EKG
Ventricular Fibrillation Management in the Child
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Ventricular Fibrillation Management in the Child
See Also
Cardiopulmonary Resuscitation
Reversible Causes of Cardiopulmonary Arrest
(
5H5T
)
Ventricular Fibrillation Management in the Adult
Management
Approach
ABC Management
CPR until
Defibrillator
available
Good quality
Cardiac Compressions
are critical for survival (
ROSC
)
Consider 5 cycles CPR (2 min) before defibrillating
Defibrillation
options (single shock)
Manual
Defibrillator
First: 2-4 J/kg
Subsequent: 4 J/kg
Maximum: 10 J/kg or up to adult dose
AED (age 1 year or older)
Child system is preferred if available ages 1-8
Secure cardiopulmonary access
See
Cardiopulmonary Resuscitation
Ventilate with 100% oxygen
Endotracheal Intubation
Obtain
Intravenous Access
Cycles
Perform 5 cycles of CPR (15:2 if two providers) for total of 2 minutes
Once
Advanced Airway
in place, give 8-10 breaths per minute (every 6-8 min) and compressions >100/minute asynchronously
Re-evaluate rhythm with minimum interruption of
Cardiac Compressions
(<10 seconds)
Organized Electrical activity: Check for pulse
Non-shockable rhythm: See Other protocols
Asystole
Pulseless Electrical Activity
(PEA)
Shock
able rhythm: Defibrillate
Ventricular Fibrillation
Pulseless Ventricular Tachycardia
(V. fib or V. Tach)
Repeat
Defibrillation
as above after each cycle
Call clear
Compressions need not be interrupted if mechanical CPR device is in place
Administer medications once IV or
IO Access
obtained (see below)
Administer during
Cardiac Compressions
(between
Defibrillation
s)
Epinephrine
(every 3-5 minutes)
First dose after second
Defibrillation
IV/IO: 0.01 mg/kg (0.1 ml/kg of 1:10,000) up to 1 mg IV
ET: 0.1 mg/kg (0.1 ml/kg of 1:10,000) up to 2.5 mg via ET
Amiodarone
(up to 3 doses)
Dose: 5 mg/kg up to a maximum of 300 mg for a single dose
First dose after the third
Defibrillation
May repeat up to 2 additional doses
Adjunctive medications
Magnesium Sulfate
Dose: 25 to 50 mg/kg IV or IO
Indications
Polymorphic VT (
Torsades de Pointes
)
Suspected
Hypomagnesemia
Management
Post
Return of Spontaneous Circulation
(
ROSC
)
Assess
Vital Sign
s
Support Airway and breathing
Consider maintaining
Antiarrhythmic
medications
Infusion of
Antiarrhythmic
that converted rhythm
Discuss with pediatric cardiology
Pursue definititive management of underlying cause
Reversible Causes of Cardiopulmonary Arrest
(
5H5T
)
Initiate
Hypothermia
protocol
Improves longterm CNS recovery post-hypoxic event
Management
Example
Cycle 1
Perform 5 cycles of CPR (15:2) for total of 2 minutes
Obtain
IV Access
concurrent with CPR
Rhythm check and Defibrillate 2 J/kg (Call 'clear' and <10 second cardiac compression interruption)
Cycle 2
Perform 5 cycles of CPR (15:2) for total of 2 minutes
Place
Advanced Airway
concurrent with CPR
Rhythm check and Defibrillate 4 J/kg (Call 'clear' and <10 second cardiac compression interruption)
Cycle 3
Perform CPR for 2 minutes (If
Advanced Airway
, give asynchronously 8-10 breaths per minute and >100 compressions/min)
Administer
Epinephrine
0.01 mg/kg IV up to 1 mg IV maximum
Treat reversible cause (e.g. contact catheterization lab if
Acute Coronary Syndrome
suspected)
With mechanical CPR device in place, inter-hospital transport is viable despite lack of
ROSC
Rhythm check and Defibrillate 4 J/kg (Call 'clear' and <10 second cardiac compression interruption)
Cycle 4
Perform CPR for 2 minutes
Administer
Amiodarone
5 mg/kg IV up to 300 mg IV maximum
Rhythm check and Defibrillate 4 J/kg (Call 'clear' and <10 second cardiac compression interruption)
Cycle 5
Perform CPR for 2 minutes
Administer
Epinephrine
0.01 mg/kg IV up to 1 mg IV maximum
Rhythm check and Defibrillate 4 J/kg (Call 'clear' and <10 second cardiac compression interruption)
Cycle 6
Perform CPR for 2 minutes
Administer
Amiodarone
5 mg/kg IV up to 300 mg IV maximum
Rhythm check and Defibrillate 4 J/kg (Call 'clear' and <10 second cardiac compression interruption)
Cycle 7: Perfusing rhythm obtained
Check for pulse (confirm not
Pulseless Electrical Activity
)
Amiodarone
maintenance to prevent recurrent
Arrhythmia
Discuss indication and dosing with pediatric cardiology
Initiate Induced
Therapeutic Hypothermia
protocol
Discuss specific protocols with local experts
Requires paralysis, sedation and
Opioid Analgesic
s to prevent shivering
References
Pediatric Resucitation
http://pediatrics.aappublications.org/content/126/5/e1361.full.html
(2010) Pediatrics 126(5): e1361 [PubMed]
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