ACLS

What heart rate defines bradycardia in children?

Less than 60 bpm

What is the number one cause of bradycardia in pediatric patients?

Hypoxia

What is the first priority in treating symptomatic pediatric bradycardia?

Oxygenation and ventilation

What should be considered if symptomatic pediatric bradycardia persists despite oxygenation and ventilation?

CPR if indicated

What is the pediatric epinephrine dose for symptomatic bradycardia?

0.01 mg/kg or 0.1 mL/kg of 1:10,000 concentration

What is the pediatric atropine dose for symptomatic bradycardia?

0.02 mg/kg

What is the minimum pediatric atropine dose?

0.1 mg

What pacing intervention may be considered for symptomatic pediatric bradycardia?

Transcutaneous pacing

What heart rate suggests SVT in an infant?

Greater than 220 bpm

What heart rate suggests SVT in a child?

Greater than 180 bpm

What are signs of stable pediatric SVT?

No complaints, lightheadedness, dizziness, palpitations, or feeling like the heart is racing

What vagal maneuvers can be used for pediatric SVT?

Bear down, apply ice to the face, or blow through a straw

What is the first pediatric adenosine dose for SVT?

0.1 mg/kg (max 6 mg)

What is the second pediatric adenosine dose for SVT?

0.2 mg/kg (max 12 mg)

Can an additional pediatric adenosine dose be considered?

Yes, an additional 0.2 mg/kg dose

How should adenosine be administered?

Rapid IV push followed by a 10-20 mL normal saline flush

What is the half-life of adenosine?

10 seconds

What are signs of unstable pediatric SVT?

Chest pain, difficulty breathing, decreased LOC, hypotension, or poor perfusion

What is the initial synchronized cardioversion dose for unstable pediatric SVT?

0.5-1 J/kg

What is the second synchronized cardioversion dose for unstable pediatric SVT?

2 J/kg

What are subsequent synchronized cardioversion doses for unstable pediatric SVT?

2 J/kg

What sedatives may be considered before synchronized cardioversion?

Valium or Versed

What heart rate threshold is used when considering treatment of VT with a pulse?

Greater than 150 bpm

What are signs of stable VT with a pulse?

No complaints, lightheadedness, dizziness, or palpitations

What is the pediatric amiodarone dose for stable VT with a pulse?

5 mg/kg over 20-60 minutes

What is the pediatric procainamide dose for stable VT with a pulse?

15 mg/kg over 30-60 minutes

What are signs of unstable VT with a pulse?

Chest pain, difficulty breathing, decreased LOC, hypotension, or poor perfusion

What is the initial synchronized cardioversion dose for unstable VT with a pulse?

0.5-1 J/kg

What is the second synchronized cardioversion dose for unstable VT with a pulse?

2 J/kg

What are subsequent synchronized cardioversion doses for unstable VT with a pulse?

2 J/kg

Which pediatric arrest rhythms are non-defibrillable?

Asystole and PEA

Should asystole be defibrillated?

No

Should PEA be defibrillated?

No

What is the first intervention for pediatric asystole or PEA?

Begin CPR immediately

What is the single rescuer pediatric CPR ratio?

30:2

What is the two rescuer pediatric CPR ratio?

15:2

How should compressions be performed after advanced airway placement?

Continuous compressions with ventilations

What is the pediatric epinephrine dose during cardiac arrest?

0.01 mg/kg or 0.1 mL/kg of 1:10,000 concentration

How often is epinephrine given during pediatric cardiac arrest?

Every 3-5 minutes

When should an advanced airway be placed during pediatric cardiac arrest?

Anytime in the early stages as time and personnel allow

What differential diagnosis mnemonic should be considered during cardiac arrest?

H’s and T’s

Which pediatric arrest rhythms are defibrillable?

Pulseless ventricular tachycardia and ventricular fibrillation

What is the initial defibrillation dose for pediatric VF/pVT?

2 J/kg

What is the second defibrillation dose for pediatric VF/pVT?

4 J/kg

What defibrillation doses may follow 4 J/kg?

6 J/kg, 8 J/kg, or 10 J/kg

When is amiodarone administered during pediatric VF/pVT?

During the second round of CPR after epinephrine

What is the pediatric amiodarone dose for refractory VF/pVT?

5 mg/kg

How many times may pediatric amiodarone be repeated during VF/pVT arrest?

Up to 2 additional boluses

What does the H in H’s and T’s stand for?

Metabolic and physiologic causes

What is the treatment for hypovolemia?

Fluid resuscitation

What is the treatment for hypoxia?

Oxygenation and ventilation

What is the treatment for hydrogen ion acidosis?

Sodium bicarbonate

What is the treatment for hyperkalemia?

Calcium

What is the treatment for hypoglycemia?

Dextrose IV push

What is the treatment for hypothermia?

Warming

What is the treatment for hyperthermia?

Cooling

What does the T in H’s and T’s stand for?

Mechanical and structural causes

What is the treatment for toxin-induced cardiac arrest from opiates?

Narcan

What is the treatment for cardiac tamponade?

Pericardiocentesis

What is the treatment for tension pneumothorax?

Needle decompression

What is the treatment for thrombosis?

Fibrinolytics