PEMCoR Megacode:
You are enjoying your quiet evening in the ED with only an hour left in your shift and suddenly EMS rolls in stating that there was a homeless man dumpster diving and came across an infant.
You bring the infant into the resuscitation room and realize the infant is maybe a few hours old has a weak cry and is mottled in appearance.
What do you do next?
A-B-C, provide O2, hook up to a monitor, and place an IV.
You get the patient hooked up to the monitor and note the following rhythm:
The remainder of vitals are: HR 72, RR 65, BP 52/24, T 36, wt approx. 2kg, SpO2 89%
You obtain an EKG and it reveals this:
After you confirm third degree heart block you plan to get a cardio consult and attempt to start pacing however the patients HR drops to 35 and becomes unresponsive and you no longer feel pulses.
What is your next step?
Start CPR, intubate and give Epinephrine
and Atropine.
What ratio of CPR do you want to do? 3:1 until intubated
What size tube do you want to use? 2.5 or 3.0 uncuffed using a size 0 blade
What drugs do you want to use for RSI? Fentanyl (1-2mcg/kg), Versed (0.1mg/kg), Roc (1mg/kg) avoid etomidate if patient is possibly septic as it can induce adrenal suppression and avoid ketamine because it isn’t studied in children less than 3 months of age.
Dose of Epinephrine: 0.01mg/kg
Dose of Atropine: 0.02mg/kg with minimum dose of 0.1mg and max dose of 0.5mg
– not part of NRP.
You could attempt placing a low-lying umbilical venous line if you don’t have IV access.
You do one round of CPR and see the following rhythm on the monitor:
What do you want to do now? Defibrillate.
What is your dose of Jules to give the patient? 2J/kg
You then start another round of CPR and give another dose of Epineprhine.
You do a full round of CPR and you see a HR of 72 with pulses and the following rhythm:
What do you do next?
Start pacing, give 10cc/kg fluid push and consider epi drip for low BP and heart block. Get Cardio consult and admit to PICU.
Teaching Points: