Compared to its adult counterpart, the Shock/Sepsis protocol for pediatrics puts a higher emphasis on addressing unstable tachyarrhythmias, partially because the other dysrhythmia protocols are written specifically for adults. In any event, the CFR and BLS portions of the protocol focus on keeping the child warm and transporting, while paramedics will further assess for hemorrhage or dehydration. If volume status appears to be the primary problem, medics will give up to two 20mL/kg crystalloid boluses (40mL/kg total). For shock states wherein the patient is in SVT or VT with a pulse, crews are instructed to contact OLMC for orders to cardiovert. As the OLMC doc, you are advised to approve synchronized cardioversion ONLY if able to deliver the appropriate weight-based dose. For SVT specifically, if unable to electrically cardiovert, you can give orders for weight-based adenosine.
Ultimately, as previously discussed, the running theme for pediatric protocols tends to be rapid transport to an appropriate hospital. But as always, having this sort of familiarity in your back pocket will help you provide the best care when stuff hits the fan.
Stay tuned for more! Until then, www.nycremsco.org !
Dave