You assess the ABC’s and the infant is not breathing and does not have a pulse.
Call for help and initiate CPR. Early activation of BLS and PALS protocols is key to survival. If you are a single rescuer and find an unresponsive infant, initiate a cycle of CPR (approximately two minutes or five rounds of 30:2 compression to breaths), then get an AED if available.
Two-person resuscitation CPR is a ratio of 15:2. Whereas, if you are the only provider, initiate CPR at a rate of 30:2.
Both nasopharyngeal airway and BiPAP can be used as airway adjuncts for an awake patient. Avoid using an oral airway in awake patients because it can stimulate the gag reflex, induce vomiting, and increased risk of aspiration.
You are addressing the ABC’s while an EKG is done which demonstrates the following:
This EKG demonstrates sinus tachycardia. However, keep in mind that if a patient is pulseless and has any electrical activity, whether sinus tachycardia, bradycardia, etc., that this is considered PEA, and CPR should be initiated.
With further evaluation, you learn the patient has had four days of nausea, vomiting and diarrhea. The child is noted to be tachycardia, with delayed cap refill, and lethargy. You note the following on the monitor:
The patient is demonstrating signs of hypovolemic shock with sinus tachycardia on the monitor. The treatment of sinus tachycardia is to identify and treat the underlying cause, in this case, providing IV fluids. Tachycardia is an important compensatory mechanism to aid in Cardiac Output (CO = heart rate x stroke volume). Attempts to slow the rate artificially can take away this compensatory mechanism and precipitate cardiac arrest.
