Carolinas Ped EM Case Conference - Dr. Magill

Family Presence During a Code

• Families want to be given the choice to be present. 
• Most like to be present and feel they comfort the child and that witnessing the resuscitative efforts help with the grieving process.
  
• Designate someone assigned to parent, not helping with code, to explain everything to parent.
  
• Be gentle, but concrete in telling what is happening. No sugar-coating.
  
• “Your child is dead and we are doing everything we can to reverse that, but his/her heart is not beating and has not been since he/she arrived here.”

If a parent becomes irate:

• Remain calm.  Their reaction is normal denial/anger.  
  
• It is not personal.  
  
• Just ensure they are not harming medical staff.  
  
• Empathize for their unimaginable loss and support.

                                             

Cardiac syncope

• Anomalous Left Coronary from the Aorta

                                               i.     0.6% of general population (72M children in US = 445K cases)
                                             ii.     Normal EKG and Physical exam
                                            iii.     Unlike ALCAPA where the EKG and PE will be abnormal from chronic ischemia
                                            iv.     Diagnosed in older children and teens
                                              v.    Usually presents with exertional syncope
                                            vi.     Needs PEDIATRIC cardiology referral

Exertional syncope is cardiac until proven otherwise!

• Always check EKG 
  
• Needs thorough physical exam
  
• Does not need stat cardiology consult at 3am, but does need good follow up and referral to peds cardiology clinic for echo.
  
• Activity restrictions until cleared by cardiology. 
  

Pediatric CPR

• Compressions 100/minute for infants and children
  
• Breaths every 3-5 seconds- don’t overventilate
  
• Weight and dosing from Broselow tape
  
• Defib 2 J/kg, then 4 J/kg, then 4 J/kg….

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