Pediatric Asystole

Section 7 - PEDIATRIC / OBSTETRICAL

7.01 PEDIATRIC ASYSTOLE

CONSIDER MEDICAL ETIOLOGY OF ASYSTOLE AND REFER TO APPROPRIATE PRACTICE PARAMETER:

• Hypoxia / Acidosis, INITIAL MEDICAL CARE (2.01)
• Injuries, CHEST INJURIES (6.04)
• Suffocation caused by a foreign body, FBAO (3.03)
• Smoke inhalation, BURNS (6.02)
• SIDS
• Sepsis / Hypovolemia, SHOCK (5.13)
• Hypothermia, COLD EMERGENCIES (5.06)

• Initiate 5 cycles of (30:2) one-rescuer or (15:2) two-rescuer CPR for approximately 2 minutes to allow blood to circulate and continue throughout resuscitation, minimizing interruptions. Assist ventilations with OXYGEN @ 100% via BVM. DO NOT HYPERVENTILATE
• If hypothermic, refer to COLD EMERGENCIES (5.06)
• INTUBATE and establish peripheral IV or IO line as able
• If hypovolemia suspected, fluid bolus 20 ml/kg

Refer to Handtevy System for medication administration

• EPINEPHRINE 1:10,000 (0.1 mg/ml) 0.01 mg/kg IV / IO
• Repeat EPINEPHRINE 1:10,000 (0.1 mg/ml) 0.01 mg/kg IV / IO, every 3-5 minutes of continued arrest
• ATROPINE SULFATE 0.02 mg/kg (minimum dosage is 0.1 mg)
• Repeat every 3-5 minutes of continued arrest for maximum dose of 1 mg

Ventilation and oxygenation always precede drug therapy.

The current national guidelines do not include ATROPINE for treatment of TRUE ASYSTOLE as there is no proof it has a therapeutic benefit. Under the Maitland Fire Rescue Practice Parameters the use of ATROPINE SULFATE is indicated in cardiac arrest that may be caused by extreme bradycardia/hypotension. The Paramedic may use ATROPINE SULFATE based on clinical impression where there is a possibility that its use will have a positive therapeutic benefit. If ATROPINE SULFATE is used, the recommended dose is: ATROPINE SULFATE 0.02 mg/kg rapid IVP or IO Repeat every 3 - 5 minutes up to a total of 0.04 mg/kg