Before the administration of any drugs the patient must be receiving continuous and effective basic life support and ventilation with oxygen.
ECG appearance of asystole shows almost straight line; occasional p wave may be seen. Check lead, connections, gain.
Epinephine 10 mcg/kg (0.1 ml/kg of 1:10 000) every 3 minutes
10x dose via ETT, then flush 1 ml N/Saline
Venous pH more meaningful than arterial. Bicarb should be considered after 1-2 doses of epinephrine (esp with tricyclic OD, hyperkalaemia). Avoid mixing with calcium, flush between epinephrine/dopamine, NOT for ETT use.
Fluid bolus should be considered.
Second dose of epinephrine can be 10 times first dose: no evidence for benefit but anecdotal cases where arrest secondary to circulatory collapse.
Calcium not recommended EXCEPT hypocalcaemia, hypokalaemia
VF associated with hypothermia, tricyclic poisoning and with cardiac disease. Precordial thump only for monitored children in whom the onset of arrhythmia is witnessed and if the defibrillator not immediately to hand. Otherwise asynchronous DC shock should be given immediately.
2, 2, 4 mg/kg DC shock. If change in rhythm at any point, check pulse.
Then check pulse and return to CPR for 1 minute, including securing of airway and high flow oxygen. Give epinephrine every 3 minutes (10 mcg/kg IV or 100 mcg/kg via ETT).
Amiodarone 5 mg/kg rapid iv bolus if resistant - shock within 60 secs (except tricyclics: use bicarb, phenytoin).
Consider lignocaine and alkalising agents.
Bizarre? Think hyperkalaemia.
Change paddle position if resistance to defibrillation (ie front and back). Try another defibrillator.
Treat as for asystole, but look for underlying cause:
Dobutamine useful in low cardiac output secondary to poor myocardial function (2-20 mcg/kg/min). Dopamine can be used instead of dobutamine or else with dobutamine but at lower "renal perfusion" dose (0.5-2 mcg/kg/min). Epinephrine infusion for shock with poor systemic perfusion from any cause unresponsive to fluid resuscitation, esp severe hypotensive shock, infants (0.1-1 mcg/kg/min).