4-6 PEDIATRIC NON-TRAUMATIC CARDIAC ARREST

Note: If Pediatric Cardiac Arrest under age 5, transport to St. Vincent Hospital is preferred due to availability of a Pediatric Intensive Care Unit. Note ** Epi Doses are in mL/kg not mg/kg **

EMR - Emergency Medical Responder

1. Establish patient responsiveness. If cervical spine trauma is suspected, manually stabilize the spine.
2. Confirm apnea and provide assisted ventilation, using a bag-valve-mask device if available, with high flow 100% oxygen.
3. Confirm absent pulses and begin chest compressions at age appropriate rate and ratio.
4. Assess the patient’s airway of patency, protective reflexes and the possible need for advanced airway management. Look for signs of airway obstruction and if present proceed as per airway obstruction protocol.
5. Open the airway via chin lift or modified jaw thrust.
6. Suction as necessary
7. Consider placing an oropharyngeal or nasopharyngeal airway adjunct if the airway cannot be maintained with positioning and the patient is unconscious.
8. Apply AED and follow AED Protocol.
9. Call for ALS intercept

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Initiate transport and Contact MEDICAL CONTROL to request ALS intercept.
2. Check blood glucose and if less than 60 mg/dL, refer to pediatric hypoglycemia protocol.
3. Apply ECG monitor & run strip (if trained, if time allows and after all other interventions are completed).

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Initiate transport and Contact MEDICAL CONTROL to request ALS intercept.
2. Establish vascular access en route and administer a 20 mL/kg NS bolus. If IV access unlikely or cannot be established within 2 attempts in a child less than 6, do not attempt further IV placement.

Intermediate - Perform/Confirm All Above Interventions

1. Apply ECG monitor and interpret rhythm.
2. If Ventricular Fibrillation or Pulseless V-Tach
   1. Perform chest compression for 2 minutes, then defibrillate at 2 J/kg
   2. Continue chest compressions for 2 minutes, then defibrillate at 4 j/kg
   3. Evaluate need for advanced airway management and ventilatory support.
   4. Establish vascular access. If IV access unlikely or cannot be rapidly established consider IO placement.
   5. Administer epinephrine 1:1,000 solution at  0.1 mL/kg (max dose 10 mL) via ET tube or 1:10,000 solution at 0.1 mL/kg (max dose 10 mL) via IV/IO route followed by flush of medication port with 10 to 20 mL of NS. Subsequent doses of epinephrine should be administered every 3 to 5 minutes for the remainder of resuscitation.
   6. Continue chest compressions after each medication bolus, then defibrillate at 4 j/kg biphasic (max 400 J) 2 minutes after each medication bolus.
   7. Administer Lidocaine 1 mg/kg IV/IO Bolus
   8. If VF or pulseless VT recurs after successful defibrillation, repeat defibrillation using the last energy level that restored perfusing rhythm.
   9. Contact MEDICAL CONTROL and initiate transport.
3. If Asystole or Pulseless Electrical Activity (PEA)
   1. Continue chest compressions and ventilation
   2. Perform endotracheal intubation and confirm ET tube placement using clinical assessment and ET CO2 measurement
   3. Establish vascular access. If IV access unlikely or cannot be rapidly established consider IO placement.
   4. Administer epinephrine 1:1,000 solution at 0.1 mL/kg (max dose 10 mL) via ET tube or 1:10,000 solution at 0.1 mL/kg (max dose 10 mL) via IV/IO route followed by flush of medication port with 10 to 20 mL of NS. Subsequent doses of epinephrine should be administered every 3 to 5 minutes for the remainder of resuscitation.
   5. Administer 20 mL/kg bolus NS
   6. Assess for and treat potential underlying causes.
   7. Contact MEDICAL CONTROL for further orders and initiate transport.

Paramedic - Perform/Confirm All Above Interventions