Pediatric Resuscitation
Put the IO in now! You can always get other access also… but get the bone drill now - Sean M. Fox

image by: Buffalo General Medical Center
HWN Suggests
Resuscitation of the crashing infant (pediatric resuscitation)
As I walk into a pediatric resuscitation, I always rapidly consider the pediatric assessment triangle.
This assessment, completed in seconds, examines 3 essential aspects of the child’s presentation from the foot of the bed: appearance, work of breathing, and circulation to the skin.
Appearance
- What is the tone? A newborn is normally slightly flexed, a 6 month old can sit and control their head, the toddler can cruise
- Are they normally interactive? A 2 month old should have a social smile, a toddler is interested in who enters the room
- What are the vocalizations?
Work of breathing
- Carefully…
Resources
A Case of Pediatric Cardiac Arrest
Pediatric patients tend to compensate and compensate – until finally they don’t.
Laryngeal Mask Airway for Neonatal Resuscitation
LMA’s come in various sizes and these may vary slightly between manufacturers. Typically, Size 1 is appropriate for newly born children who are less than 5000 grams and over 1500 grams or 34 or more weeks gestation.
Pediatric Medical Resuscitation – The Airway
In children less than 4 – 6 years of age, avoid jet ventilation instead ventilate with a BVM attached to the catheter. Caution should be used if jet ventilating older children due to the risk of barotrauma. Children up to 10 years or 30kg can likely be adequately ventilated with a BVM rather than jet device. To connect the BVM to the catheter: Use a 3.0mm ETT adapter with the angiocath directly Attach a 3mL syringe to the catheter, and use an 8.0 ETT adapter.
Pediatric Push Dose Epinephrine: Getting the Epi Dose Right During Pediatric Resuscitation
Dilute the patient’s individualized code dose of epi (0.01 mg/kg) to a total volume of 10cc with saline. Give 1cc of epi spritzer IV up to every 2 minutes as needed.
Pediatric Resuscitation Pitfalls
Kids are not aliens… Basics that work for adults also apply to children! High Quality CPR, Early Defibrillation, Early Administration of Epi, and Post ROSC management should be the focus.
The Undifferentiated Sick Infant
You have all of the skills you need to care for an acutely ill infant. Learn a few pearls to make this a smoother endeavor.
Resuscitation of the crashing infant (pediatric resuscitation)
Take out the Broselow tape and pediatric resuscitation cart. Hopefully this is out before the child arrives. For the first 10 minutes, all of my drug doses and equipment sizes are entirely based off the Broselow length. The Broselow tape may not be perfectly accurate, and I will get an accurate weight when there is time, but the Broselow is good enough to get things started.
CRACKCast
Rosen’s advocates for the “encircling” hands technique in infant CPR, which according to animal models gives better hemodynamics than using the standard two finger technique.

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