2 min CPR Assess rhythm 2 min CPR Assess rhythm Queensland Paediatric CPR Algorithm CPR 15 compressions : 2 breaths Minimise interruptions Attach monitor Assess rhythm DC shock 4 J/kg (max. 200J) 2 min CPR Assess rhythm Secure airway: ETT / LMA Followed immediately by IV/IO Adrenaline 10 micrograms/kg (max. 1mg) 0.1 mL/kg of 1:10,000 DC shock 4 J/kg (max. 200J) Adapted from: Australian Resuscitation Council Guideline 12.2, 5 Protocols for Paediatric Advanced Life Support December 2010 & ILCOR Guidelines – “Paediatric Basic and Advanced Life Support” in Resuscitation (2010). Consider and Correct Reversible Causes Consider IV Na Bicarbonate 8.4% 1mL/kg in cases of: • Severe metabolic acidosis • Hyperkalaemia • Hypoxia • Hypovolaemia • Hypo / Hyperthermia • Hypo / Hyperkalaemia 4H’s • Tamponade (cardiac) • Tension Pneumothorax • Toxins / poisons / drugs • Thrombosis – pulmonary / coronary 4T’s SHOCKABLE NON SHOCKABLE Pulseless Ventricular Tachycardia Ventricular Fibrillation Asystole PEA IO / IV access IV/IO Amiodarone 5 mg/kg (max. 300mg) DC shock 4 J/kg (max. 200J) DC shock 4 J/kg (max. 200J) 2 min CPR Assess rhythm IV/IO Adrenaline 10 micrograms/kg (max. 1mg) DC shock 4 J/kg (max. 200J) 2 min CPR Assess rhythm IV/IO Adrenaline 10 micrograms/kg (max. 1mg) DC shock 4 J/kg (max. 200J) 2 min CPR Assess rhythm IO / IV access IO / IV fluids IV / IO Adrenaline Immediately 10 micrograms/kg (max. 1mg) 0.1 mL/kg of 1:10,000 Then every 4 mins i.e. every 2nd loop Secure airway ETT / LMA Assess End tidal CO 2 NB: End tidal CO2 will be low in Cardiac Arrest Assess cardiac rhythm every 2 minutes If rhythm organised check pulse • Ask everyone to stand clear • Reassess rhythm and absence of pulse • Press SHOCK • Immediately resume CPR for 2 min LEAD SIZE SYNC SHOCK CHARGE ENERGY SELECT ON OPTIONS EVENT ALARMS ANALYZE ADVISORY PACER RATE CURRENT PAUSE Home Screen Batt Chg Service 1 2 3 S E L E C T O R Select Energy 4 J/kg (max. 200J) for all shocks Press CHARGE Continue CPR while charging 1 2 3
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2 min CPRAssess rhythm
2 min CPRAssess rhythm
Queensland Paediatric CPR AlgorithmCPR
15 compressions : 2 breathsMinimise interruptions
Attach monitorAssess rhythm
DC shock 4 J/kg (max. 200J)
2 min CPRAssess rhythm
Secure airway:ETT / LMA
Followed immediately byIV/IO Adrenaline
10 micrograms/kg (max. 1mg)0.1 mL/kg of 1:10,000
DC shock 4 J/kg (max. 200J)
Adapted from: Australian Resuscitation Council Guideline 12.2, 5 Protocols for Paediatric Advanced Life Support December 2010 & ILCOR Guidelines – “Paediatric Basic and Advanced Life Support” in Resuscitation (2010).
Consider and CorrectReversible Causes
Consider IV Na Bicarbonate 8.4% 1mL/kg in cases of:• Severe metabolic acidosis• Hyperkalaemia
10 micrograms/kg (max. 1mg)0.1 mL/kg of 1:10,000Then every 4 minsi.e. every 2nd loop
Secure airwayETT / LMA
Assess End tidal CO2
NB: End tidal CO2 willbe low in Cardiac Arrest
Assess cardiac rhythm every 2 minutes
If rhythm organised check pulse
• Ask everyone to stand clear
• Reassess rhythm and absence of pulse
• Press SHOCK• Immediately
resume CPR for 2 min
LEAD SIZE SYNC
SHOCK
CHARGE
ENERGYSELECT
ON
OPTIONS
EVENT
ALARMS
ANALYZE
ADVISORY
PACER
RATE
CURRENT
PAUSE
HomeScreen
Batt ChgService
123
SE L E C T O R
Select Energy4 J/kg (max. 200J) for all shocks
Press CHARGEContinue CPR while charging
1
2
3
Press SYNCConfirm recognition of QRS complex– R wavesare markedwith a triangle.
1
NB: Select SYNCfor each repeat synchronised shock
Select EnergyFor the first shock 1 J/kg is used
2
3
4
Press CHARGEConfirm correct joules are available
Press SHOCKAsk everyone to stand clear.Confirm:• All clear• Correct joules• SYNC mode on & R waves marked• RhythmPress and hold SHOCK button to deliver the shock
Management of Supraventricular Tachycardia
Consider anti-arrhythmice.g. IV Amiodarone
5 mg/kg over 20 min (max. 300mg)
Synchronous DC shock1 J/kg (max. 200J)
Supraventricular Tachycardia• P waves absent or abnormal• HR not variable• Infants: Rate >220/min• Children: Rate >200/min
Call Cardiologist
Vagal manouevres• Infant / young child:
Apply ice to face• Older child: Valsalva
manoeuvre (i.e. blow through a narrow straw or syringe, ask the child to cough) / Carotid massage
Adenosine300 micrograms/kg (max. dose 12mg)
Use sedationwhere possible
prior tocardioversion
Attempt vagal manoeuvres(no delays)
Adenosine100 micrograms/kg (max. dose 6mg)
Adenosine200 micrograms/kg (max. dose 12mg)
Establish large boreproximal IV access
Is the defibrillator immediately available?
Synchronous DC shock2 J/kg (max. 200J)
2 minutes
YesNo
Synchronous DC shock2 J/kg (max. 200J)
SHOCK PRESENTAttach monitorAssess rhythm
YES NO
2 minutes
Press SYNCConfirm recognition of QRS complex– R wavesare markedwith a triangle.
1
NB: Select SYNCfor each repeat synchronised shock
Select EnergyFor the first shock 1 J/kg is used
2
3
4
Press CHARGEConfirm correct joules are available
Press SHOCKAsk everyone to stand clear.Confirm:• All clear• Correct joules• SYNC mode on & R waves marked• RhythmPress and hold SHOCK button to deliver the shock
Management of Bradycardia
Adapted from: Protocols for Paediatric Advanced Life Support December 2010 & ILCOR Guidelines – ‘Defibrillation and Advanced Life Support’ in Resuscitation (2010).
Consider Pacing Adrenaline Infusion
Continue to monitorNotify PICU Consultant & Cardiologist