Pediatric Cardiac Arrest: Asystole or PEA
Key Points/Considerations
• Call physician and begin transport to the closest hospital as soon as possible
• Do not interrupt compressions for placement of an advanced airway during the first 4
minutes of CPR
• Confirm asystole in more than 1 lead
• Perform CPR for at least 3 minutes between medication doses
• Consider airway obstruction
• Consider and treat causes that EMS can manage: Hypoglycemia, Hypovolemia, Hypoxia,
Hydrogen ion (acidosis), Hyperkalemia, Toxins, Tension pneumoThorax, Trauma
Pediatric Cardiac Arrest: V-Fib/Pulseless V-Tach
Key Points/Considerations
• Call physician and begin transport to the closest hospital as soon as possible
• Do not interrupt compressions for placement of an advanced airway during the first 4
minutes of CPR
• Treat V-Tach without a pulse as V-fib
• Use the small (pediatric) pads for patients less than 10 kg
• Initial defibrillation 2 J/kg
• Defibrillate at 4 J/kg after each medication administration
• V-fib cardiac arrest is rare in children
• Consider toxic ingestions including tricyclic antidepressants
• Consider and treat causes that EMS can manage: Hypoglycemia, Hypovolemia, Hypoxia,
Hydrogen ion (acidosis), Hyperkalemia, Toxins, Tension pneumoThorax, Trauma
Pediatric Cardiac: Bradycardia
Key Points/Considerations
• Call Physician as soon as possible
• Newborn/Infant bradycardic if pulse less than 60 bpm
• Symptomatic includes poor systemic perfusion, hypotension, respiratory difficulty or
altered level of consciousness
• If you suspect bradycardia is due to increased vagal tone or primary AV block give
atropine before giving epinephrine
• Do not treat asymptomatic bradycardia. Contact Medical Control
Pediatric Cardiac: Tachycardia
Key Points/Considerations
• Call physician as soon as possible
• Newborn/Infant SVT if pulse greater than 220 bpm; child over 1 year of age SVT if pulse
greater than 180 bpm, with no discernable p-waves on PRINTED EKG strip
• The most common causes of Sinus Tachycardia in children are fever and dehydration, not
cardiac etiology
• UNSTABLE includes cardio-respiratory compromise, hypotension, or altered level of
consciousness
• Do not treat asymptomatic tachycardia. Contact Medical Control.
Pediatric: Acute Asthma
Key Points/Considerations
• Absence of breath sounds can be indicative of status asthmaticus. Be prepared for
imminent respiratory arrest
• EpiPen use by EMT or AEMT is Medical Control option only and must be reported for
Regional QI by the agency
Pediatric: Allergy and Anaphylaxis
Key Points/Considerations
• If an EMT has administered an EpiPen, or the patient has administered their own
epinephrine, consult physician prior to administering additional epinephrine
• If an EMT has administered an EpiPen, or the patient utilized their own epinephrine
autoinjector, consult physician prior allowing a patient to RMA
Pediatric: Diabetic
Key Points/Considerations
• If the patient’s parent or guardian wishes to RMA the patient and you have administered
any medications including oral glucose you must contact a Medical Control Physician
prior to completing the RMA
• Do NOT hang D10 drip on a pediatric patient
• If patient regains normal responsiveness prior to infusion of the complete dose, please stop
dextrose administration and record amount infused
• Diabetic patients may exhibit signs of hypoglycemia with a blood sugar between 60-80
mg/dl. If suspected titrate dextrose up to 5 gm (D10 50 ml) for treatment and diagnosis
Pediatric: Hypoperfusion
Key Points/Considerations
• Consult Medical Control Physician if you suspect cardiogenic shock
• Do not use Normal Saline 1000 ml (liter) bags for pediatric patients unless > 50 kg
• Diagnostic criteria for hypoperfusion includes: capillary refill time > 2 seconds, cool,
clammy or mottled skin, inability to recognize parents, restlessness, listlessness,
tachycardia, tachypnea, SBP < 70 (2 years and older)
• Contact receiving hospital early
Pediatric: Nausea and/or Vomiting (> 2 y/o)
Key Points/Considerations
• Protocol does not apply to patients under the age of 2 years old
• A single dose of medication may be given prior to seeking medical consultation
Pediatric: Overdose or Toxic Exposure
Key Points/Considerations
• Consult Medical Control Physician as soon as possible
• Only give Naloxone if the patient has hypoventilation or respiratory distress,
• Includes patients who are unconscious/unresponsive without suspected trauma or other
causes, and patients with a brief loss of consciousness
• If suspected WMD refer to NYS Advisory on Mark I Kits, SEMAC Advisory 03-05
Pediatric: Pain Management
Key Points/Considerations
• Morphine up to maximum dose may be given on standing orders.
• Fentanyl may be given intranasally on standing orders
• Contraindications to standing order pain management: altered mental status,
hypoventilation, hypoperfusion, other traumatic injuries
• Fentanyl should be used if there is concern for potential hemodynamic instability
• For ease of administration, if clinically appropriate, consider Fentanyl dosing to nearest of
25 or 50 mcg and consider Morphine dosing of 2.5 or 5 mg
• Opioids and Benzodiazepines may not be used together without consultation with a
physician
Pediatric: Procedural Sedation
Key Points/Considerations
• Consult Medical Control Physician as soon as possible
Pediatric: Seizures
Key Points/Considerations
• Consult Medical Control Physician as soon as possible if seizures persist
• Protect the patient and EMS crew from injury during the seizure
• Any EMS provider may assist the patient’s family or caregivers with administration of
rectal Valium (Diastat)
Pediatric: Stridor
Key Points/Considerations
• Consult Medical Control Physician as soon as possible
