Resuscutation Sequence: Unwitnessed VFib Arrest

1.  2 minutes of CPR (prime the pump)
2.  Shock (120-200 J biphasic defibrillator)
3.  RESUME CHEST COMPRESSIONS immediately following shock (to eliminate delays)
4.  Check pulse (10 seconds during second round of chest compressions)
5.  If no pulse: Shock 200 J
6.  RESUME CHEST COMPRESSIONS immediately following shock

Local Anesthesia Toxicity (Lidocaine)

Local Anesthetic Agents Used Commonly for Infiltrative Injection

Agent	Duration of Action	Maximum Dosage Guidelines (Total Cumulative Infiltrative Injection Dose per Procedure*)
Amides
Lidocaine (Xylocaine)	Medium (30-60 min)	Without epinephrine: 4.5 mg/kg; not to exceed 300 mg
Lidocaine with epinephrine	Long (120-360 min)	With epinephrine: 7 mg/kg
Bupivacaine (Marcaine)	Long (120-240 min)	Without epinephrine: 2.5 mg/kg; not to exceed 175 mg total dose
Bupivacaine with epinephrine	Long (180-420 min)	With epinephrine: Not to exceed 225 mg total dose

		Bottom line Lidocaine 1% => 10mg per ml = Don't give more then 30 mls

Pediatic Resuscitation: SVT

Stable SVT

Vagal maneuvers: 

1. Ice to face
2. Blow through straw

Adenosine:

1. Initial: 0.1 mg/kg  (max 6 mg)
2. Susequant: 0.2 mg/kg (max 12 mg)

Consider alternative medication:

1. Amiodarone: 5 mg/kg (over 20-60 min)
2. Procainamide: 15 mg/kg (over 30-60 min)

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Verapamil should not be used as blocking agent for in infants...Bradycardia and Hypotension

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Unstable SVT:

Cardioversion:

1. First dose: 0.5 - 1 J/kg
2. Second dose: 2J/Kg

Scarlet Fever

CAUSED BY: Group A Strep


Sand paper rash:

Pastia's Lines

Strawberry Tongue

Kawasaki's

My HEART

Mucosal involvement (strawberry tongue/fissured lips)
Hands (erythema palms/soles)
Eyes (conjuctivtis)
Adenopathy (cervical)
Rash: (usually trunk)
Temp: > 5 days

Criteria for Dx is Temp for 5 days and any 4 of the above

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Additional Mnemonic: CRASH and Burn


C-Conjunctivitis
R-Rash
A-Adenopathy
S-Strawberry tongue
H-Hand and feet swelling

Burn-fever for more than 5 days

Pediatric Fever without focus Management

Terrible T's: cyanoisis

 Tetrology of Falot

a congenital heart defect which is classically understood to involve four anatomical abnormalities (although only three of them are always present). It is the most common cyanotic heart defect, and the most common cause of blue baby syndrome.


Tricuspid Atresia

Tricuspid fails to form (unopened).  No blood flow from RA to RV.  Tiny RV.  Blood instead shunts across Foramen Ovale or ASD into Pulmonary Arterial system for oxygenation.