Best Case Ever 42 Pediatric Cardiac Arrest

When was the last time you saw ventricular fibrillation in a 4 month old? Dr. Rob Simard tells his Best Case Ever of a Pediatric Cardiac Arrest in which meticulous preparation, sticking to his guns, early activation of the transportation service, and clever use of point of care ultrasound helped save the life of a child. He explains the importance of debriefing your team after an emotionally charged case.

Published November 2015

Dr. Simard’s tips on drawing up epinephrine in preparation for pediatric cardiac arrest

Use 3 tuberculin syringes (1mL each) and attach a 3-way stopcock to the cardiac emergency management of pediatric seizurescart epinephrine syringe and draw up 3 tuberculin syrninges of epinephrine in advance.

 

Annals of EM study on colour coded pre-filled syringes for pediatric resuscitation showing faster time to administration and lower medication error rates Full PDF

Pediatric Cardiac Arrest

From Annals of EM

References

Moreira ME, Hernandez C, Stevens AD, et al. Color-Coded Prefilled Medication Syringes Decrease Time to Delivery and Dosing Error in Simulated Emergency Department Pediatric Resuscitations. Ann Emerg Med. 2015;66(2):97-106.e3.

Other FOAMed Resources

Debriefing in the ED on St Emlyns Blog

American College of Cardiology 2015 Update for Pediatric Life Support Guidelines Key Points

 

Dr. Helman & Dr. Simard of no conflicts of interest to declare

 

 

For more EM Cases content on Pediatric Emergencies check out our free interactive eBook,

EM Cases Digest Vol. 2 Pediatric Emergencies here.

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About the Author:

Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine, the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute and is on the advisory board of The Teaching Institute. He is the founder and host of Emergency Medicine Cases.

One Comment

  1. Jeff Bishop November 19, 2015 at 1:53 pm - Reply

    Great case discussion! I would totally echo the comments on the utility of P.O.C.U.S. in paediatric pneumothorax.

    I had a recent case of a crashing term neonate in the NICU with a tension pneumo. The clinical signs were all present (tachycardia, desaturation, narrowing pulse pressure, hypotension, terrible peripheral perfusion) and neither I nor the other paediatrician were able to hear any breath sounds on the right. We set up for needle decompression just as one of our nurses brought over the US. A 2 second scan with the linear probe showed beautiful lung sliding on the right. On the left however, there was no lung sliding and a clear lung point was present. The pneumo was completely on the left and resolved nicely with intervention on the correct side.

    The clinical exams we talk about and look for in tension pneumo (shifted trachea, hyper resonance to percussion, elevated JVP etc) are rarely easy to assess in small babies and as I learned from this case, my ability to hear where the breath sounds are in a noisy NICU is not as good as I would like it to be. I’m pretty thankful we had the use of a bedside US.

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