EMS Protocol of the Week - Non-Traumatic Cardiac Arrest and Severe Bradycardia (Pediatric)

Pediatric cardiac arrests are high stress scenarios in the best of times, so you can imagine how much more taxing they may be in the out-of-hospital setting, with even fewer resources. Keeping things heavily protocolled may be beneficial in these cases, giving EMS a fixed task list to complete to help work through all the chaos of the situation.

We’ve got a few key differences between the pediatric cardiac arrest protocol (which includes all arrest rhythms) and the adult counterparts we just covered. One is the increased emphasis on ventilator support and appropriate CPR at the CFR level, particularly given the heavy respiratory component of most pediatric arrests. Two is the increased priority of initiating transport at the BLS level, as opposed to many adult arrests that are often extensively worked up on the scene. And three is the high detail on defibrillation when indicated, utilizing appropriate Joules (or the lowest setting if unable to administer at the weight-based amount) and pad sizing. Medical Control Options look a little different here compared to the adult protocols, leading off with naloxone (again, considering respiratory etiologies), and following off with options for dextrose, bicarb, magnesium, or crystalloid.

Recognize that most of the paramedic interventions – and hence the calls for MCOs – will take place en route to the hospital, given how early in the protocol BLS is instructed to begin transport. But also realize that these transports can occasionally be prolonged, and they may feel excruciatingly drawn out for the paramedics sitting with the patient in the back of the ambulance, desperate for something to do. So listen closely to their presentations on the OLMC phone, give some real considerations to the meds they’re looking to give, and do what you can to work in tandem with them in those crucial minutes before they hit our ambulance bay. 

That’ll do it for this week, see you all next week, and give some love to www.nycremsco.org or the protocol binder.

Dave