Pediatric Code Blue Algorithm & How to Apply it in PALS

Doctors and nurses respond to a code blue

 Pediatric Code Blue Algorithm & How to Apply it in PALS

What to do When a Pediatric Code Blue is Activated?

Pediatric code blue is a medical emergency that requires an immediate response. The algorithm for pediatric code blue, or the Pediatric Cardiac Arrest Algorithm, is activated when the patient has a heart rate below 60 or if they are unresponsive. Team members should act in a coordinated, swift manner and give high-quality CPR with minimal interruptions while administering shocks and PALS medications.

The code will trigger the following steps:

  • Start CPR
  • Start bag-mask ventilation and give O₂.
  • Attach a defibrillator/monitor.
  • Determine if the rhythm is shockable or non-shockable.

RELATED: PALS Megacode Practice

 

Pediatric doctor responds to Code Blue.
A doctor takes a patient’s pulse.

What to Do in Pediatric Cardiac Arrest if the Rhythm is Shockable?

If the initial rhythm is shockable (VF/pVT), follow these steps on the Pediatric Cardiac Arrest Algorithm: 

  • Give the first shock using 2 joules (J)/kg.
  • Immediately resume CPR for 2 minutes.
  • Obtain IV/IO access.
  • Allow the defibrillator to reanalyze the rhythm.

If the rhythm is still shockable, deliver the second shock at 4 J/kg, immediately resume CPR for 2 minutes, give epinephrine every 3–5 minutes, and consider an advanced airway.

  • Allow the defibrillator to reanalyze the rhythm.

If the rhythm is again shockable, deliver subsequent shocks at ≥4 J/kg with maximum dose of 10 J/kg. Immediately resume CPR for 2 minutes, give amiodarone or lidocaine, and treat reversible causes.

If the child continues to have a shockable rhythm, repeat the steps (shock-medication-shock), but use the highest dose shocks at ≥4 J/kg.

Ventricular Fibrillation is considered a shockable rhythm in pediatric cardiac arrest that should initiate a code blue response.
Ventricular Fibrillation visualized on an electrocardiogram (ECG)

What to Do in Pediatric Cardiac Arrest if the Rhythm is Not Shockable?

If the rhythm is not shockable and there is ROSC (return of spontaneous circulation), move onto post-cardiac care. 

If the rhythm is not shockable and no sign of ROSC:

  • Obtain IV/IO access, and give epinephrine ASAP.
  • Continue to give epinephrine every 3–5 minutes.
  • After each epinephrine dose, immediately resume CPR for 2 minutes.
  • Consider advanced airway and capnography.
  • Allow the defibrillator to reanalyze the rhythm.

If the rhythm remains nonshockable and no sign of ROSC, then resume CPR, and continue the pattern of epinephrine-CPR-epinephrine.

RELATED: The SVT PALS Algorithm: How does it work and why is it important?

Where Can I Obtain the Full 2020 Pediatric Cardiac Arrest Algorithm?

The American Heart Association (AHA) released updated algorithms in 2020. These algorithms are used by medical trainers and professionals alike when applying the latest PALS protocols in pediatric cardiac emergencies.

RELATED: Your Guide to the American Heart Association’s Basic Life Support Algorithms (BLS) 2020

Medical ProCerts has adopted these algorithms, including the Pediatric Cardiac Arrest Algorithm, and included them in a FREE downloadable course pack full of updated PALS protocols, ECG visualizations, and full-color algorithms for pediatric healthcare providers to use and study to prepare themselves for a code blue.

RELATED: PALS Algorithm Course Pack

If it is time for you to get certified in PALS or get re-certified, Medical ProCerts also provides an online PALS certification course and exam that you can take at your own pace. Their online course will save you the time and money you would otherwise spend in-class, and provides a comparable, AHA-compliant certification that your employer will love–or your money back.

Download your free PALS course pack now and start studying. Or register now, and receive your certification in just a few hours!

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