Overview
Pediatric Defibrillation is a critical emergency procedure used to terminate ventricular fibrillation and pulseless ventricular tachycardia in children. This procedure requires specific energy settings and techniques adapted for pediatric patients.
Defibrillation is the definitive treatment for shockable rhythms in pediatric cardiac arrest. Early defibrillation significantly improves survival rates. Proper technique and energy selection are crucial for successful outcomes.
Learn more in our comprehensive RxDx Pediatrics Course
Indications
Chaotic, disorganized electrical activity of the heart
Rapid ventricular rhythm without palpable pulse
Cardiac arrest with shockable rhythm
Persistent shockable rhythm despite defibrillation
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes ensuring the defibrillator is charged and functional, selecting appropriate energy settings, preparing defibrillation pads, and ensuring all team members are clear of the patient during shock delivery.Step-by-Step Procedure
Step 1: Rhythm Recognition
Recognize shockable rhythm (VF/pVT) on monitor. Ensure patient is pulseless. Prepare for defibrillation while continuing CPR.
⚠️ Common Mistakes to Avoid:
- Failure to recognize shockable rhythm
- Defibrillating non-shockable rhythm
- Delayed defibrillation
💡 Pro Tip:
VF appears as chaotic, irregular waves without organized QRS complexes.
Step 2: Energy Selection
Select appropriate energy: 2 J/kg for first shock, 4 J/kg for subsequent shocks. Use maximum energy for manual defibrillator if weight unknown.
⚠️ Common Mistakes to Avoid:
- Incorrect energy selection
- Using adult energy settings
- Inadequate energy for subsequent shocks
💡 Pro Tip:
Start with 2 J/kg for first shock, increase to 4 J/kg for subsequent shocks.
Step 3: Pad Placement
Place pads in anterior-posterior position: one pad on anterior chest, one on back. Ensure good contact and no air gaps.
⚠️ Common Mistakes to Avoid:
- Poor pad placement
- Air gaps under pads
- Incorrect pad size
💡 Pro Tip:
Anterior-posterior placement is preferred for pediatric patients.
Step 4: Safety Check
Ensure all team members are clear of patient and bed. Check that no one is touching patient or equipment. Announce "clear" before shock.
⚠️ Common Mistakes to Avoid:
- Inadequate safety check
- Team members not clear
- Poor communication
💡 Pro Tip:
Always announce "clear" and ensure everyone is away from patient before shock.
Step 5: Shock Delivery
Deliver shock. Immediately resume CPR for 2 minutes. Do not check rhythm or pulse immediately after shock.
⚠️ Common Mistakes to Avoid:
- Delayed CPR resumption
- Checking rhythm immediately
- Interrupting CPR too early
💡 Pro Tip:
Resume CPR immediately after shock - do not check rhythm or pulse.
Step 6: Post-Shock Management
Continue CPR for 2 minutes. Re-analyze rhythm. Prepare for additional shocks if needed. Administer medications as per PALS algorithm.
⚠️ Common Mistakes to Avoid:
- Inadequate CPR between shocks
- Poor rhythm analysis
- Delayed medication administration
💡 Pro Tip:
High-quality CPR between shocks is crucial for successful defibrillation.
Master Pediatric Defibrillation with RxDx
Access 100+ procedure videos and expert guidance with the RxDx app
Post-procedure Care
Post-defibrillation care involves immediate resumption of CPR, rhythm analysis, and preparation for additional shocks if needed. Continuous monitoring and documentation are essential.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Skin burns | 5-10% | Redness, blistering at pad sites | Topical treatment, monitor for infection | Good pad contact, appropriate energy |
| Myocardial injury | Rare | Elevated cardiac enzymes, ECG changes | Monitor cardiac function | Appropriate energy selection |
| Failure to convert | 60-70% | Persistent VF/pVT | Continue PALS algorithm | Early defibrillation, good CPR |
| Equipment malfunction | Rare | Shock not delivered, error messages | Troubleshoot equipment, backup plan | Regular equipment checks |
Clinical Pearls
Start with 2 J/kg for first shock, increase to 4 J/kg for subsequent shocks.
Anterior-posterior placement is preferred for pediatric patients.
Always announce "clear" and ensure everyone is away from patient before shock.
Resume CPR immediately after shock - do not check rhythm or pulse.
High-quality CPR between shocks is crucial for successful defibrillation.
VF appears as chaotic, irregular waves without organized QRS complexes.
Use maximum energy for manual defibrillator if patient weight is unknown.