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Welcome to the lesson on Recognizing Cardiac Arrest. In this video, we will discuss recognizing cardiac arrest and reversible causes of cardiac arrest.

Unlike cardiac arrest in adults, which is very common due to acute coronary syndrome, cardiac arrest in pediatrics is more commonly the consequence of respiratory failure or shock. Thus, cardiac arrest can often be avoided if respiratory failure or shock is successfully managed.

Less than 10 percent of the time, cardiac arrest is the consequence of ventricular arrhythmia and occurs suddenly. It may be possible to identify a reversible cause of cardiac arrest and treat it quickly.

The reversible causes are essentially the same in children and in infants as they are in adults.

The reversible causes of cardiac arrests are divided into the H’s and the T’s. The H’s include hypovolemia, hypoxia, H+ (acidosis), hypo- and hyperkalemia, hypoglycemia, and hypothermia. The T’s include tension pneumothorax, tamponade, toxins, coronary thrombosis, pulmonary thrombosis, and unrecognized trauma.

Recognizing cardiopulmonary failure can be done by following the ABCDE survey, which checks for airway, breathing, circulation, disability, and exposure. For further details on these factors, refer to Table 22 in your corresponding PALS manual.

It is also helpful to be able to recognize arrest rhythms such as asystole, pulseless electrical activity, or PEA, ventricular fibrillation, or VF, and pulseless ventricular tachycardia, or VT. The upcoming videos will cover details on these arrest rhythms.

This concludes our lesson on Recognizing Cardiac Arrest. Next, we will review Pulseless Electrical Activity and Asystole.

Welcome to the lesson on Pulseless Electrical Activity and Asystole. In this video, we will discuss recognizing pulseless electrical activity, or PEA, and asystole cardiac rhythms.

PEA and asystole are related cardiac rhythms in that they are both life-threatening and unshockable.
Asystole is the absence of electrical or mechanical cardiac activity and is represented by a flat-line ECG. There may be subtle movement away from baseline (that is, drifting flat-line), but there is no perceptible cardiac electrical activity. Make sure that a reading of asystole is
not a technical error. Ensure that the cardiac leads are connected, gain is set appropriately, and the power is on. Check two different leads to confirm.

PEA is one of any number of ECG waveforms (even sinus rhythm) but without a detectable pulse. PEA may include any pulseless waveform except VF, VT, or asystole. Asystole may be preceded by an agonal rhythm. An agonal rhythm is a waveform that is roughly similar to a normal waveform but occurs intermittently, slowly, and without a pulse.

PEA and asystole are both unshockable rhythms.

This concludes our lesson on Pulseless Electrical Activity and Asystole. Next, we will review Ventricular Fibrillation and Pulseless Ventricular Tachycardia.

Welcome to the lesson on Ventricular Fibrillation and Pulseless Ventricular Tachycardia. In this video, we will discuss recognizing ventricular fibrillation, or VF, and pulseless ventricular tachycardia, or VT.

VF and pulseless ventricular tachycardia (VT) are life-threatening cardiac rhythms that result in ineffective ventricular contractions.

VF is a rapid quivering of the ventricles instead of a forceful contraction. The ventricular motion of VF is not synchronized with atrial contractions.

Pulseless VT occurs when the rapidly contracting ventricles are not pumping blood
sufficiently to create a palpable pulse.

In both VF and pulseless VT, individuals are not receiving adequate perfusion. VF and pulseless VT are shockable rhythms.

This concludes our lesson on Ventricular Fibrillation and Pulseless Ventricular Tachycardia. Next, we will review Responding to Cardiac Arrest.

Welcome to the lesson on Responding to Cardiac Arrest. In this video, we will discuss cardiac arrest management and responding to cardiac arrest with CPR, shock energy, advanced airway, and drug therapy.

The first management step in cardiac arrest is to begin high-quality CPR. For details on high-quality CPR, please refer to the BLS videos or your corresponding BLS manual.
For Pediatric Cardiac Arrest Algorithm, refer to Figure 16 in your corresponding PALS manual.

To ensure CPR quality when responding to cardiac arrest, make sure the chest compression rate is at least 100 to 120 per minute. Compressions depth should be one third the diameter of chest, that is 1.5 inches in infants and two inches in children. Minimize interruptions and do not over ventilate.

Additionally, rotate compressor every two minutes. If no advanced airway is available, the compression to ventilation ratio should be 15 to 2. If advanced airway is available, then give 8 to 10 breaths per minute with continuous chest compressions.

When giving shock energy, the first shock should be 2 J/kg. Second shock should be 4 J/kg. Subsequent shocks should be greater than or equal to 4 J/kg. Maximum dose of the shock should not exceed 10 J/kj or adult dosage.

When working with advanced airways, use supraglottic advanced airway or ET intubation. Use waveform capnography to confirm and monitor ET tube placement. Once the advanced airway is in place, give one breath every 6 to 8 seconds, that is 8 to 10 breaths per minute.

If providing drug therapy, epinephrine dosage via intravenous or intraosseous access should be 0.01 mg/kg. Repeat this dosage every 3 to 5 minutes. If there is no intravenous or intraosseous access, then you may give endotracheal dose of 0.1 mg/kg.

Amiodarone dosage should be given via intravenous or intraosseous access in 5 mg/kg bolus during cardiac arrest. You may repeat this up to two times for refractory VF or pulseless VT.

This concludes our lesson on Responding to Cardiac Arrest. Next, we will review Post-Resuscitation Care.