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Extra info for ACLS Supplementary materials

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Although the pediatric heart is capable of increasing stroke volume, cardiac output during infancy and childhood largely depends on maintenance of an adequate heart rate. Bradycardia Bradycardia may be associated with a rapid fall in cardiac output, leading to rapid deterioration in systemic perfusion. In fact, bradycardia is one of the most common terminal rhythms observed in children. Healthcare providers are taught to provide chest compressions when there is no pulse or when severe bradycardia (heart rate less than 60 beats per minute [bpm]) is present despite adequate oxygenation and ventilation and is associated with signs of poor systemic perfusion.

The right to refuse care does not mean that the patient has the right to demand nonbeneficial treatments. However, it is often difficult to determine if a resuscitative attempt will be futile or of no benefit to the patient. The determination of efficacy or futility should be based on physiological outcome criteria, not quality-of-life criteria. Initiating and Discontinuing CPR Determination of Death in the Out-ofhospital Setting For patients who experience sudden cardiac arrest, prompt initiation of CPR remains the standard of care.

2006 American Heart Association 33 Step 1 2 3 4 5 6 7 History Action Assess to determine whether you need to start the steps of CPR. • If yes, start CPR. • If no, go to step 2. Have the victim position himself so that he is comfortable and have him rest. Have an AED nearby and ready to use in the event the victim becomes unresponsive, stops breathing, and does not have a pulse. If you do not need to give CPR, provide supplementary oxygen even if initial evidence of oxygenation is good. Provide aspirin and nitroglycerin if trained and authorized to do so.

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