FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- Do not use adult medication doses or adult fixed-energy shocks for a child.
- The current pediatric arrest order does not include routine sodium bicarbonate; an I-20 preparation row alone does not establish an indication.
Start resuscitation
- Begin or continue high-quality CPR and support ventilation with high-flow oxygen by BVM. Obtain the rhythm and defibrillator without unnecessary interruption.
- Make base contact as soon as possible; a pediatric-capable base is preferred. Establish IV/IO access while maintaining compressions.
VF / pulseless VT
- Initial defibrillation: 2 J/kg biphasic, or the programmed or manufacturer-recommended setting. Continue CPR for about 2 minutes.
- For persistent VF/pulseless VT, use 4 J/kg at the subsequent shock steps. Continue CPR between rhythm assessments and shocks.
- For continued VF/pulseless VT, epinephrine is 0.01 mg/kg IV/IO using 0.1 mg/mL, repeated approximately every 3 minutes.
- For persistent shockable arrest, give amiodarone 5 mg/kg IV/IO, with repeat doses at 5 and 10 minutes and a maximum of 450 mg. Alternative: lidocaine 1 mg/kg IV/IO, maximum 100 mg, once. Follow the full sequence and account for prior doses.
PEA / asystole
- Continue CPR and ventilation, establish IV/IO, and give epinephrine 0.01 mg/kg of 0.1 mg/mL IV/IO approximately every 3–5 minutes.
- Look for reversible causes, including hypoxia, hypovolemia, glucose/electrolyte abnormalities, hypothermia, acidosis, tension pneumothorax, tamponade, toxins, or thrombosis.
- For a diabetic patient with suspected hypoglycemia, the arrest order lists D10 5 mL/kg IV/IO, maximum 250 mL. If VF/pulseless VT appears during this branch, follow its 4 J/kg transition step.
ROSC or continuing arrest
- After a pulse returns, continue oxygenation and ventilation and correct hypoxia or hypovolemia. Contact base for destination and ALS transport. If base cannot be reached, transport to the nearest ERC.
- For continuing arrest, request further resuscitation orders and destination direction from base. Report weight, rhythm changes, shocks, medication totals/times, ETCO₂ when available, and any ROSC.
VISUAL FIELD REFERENCE
Pediatric arrest: weight-based shock sequence
Pediatric · ALS
These are rhythm-specific checkpoints, not the complete resuscitation sequence. See the PEA/asystole section for its VF/VT transition instruction.
- 2 J/kg
Initial VF / pulseless VT shock
Initial defibrillation: 2 J/kg biphasic, or the programmed or manufacturer-recommended setting. Continue CPR for about 2 minutes.
- 4 J/kg
Persistent VF / pulseless VT
For persistent VF/pulseless VT, use 4 J/kg at the subsequent shock steps. Continue CPR between rhythm assessments and shocks.
PEA / asystole is a separate branch
Continue CPR and ventilation, establish IV/IO, and give epinephrine 0.01 mg/kg of 0.1 mg/mL IV/IO approximately every 3–5 minutes.
- Make base contact as soon as possible; a pediatric-capable base is preferred. Establish IV/IO access while maintaining compressions.
- Do not use adult medication doses or adult fixed-energy shocks for a child.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-P-040
UNDERSTAND THE CARE
How to coordinate a pediatric arrest without losing the dose record
Weight links the shock and medication decisions, so the team should agree on and communicate the working weight. Assign the rhythm, ventilation, access and documentation tasks while maintaining compressions. The shockable and non-shockable branches have different sequences; track the current branch and any transition.
Applying the guidance
Before a repeat dose, state the drug, route, concentration, last administration and cumulative amount. A preparation chart explains how to measure an authorized treatment but does not independently create the indication. After ROSC, report the arrest course and current oxygenation, ventilation and perfusion while obtaining destination direction.
Putting it together
Teaching example: an arriving clinician asks for the next medication. The recorder supplies the child’s weight, current rhythm branch, prior doses and times so a repeated treatment is deliberate rather than duplicated.
Diagram text & teaching checkpoints
- Weight
- Make the working weight explicit.
- Rhythm
- Follow the appropriate pediatric branch.
- Resuscitation record
- Energy, medication, concentration and times.
- ROSC or ongoing arrest
- Continue support and base direction.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.