Problem
Scenario: You are the peds nurse. One of the ECRNs comes around the corner with a run sheet from Maywood. They are coming to the ED with a 4 month old baby girl who is unresponsive. In the report, Maywood said that the parents were on the scene and hysterical; apparently mom was breast feeding and fell asleep on top of the baby; unknown downtime.
A. What things do you prepare in the room for the baby's arrival?
B. What medications should be available in the room?
C. Where do you find doses for pediatric patients (at least 2 places)?
Maywood arrives and puts the baby down on the cart in Peds Trauma 1. They are bagging and doing CPR. Another nurse in the room puts the babe on the monitor while someone else starts an IV. The baby has no pulse and is not breathing. The doctor is getting ready to intubate the baby and asks you to give a dose of Epinephrine through the IV your colleage just started. The Broselow tape is on the bed and the patient falls in the 8 kg section.
D. Which vial of Epi do you have in the room (1:1000 or 1:10000)? How many mg of Epi do you calculate for this patient? How many mls do you draw up?
E. How often do you dose a baby with Epi during a code?
The doctor has some difficulty intubating the patient and asks for sedation. He tells you Ketamine, Succinylcholine, and Atropine.
F. What are the doses of the above medications and what does each dose do?
G. What size ET tube should the baby be intubated with and how do you get the answer?
The baby is successfully intubated; breath sounds are clear and equal bilaterally with bagging; the end tidal CO2 detector is positive and the doctor orders a chest xray for placement. The baby is being bagged and PALS is continued.
H. What other medications could be given to this baby and what are the doses?
I. What is the main cause of cardiac arrest in children?