.

■ Epinephrine: Same dose/route as symptomatic bradycardia.

■ Defibrillate: 2 J/kg, 2–4 J/kg, 4 J/kg (pattern: drug, CPR, shock).

■ Amiodarone: 5 mg/kg IV or IO bolus; or

■ Lidocaine: 1 mg/kg IV, IO, or ET bolus; or

■ Magnesium: 25–50 mg/kg IV, or IO max 2 gm (Torsade).

Asystole—PEA

■ Epinephrine: Same dose/route as symptomatic bradycardia.

■ Continue CPR up to 5 cycles and then reassess rhythm.