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The general approach to this electrocuted child would ideally be as follows:
1. Because the child is already being ventilated, his pulse should be checked and he should be placed on a monitor.
2. Once ventricular fibrillation and pulseness are detected, CPR should be started until a defibrillator is available.
3. Once a defibrillator is available, the patient should be defibrillated with 2 joules/kg.
4. If this is unsuccessful, he should be defibrillated again at 4 joules/kg.
5. If this is unsuccessful, he should be defibrillated again at 4 joules/kg.
6. If this is unsuccessful, CPR should be started.
7. An intravenous line should be attempted at this time. It is also appropriate for immediate intubation to be attempted at this time.
8. Intubation of this 32 month old should be performed with a #1 or #2 straight blade laryngoscope.
9. An uncuffed, size 4.5 endotracheal tube should be used.
10. Once either intubation or an intravenous is obtained, epinephrine can be administered..
11. Epinephrine can be administered either IV or endotracheally. The initial recommended dose is 0.01 mg/kg IV or 0.1 mg/kg via ETT. Subsequent doses should be 0.1mg/kg IV. It is probably acceptable to try 0.1 mg/kg IV as an initial dose as well.
12. After drug administration, defibrillation should again be performed at 4J/kg.
13. In this case, the patient's rhythm is corrected by defibrillation. At this time, pulse status should be determined. If a pulse is obtained, the blood pressure should be determined. In this case, the pediatric intensivist arrives to take over for you at this time.
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