110 yr Systolic less than Age x2 70 gt 10 yr Systolic less than 90 Fluid Bolus Isotonic Lungs Clear 20mlkg Lungs Wet 5mlkg 20mlkg over 5 minutes 5mlkg over 20 minutes Vasopressor Support ID: 909357
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Slide1
Slide2Slide3Hypotensive Shock
<1 yr. Systolic less than 70
1-10 yr. Systolic less than (Age x2) +70
> 10 yr. Systolic less than 90
Fluid Bolus (Isotonic)
Lungs Clear = 20ml/kg
Lungs “Wet” = 5ml/kg
20ml/kg over 5 minutes5ml/kg over 20 minutes
Vasopressor Support
(infusion)
Warm Shock = Norepi
Cold Shock = Epi
Slide4VF/pVT =
Defib
Start CPR
Defib 2 J/kg
2 minutes of CPR
Defib 4 J/kg
2 minutes of CPR &
Epi 0.01mg/kgDefib 4-10 J/kg2 minutes of CPR &Amio 5mg/kg orLido 1mg/kg
Asystole/
P
ulseless
Electrical ActivityStart CPR, Epi 0.01mg/kg ASAP (then every other rhythm check), H + T’sand recheck pulse & rhythm every 2 minutes. PEA = Push Epi Ask whyPEA = Push Epi All the timePEA = Push Epi AlwaysPEA = Push Epi Again
Post Cardiac Arrest Care
4 H’s to Avoid
Hypoxia: Maintain 94-99% SPO
2
Hypotension: Manage BP for age, use fluids or pressor
Hypoglycemia: Treat with D10 or D25
Hyperthermia: Don’t confuse with Targeted Temp Management
Also. prone to seizures, may monitor with EEG
Slide5# 1 Cause of Bradycardia in Pediatrics =
Hypoxia
1. Positive Pressure Ventilation First
2. If Heart Rate and patient condition does not improve, start CPR
3. Once vascular access obtained 0.01mg/kg Epi
4. Recheck pulse and rhythm every 2 minutes
*Consider Atropine if a heart block or increased vagal tone such
as suctioning, rectal temperature, or patient bearing down caused
the bradycardia
Slide6Identify patient as stable or unstable/poor perfusion (altered LOC or hypotension)
Stable = Medicine
Unstable (Poor Perfusion) = Edison
SVT or Monomorphic VT
Stable
= Vagal Maneuvers while preparing
Adenosine on a 3-way stop-cock and placing
defib pads on patient as a precaution
1
st
dose = 0.1mg/kg
2nd dose = 0.2mg/kgIf you are 100% sure it is Ventricular Tach, skip adenosine and proceed to amio/lidoSVT or Mono or Polymorphic VTUnstable = Cardioversion 0.5 to 1 J/kgIncrease to 2 J/kg if 1st shock not effective*Consider sedation, but don’t delay cardioversion