Pediatric Pacing

[MedicCallie]

I don't know if any of you have every been presented with this, but maybe you could help

I'm currently doing an elective rotation through a children's ER, and we had a 3 y/o with symptomatic bradycardia. We did the normal CPR (her HR was 36), epi and all. Anyways she went asystole so then we worked pulseless arrest algorithm on her.

And it made me think about this: Let's say any peds continued to stay brady for a little while (not too long with a pulse like that). In our algorithms, it says the normal CPR; epi; atropine if AV block; consider cardiac pacing. Well were would we even start off our machine at for pacing?

I've looked all around and have found no real support on pediatric pacing, just because it's never really done.

[bassnmedic]

The landmarks for pediatric pacing electrode placement are the same for adults and children, however, placement on a child is more challenging due to limited torso size. Anterior/posterior is the most common placement of electrodes. Anterior/Lateral is acceptable but will take up more space on an already crowded chest. In order to obtain a clear tracing on the monitor, pacing electrodes should be placed well away from ECG electrodes.

Pediatric pacing electrodes should be used in kids <33 lbs(15kg), adult size in patients in which the pads will not overlap the sternum,spine and diaphragm.

Capture thresholds are similar to those in adults. Studies indivate no relationship between body surface area,weight and carture thresholds and although many children will achieve capture between 50-100 MA, higher current requirements are possible. Pace at a rate high enough to achieve perfusion. Consider initial rate at 80-100 and initial MA at 60-80

Todd

[Just Plain Ruff]

I hope to never never never never never never can I say never enough times, to have to pace a child. CPR and workign the codes are bad enough.