Paediatric Arrest

🔑 Key Priorities

  • Declare emergency: "This is a CRISIS – Paediatric Cardiac Arrest"

  • Focus on high-quality CPR and oxygenation

  • Identify and address reversible causes, especially hypoxia

🧠 Team Actions

Role

Task

Team Leader

Coordinate team and CPR cycles

Airway Manager

Secure airway, ventilate with 100% O₂

Circulation Lead

IV/IO access, administer drugs

Compressor

CPR (100–120/min), rotate every 2 mins

Recorder

Document times, drugs, shocks, rhythms

🧭 Management Algorithm

Start Immediately:

  1. Begin CPR (15:2 if no airway, 100–120/min otherwise)

  2. Secure airway, ventilate 100% O₂

  3. Confirm rhythm and classify as shockable or non-shockable

  4. If shockable (VF/VT):

    • Shock 4J/kg → Resume CPR

    • Adrenaline 10mcg/kg IV/IO after 2nd shock

    • Amiodarone 5mg/kg IV after 3rd shock

  5. If non-shockable (Asystole/PEA):

    • Adrenaline 10mcg/kg IV/IO ASAP

Ongoing Cycles:

  • Repeat adrenaline every 2nd cycle

  • Rhythm and pulse check every 2 mins

  • Seek and treat reversible causes

💉 Drug Table

Drug

Dose

Notes

Adrenaline

10mcg/kg IV or IO

Every 3–5 mins

Amiodarone

5mg/kg IV

After 3rd shock

Defibrillation

4J/kg

Repeat every cycle if VF/VT

Atropine

20mcg/kg IV/IO

For vagal-induced bradycardia

Calcium Chloride

0.1–0.2mL/kg of 10%

For hyperkalaemia

Sodium Bicarbonate

1mEq/kg of 8.4%

TCA overdose

🔁 Reversible Causes (Paeds focus)

  • Hypoxia (most common)

  • Hypovolaemia

  • Hypo/Hyperkalaemia

  • Hypothermia

  • Tension Pneumothorax

  • Tamponade (cardiac)

  • Toxins

  • Thrombosis

🔄 Ideal Crisis Flow

     Paediatric Cardiac Arrest
              ↓
    → CPR 15:2 or continuous with airway
    → Secure airway + 100% O₂
    → Rhythm check: Shockable?
      → Yes: Shock 4J/kg → Adrenaline → Amiodarone
      → No: Adrenaline immediately
    → Repeat cycles, monitor EtCO₂
    → Correct reversible causes

🧊 Post-ROSC Care

  • Maintain SpO₂ 94–98%, EtCO₂ >15mmHg

  • Maintain systolic BP within age-appropriate targets

  • Avoid hypo/hyperthermia

  • Correct glucose, calcium, and acid-base disturbances

  • Prepare for ICU transfer with full documentation

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