PEDIATRIC VENTRICULAR FIBRILLATION /PULSELESS VENTRICULAR TACHYCARDIA

Cardiopulmonary arrest, as manifested by ventricular fibrillation or pulseless ventricular tachycardia, is quite rare in infants and children and is usually the end result of deterioration in respiratory and circulatory function. Common causes can be: sepsis, foreign body aspiration, SIDS, traumatic hemorrhages and meningitis. Primary cardiac insults are rare but may be due to: congenital heart disease, myocarditis or primary dysrhythmias.

 

ASSESSMENT / TREATMENT PRIORITIES

1. Maintain universal blood and body fluid precautions.

2. Determine unresponsiveness, absence of breathing and pulselessness.

3. Maintain an open airway, remove secretions, vomitus, and initiate CPR with supplemental high concentration of oxygen.

4. Continually assess Level of Consciousness, ABCs and Vital Signs including capillary refill.

5. Obtain appropriate history related to event, including recent and Past Medical History, Medications, Drug Allergies, and Substance Abuse including possible ingestion or overdose of medications. Observe for signs of child abuse.

6. Every effort should be made to determine the possible cause(s) of the infantís / childís presentation.

 

TREATMENT

BASIC PROCEDURES

1. Maintain universal blood and body fluid precautions.

2. Determine unresponsiveness and cardiopulmonary arrest.

3. Maintain an open airway and assist ventilations (ensure proper seal around the ventilation mask). This may include repositioning of the airway, suctioning to remove secretions and /or vomitus. Use airway adjuncts as indicated. If indicated, treat spinal injury per protocol.

4. If unable to ventilate child after repositioning of airway, assume upper airway obstruction and follow Pediatric Upper Airway Obstruction Protocol.

5. Initiate Cardiopulmonary Resuscitation.

6. Activate ALS intercept, if available.

7. Initiate transport as soon as possible, with or without ALS.

8. Notify receiving hospital.

 

INTERMEDIATE PROCEDURES

1. Maintain universal blood and body fluid precautions.

2. Determine unresponsiveness and cardiopulmonary arrest.

3. Maintain an open airway and assist ventilations (ensure proper seal around the ventilation mask). This may include repositioning of the airway, suctioning to remove secretions and /or vomitus. Use airway adjuncts as indicated. If indicated, treat spinal injury per protocol.

4. If unable to ventilate child after repositioning of airway, assume upper airway obstruction and follow Pediatric Upper Airway Obstruction Protocol.

5. Initiate Cardiopulmonary Resuscitation.

6. ALS STANDING ORDERS

a. Provide advanced airway management, if indicated.

b. Hyperventilate with 100% oxygen.

c. Initiate IV Normal Saline KVO while en route.

7. Contact MEDICAL CONTROL: Medical Control may order:

a. Normal Saline fluid bolus(es) at expected 20 ml / kg.

8. Activate Paramedic intercept, if available.

9. Initiate transport with or without Paramedics.

10. Notify receiving hospital.

 

PARAMEDIC PROCEDURES

1. Maintain universal blood and body fluid precautions.

2. Determine unresponsiveness and cardiopulmonary arrest.

3. Maintain an open airway and assist ventilations (ensure proper seal around the ventilation mask). This may include repositioning of the airway, suctioning to remove secretions and /or vomitus. Use airway adjuncts as indicated. If indicated, treat spinal injury per protocol.

4. If unable to ventilate child after repositioning of airway, assume upper airway obstruction and follow Pediatric Upper Airway Obstruction Protocol.

5. Initiate Cardiopulmonary Resuscitation.

6. ALS STANDING ORDERS:

a. Provide advanced airway management, if indicated.

b. Hyperventilate with 100% oxygen.

c. Initiate IV / IO Normal Saline, but do not delay defibrillation.

d. Defibrillate up to 3 (three) times if needed: 2J/kg, 4J/kg, 4J/kg.

e. Epinephrine:
    • Epinephrine IV / IO: 0.01 mg/kg (1:10,000, 0.1mL/kg).
    • Epinephrine ET: 0.1 mg/kg (1:1,000. 0.1mL/kg).

 

f. Defibrillate 4J/kg 30-60 seconds after each medication.

g. Lidocaine 1 mg/kg IV / IO.

h. Defibrillate 4J/kg 30-60 seconds after each medication.

i. Epinephrine (subsequent doses):

    • IV / IO / ET: 0.1 mg/kg (1:1,000, 0.1 mL/kg). May repeat every 3-5 minutes. (IV/IO doses up to 0.2 mg/kg of 1:1,000 may be effective).

j. Lidocaine 1mg/kg IV / IO.

k. Defibrillate 4J/kg 30-60 seconds after each medication.

l. Consider Bretylium 5 mg/kg IV first dose; subsequent dose: Bretylium 10 mg/kg IV.

m. Defibrillate 4J/kg 30-60 seconds after each medication.

7. Contact MEDICAL CONTROL. Medical Control may order:

a. Fluid bolus(es) of Normal Saline at expected rate of 20 ml/kg.

b. Sodium Bicarbonate 1 mEq/kg IV / IO.

c. All other treatment modalities based upon suspected cause of VF / VT.

8. Intitiate transport as soon as possible.

9. Notify receivng hospital.






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