A Review of the 2020 Update of the Pediatric Advanced Life Support Guidelines (Pharmacology CME)

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Delivery Method:	Online
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Publication Date: June 2023 (Volume 20, Number 6)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 06/01/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology CME credit, subject to your state and institutional approval.

Authors

Peer Reviewers

Abstract

Pediatric cardiac arrest presents an infrequent but high-stakes event for emergency clinicians, who need to maintain expertise in this area. Evidence regarding pediatric resuscitations has been accumulating substantially over the past decade and highlights the unique considerations and challenges when resuscitating children. This issue reviews resuscitation principles of children in cardiac arrest while addressing the newest evidence-based and best-practice recommendations by the American Heart Association.

Case Presentations

A 12-year-old boy presents after collapsing during a football game…

• Bystanders were unable to palpate a pulse. They immediately called for help and initiated CPR. An automated external defibrillator was brought to the scene, and a shockable rhythm was detected. The shock was applied, and CPR was resumed.
• You arrive with EMS at the scene shortly after the initial shock is delivered. No pulse is detectable. You begin bag-mask ventilation and confirm adequate chest rise.
• In anticipation for transport, you begin to consider whether you should intubate the patient now or continue to ventilate the patient using a bag-mask?

An ill-appearing 9-month-old boy is brought into the ED resuscitation bay…

• You encounter an infant who appears blue, with shallow respirations. Oxygen saturation is not detectable despite high-quality bag-mask ventilation, so you decide to intubate the patient. On Broselow tape, the patient falls into the PURPLE category. A cuffed 3.5 endotracheal tube or an uncuffed 4.0 endotracheal tube is recommended.
• As you prepare the airway equipment, you consider whether you should use a cuffed or uncuffed tube.

A 3-year-old girl is brought into the ED with severe diarrhea...

• The triage nurse sees that the child is unresponsive and immediately calls for help. No pulse is identified, and CPR is started as the patient is taken to a resuscitation room. CPR continues as pads are placed. You look up at the monitor and note pulseless electrical activity.
• You need to obtain venous access but are worried about successfully placing an IV line. What other options should you consider? When should epinephrine be administered and how frequently should it be given? Should you use end-tidal CO₂ to monitor the quality of CPR?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.