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| ==Background== | | ''See [[critical care quick reference]] for drug doses and equipment size by weight.'' {{Peds top}} [[ACLS (Main)]].'' |
| hypotension is defined as a systolic blood pressure:
| | ==Algorithms== |
| �60 mm Hg in term neonates (0 to 28 days)
| | *[[BLS]] |
| �70 mm Hg in infants (1 month to 12 months)
| | *[[Pediatric Pulseless Arrest]] |
| �70 mm Hg � (2 � age in years) in children 1 to 10 years
| | *[[PALS: Bradycardia]] |
| �90 mm Hg in children �10 years of age
| | **Use [[Pediatric Pulseless Arrest]] algorithm if no pulse = PEA |
| | | *[[PALS: Tachycardia]] |
| If the infant or child is not intubated, pause after 30 chest
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| compressions (1 rescuer) or after 15 chest compressions (2
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| rescuers) to give 2 ventilations (mouth-to-mouth, mouth-tomask,
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| or bag-mask). Deliver each breath with an inspiratory
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| time of approximately 1 second. If the infant or child is
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| intubated, ventilate at a rate of about 1 breath every 6 to 8
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| seconds (8 to 10 times per minute) without interrupting chest
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| compressions
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| In the victim with a perfusing rhythm but absent or
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| inadequate respiratory effort, give 1 breath every 3 to 5
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| seconds (12 to 20 breaths per minute), using the higher rate
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| for the younger child (Class I, LOE C). One way to achieve
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| that rate with a ventilating bag is to use the mnemonic
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| “squeeze-release-release” at a normal speaking rate.
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| Both cuffed and uncuffed endotracheal tubes are acceptable
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| for intubating infants and children
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| | ==See Also== |
| | *[[AHA Recommendation Changes by Year]] |
| | *[[Synchronized cardioversion]] |
| | *[[Post Cardiac Arrest]] |
| | *[[ACLS (Main)]] |
| | *[[ACLS (Treatable Conditions)]] |
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| If an uncuffed endotracheal tube is used for emergency
| | {{Pediatric critical care pages}} |
| intubation, it is reasonable to select a 3.5-mm ID tube for infants
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| up to one year of age and a 4.0-mm ID tube for patients between
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| 1 and 2 years of age. After age 2, uncuffed endotracheal tube
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| size can be estimated by the following formula:
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| Uncuffed endotracheal tube ID (mm)�4�(age/4)
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| If a cuffed tube is used for emergency intubation of an infant
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| less than 1 year of age, it is reasonable to select a 3.0 mm ID
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| tube. For children between 1 and 2 years of age, it is
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| reasonable to use a cuffed endotracheal tube with an internal
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| diameter of 3.5 mm (Class IIa, LOE B).89,98–100 After age 2 it
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| is reasonable to estimate tube size with the following formula
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| (Class IIa, LOE B:89,98–101):
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| Cuffed endotracheal tube ID (mm)�3.5�(age/4)
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| CPR Guidelines for Newborns With Cardiac
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| Arrest of Cardiac Origin
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| Recommendations for infants differ from those for the newly
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| born (ie, in the delivery room and during the first hours after
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| birth) and newborns (during their initial hospitalization and in
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| the NICU). The compression-to-ventilation ratio differs
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| (newly born and newborns – 3:1; infant two rescuer - 15:2)
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| and how to provide ventilations in the presence of an
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| advanced airway differs (newly born and newborns – pause
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| after 3 compressions; infants – no pauses for ventilations).
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| This presents a dilemma for healthcare providers who may
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| also care for newborns outside the NICU. Because there are
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| no definitive scientific data to help resolve this dilemma, for
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| ease of training we recommend that newborns (intubated or
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| not) who require CPR in the newborn nursery or NICU
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| receive CPR using the same technique as for the newly born
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| in the delivery room (ie, 3:1 compression-to-ventilation ratio
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| with a pause for ventilation). Newborns who require CPR in
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| other settings (eg, prehospital, ED, pediatric intensive care
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| unit [PICU], etc.), should receive CPR according to infant
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| guidelines: 2 rescuers provide continuous chest compressions
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| with asynchronous ventilations if an advanced airway is in
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| place and a 15:2 ventilation-to-compression ratio if no advanced
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| airway is in place (Class IIb, LOE C). It is reasonable
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| to resuscitate newborns with a primary cardiac etiology of
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| arrest, regardless of location, according to infant guidelines,
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| with emphasis on chest compressions
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| IO access is a rapid, safe, effective, and acceptable route for
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| vascular access in children,172–179,181 and it is useful as the
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| initial vascular access in cases of cardiac arrest
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| Therefore, regardless of the
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| patient’s habitus, use the actual body weight for calculating
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| initial resuscitation drug doses or use a body length tape with
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| precalculated doses
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| Amiodarone
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| Decrease the infusion rate if there is prolongation
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| of the QT interval or heart block; stop the infusion if
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| the QRS widens to �50% of baseline or hypotension develops.
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| Amiodarone should not be administered together with another
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| drug that causes QT prolongation, such as procainamide,
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| without expert consultation.
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| Calcium administration is not recommended for pediatric cardiopulmonary
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| arrest in the absence of documented hypocalcemia,
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| calcium channel blocker overdose, hypermagnesemia, or
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| hyperkalemia
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| Lidocaine decreases automaticity and suppresses ventricular
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| arrhythmias,227 but is not as effective as amiodarone for
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| improving ROSC or survival to hospital admission among adults
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| Procainamide
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| Decrease the infusion rate if there is prolongation of the QT
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| interval, or heart block; stop the infusion if the QRS widens
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| to �50% of baseline or hypotension develops. Do not
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| administer together with another drug causing QT prolongation,
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| such as amiodarone, without expert consultation a
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| Pulseless Arrest
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| ==Diagnosis==
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| ==Work-Up==
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| ==DDx==
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| ==Treatment==
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| ==Disposition==
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| ==See Also==
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| ==Source== | | ==External Links== |
| | *[https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf 2020 AHA Guidelines] |
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| | ==References== |
| | <references/> |
| | AHA 2010 Guidelines for PALS |
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| [[Category:Peds]] | | [[Category:Critical Care]] |
| | [[Category:Cardiology]] |
| | [[Category:Pediatrics]] |
| | [[Category:EMS]] |
