CASE STUDY P.1
A 9-year-old, 35 kg. female has collapsed while playing with friends during recess at school. The event was witnessed by several teachers who summoned 911 and began quality CPR. (Compressions given ⅓– ½ of the A-P diameter; compression rate of 100/minute; allowing the chest to completely recoil after each compression; and minimizing interruptions to chest compressions to 10 seconds.)
EMS arrives and takes over ventilations (8-10 breaths/minute) using oxygen. The quick-patches (used to monitor and defibrillate) are placed on the chest and the following is observed:
Paramedics deliver a 70 joule shock (approximately 2 joules/kg) after announcing the shock and visually making sure no one is in contact with the patient. The shock is not successful, so 5 more cycles of CPR are given. During CPR, the child is intubated, and an antecubital IV line is inserted. The patient is shocked a second time using 150 joules (approximately 4 joules/kg). CPR is resumed for 5 cycles (ventilation is provided at 8-10 breaths/minute). Epinephrine 3.5 ml of 10,000 solution is given IV push and circulated with CPR for several minutes. A third shock of 150 joules causes the following change to be seen on the monitor. The patient has a palpable pulse.
After stabilizing the patient, she is transported by helicopter to the regional children’s hospital.