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Management of Cardiac Arrest

Beginning high-quality CPR is the first management step in cardiac arrest.

Pediatric Cardiac Arrest Algorithm

Figure 16

Quality CPR consists of:

  • A rate of 100 to 120 compressions per minute
  • A compression depth of one-third the diameter of the chest (1.5 inches in infants (4 cm) and 2 inches (5 cm) in children)
  • Minimize interruptions
  • Never over-ventilate
  • Every two minutes, rotate compressor
  • 30:2 compression ventilation ratio for one provider and 15:2
    compression ventilation ratio for two providers if no advanced airway
  • 10 to 15 breaths per minute for one provider or 20 to 30 breaths per
    minute for two providers with continuous chest compressions if there is advanced airway

Shock Energy

  • First shock: 2 J/kg
  • Second shock: 4 J/kg
  • Subsequent shocks: greater than or equal to 4 J/kg
  • Maximum dose of the shock: 10 J/kg or adult dose

Return of Spontaneous Circulation

  • Return of pulse and blood pressure
  • Spontaneous arterial pressure waves with intra-arterial monitoring

Advanced Airway

  • Supraglottic advanced airway or ET intubation
  • Waveform capnography to observe and confirm ET tube placement
  • Give one breath every 2 to 3 seconds, or 20 to 30 breaths per minute, once advanced airway is in place

Drug Therapy

  • Epinephrine IV/IO dose: 0.01 mg/kg (repeat every 3 to 5 minutes; if no IO/IV access, may give endotracheal dose of 0.1 mg/kg)
  • Amiodarone IV/IO dose: 5 mg/kg bolus during cardiac arrest (repeat up to two times if necessary for refractory VF/pulseless VT)

Reversible Causes

  • Hypovolemia
  • Hypoxia
  • H+ (acidosis)
  • Hypothermia
  • Hypo-/hyperkalemia
  • Hypoglycemia
  • Tamponade, cardiac
  • Toxins
  • Tension pneumothorax
  • Thrombosis, pulmonary
  • Thrombosis, coronary
  • Trauma
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