Question: ROSC Protocol states bolus 10ml/kg if under 12 check at 100ml and over 12 check at 250. Cardiogenic Shock Protocol (includes ROSC) -states bolus 10ml/kg -if 2 to 18 check at 100ml and over 18 check at 250ml. One states the 12 to 18 range at 250ml but the other 2 to 18 at 100ml. Can you clear this up for me please?
You are correct, there is an inconstancy here. The concern is volume overloading a young patient post cardiac arrest. In the ROSC directive, the volume of saline is 10ml/kg reassess every 100ml < 12yo. Pediatric arrests unfortunately do happen, and as such we need to be cautious with fluid administration. With that said, it would be rare to see a ROSC patient who most likely has come element of aspiration and who received CPR actually have a clear chest on auscultation which is a listed condition.
In the Cardiogenic Shock Protocol, the age cut off is 18yo for the reassess every 100ml/kg however it lists STEMI positive ECG as an indication. STEMI is extremely rare in patients less than 30yo let alone between 12yo and 18yo. Bottom line: if treating with IV fluid under either directive, be cautious with the volume and ensure the chest is clear as often as possible. Paediatric cardiac arrests fortunately are rare and Paediatric STEMI fortunately rarer still. Focus more on the essentials of paediatric cardiac arrest management (proper defib settings, proper drug dosing) rather than when to reassess the chest with your stethoscope in these chaotic noisy environments.