The majority of pre-hospital pediatric arrest are secondary to trauma, and the EMT must remember that definitive care can only be obtained in the Operating Room, and BLS providers must request the appropriate personnel to provide airway and volume support during transport.

1. For all pediatric arrests, initiate immediate transport and request ALS Intercept.
2. Provide Oxygenation, Ventilations, and Compression per AHA Guidelines.

INTERMEDIATE LIFE SUPPORT

1. Initiate IV or IO access for administration of fluids/medications.
2. Administer 20cc/kg of an Isotonic Solution.
3. If cardiopulmonary arrest not responding to Oxygenation/Ventilations/Fluids/Compressions
4. Administer Epinephrine 1:10,000 0.01mg/kg , then repeat q 5/min. Contact Medical Control

ADVANCED LIFE SUPPORT

Ventricular Fibrillation / Pulseless Ventricular Tachycardia

1. Defibrillate at 2j/kg. Repeat at 4j/kg X 2 if necessary.
2. Continue CPR, Intubate, Hyperventilate with 100% O2
3. Obtain IV/IO access, if not already in place
4. Administer Epinephrine 1:10,000 (first dose) IV/IO 0.01mg/kg | ETT: 0.1mg/kg (1:1,000) repeat in 3-5/min see below.
5. Defibrillate at 4j/kg, 30-60 seconds after each medication administration
6. Administer Lidocaine IV/IO 1mg/kg | ETT 2mg/kg repeat every 3.-5 min to max 3.0 mg/kg.
7. Defibrillate at 4j/kg, 30-60 seconds after each medication administration
8. Administer Epinephrine second and subsequent doses: IV/IO/ETT: 0.01 mg/kg (1:10,000)
9. Defibrillate at 4j/kg, 30-60 seconds after each medication administration

Asystole / Pulseless Electrical Activity

1. Identify & Treat Causes
   1. Severe hypoxemia
   2. Severe acidosis
   3. Severe hypovolemia
   4. Tension pneumothorax
   5. Profound hypothermia
   6. Overdose
   7. Cardiac tamponade
   8. Hyperkalemia
2. Continue CPR, Intubate, Hyperventilate with 100% O2
3. Obtain IV/IO access, if not already in place
4. Administer Epinephrine 1:10,000 (first dose) IV/IO 0.01mg/kg | ETT: 0.1mg/kg (1:1,000) repeat in 3-5/min see below.
5. Administer Atropine HR < 80/min IV/IO 0.02 mg/kg, repeat in 5/min intervals to max of 0.04mg/kg
6. May consider Sodium Bicarbonate 1 mEq/kg and repeat once in 10/minutes.