Pediatric pulseless arrest

See critical care quick reference for drug doses and equipment sizes by weight.

Asystole and PEA

Give Epi 0.01mg/kg (0.1 mL/kg 1:10,000) (max 1mg) q3-5min
Rhythm check q2min
Prioritize adequate oxygenation and ventilation, as respiratory arrest is the most common cause of pediatric cardiac arrest
Consider H's and T's
- Hypoglycemia
- Hypovolemia
- Hypoxia (most common cause of pediatric arrest)
- Hydrogen ion
- Hypokalemia or hyperkalemia
- Hypothermia
- Tension pneumothorax
- Tamponade
- Toxins
- Thrombosis, pulmonary
- Thrombosis, coronary

Shock as quickly as possible and resume CPR immediately
- First shock 2 J/kg
- Second shock 4 J/kg
- Subsequent shocks ≥ 4 J/kg (max 10 J/kg)
Give Epi if (shock + 2min CPR) fails to convert rhythm
Perform pulse check/shock if appropriate q2min
Give antiarrhythmic if (2nd shock + 2min CPR) again fails
- 1st line: Amiodarone
  - 5mg/kg (max 300mg)
  - May repeat twice up to 15mg/kg
- 2nd line: Lidocaine
  - 1mg/kg
- Magnesium
  - 25-50mg/kg (max 2g) IV
  - Only for polymorphic V-tach

AHA 2010 Guidelines for PALS

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