PALS – 2010 GUIDELINESHELPFUL INFORMATION

Life Support Education

PEDIATRIC ASSESSMENT TRIANGLE

P A TApp

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Work of B

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Circulation

PEDIATRIC ASSESSMENT TRIANGLE

PEDIATRIC CHAIN OF SURVIVAL

Prevention

Early CPR

Prompt Access to EMS

Rapid Pediatric Advanced Life Support (PALS)

Integrated Post-Cardiac Arrest Care

SYSTEMATIC APPROACH

Evaluate Primary Assessment

Identify Secondary Assessment Focused Exam SAMPLE History

Intervene Diagnostic Tests Tertiary Assessment

ASSESSMENT

AIRWAY & RESPIRATORY CONSIDERATIONS

OPA – NPA – When do we use them

Signs of progressive Respiratory Failure -Respirations decreasing and more lethargic

Following Breathing Treatments – ABC’s

Indications for needle decompression

Treatment options for allergic reactions

AIRWAY MANAGEMENT RESCUE BREATHING

One (1) Rescue Breath every 3 – 5 Seconds

Pediatric Patient with a pulse but not breathing BVM = 1 Breath every 3 – 5 seconds

Has an ET Tube = 1 Breath every 3 – 5 seconds

CPR with advanced airway – Continuous Compressions and 1 breath every 6 –

8 seconds (8 – 10/minute)

ET Tube Sizes

UN-Cuffed Age/4 + 4

Cuffed Age/4 + 3.5

Listen------- Epigastric AXilla Lungs

BREATHING Diminished breath sounds

Diminished rise of the chest on one side

Respiratory distress with stridor (possible allergic reaction (Epi IM)

Barking cough (moderate stridor & retractions) (Nebulized Epi)

AIRWAY & RESPIRATORY CONSIDERATIONS

Oxygen should be administered to patients with low O2 saturations and increased work of breathing

Nebulized Epinephrine is for stridor, mild to moderate retractions, barking cough

ADDITIONAL INFORMATION

Tracheal deviation – absence of breath sounds - Needle decompression

Following a seizure – ABC’s manage airway/breathing

Equipment Treat patient

Blood Pressure- Lower 5th percentile

Estimate of Minimum Systolic Blood Pressure

Age Minimum systolic blood pressure

0 to 1 month 60 mm Hg >1 month to 1 year 70 mm Hg 1 to 10 years of age 70 mm Hg + (2 x age in years) >10 years of age 90 mm Hg

RHYTHM DISTURBANCES

Hypovolemic – Fluid boluses

SVT- Vagal Maneuvers – Adenosine 0.1 mg/kgAdenosine 0.2 mg/kgSynchronized Cardioversion - 0.5 - 1 joulesSynchronized Cardioversion – 2 joules/kg

Bradycardia in Pediatrics

Initial thoughts - Oxygenation and Ventilation CPR if HR <60/min with poor perfusion

despite oxygenation and ventilation

Expert Consultation Epinephrine - .01 mg/kg every 3 – 5 minutes May consider Atropine 0.02 mg/kg if vagal response Consider pacing if not responding or heart blocks Treat underlying cause (H’s & T’s)

Narrow Complex Tachycardia in Pediatrics

SVT (Supraventricular tachycardia) Children - > 180 Infants - > 220

History – Level of Consciousness Vagal Maneuvers IV/IO Access Adenosine 0.1 mg/kg (max 6mg)

0.2 mg/kg (max 12 mg) [second dose]

No Access or condition deteriorates – Synchronized Cardioversion 0.5 – 1 joule/kg

If condition continues – 2 joules/kg

Wide Complex Tachycardia in Pediatrics

History – Level of Consciousness Consider Adenosine if time Stable Patient –

Amiodarone 5 mg/kg over 20 to 60 min. Expert Consultation Unstable Patient –

Synchronized Cardioversion 0.5 – 1 joule/kg

CARDIAC ARREST Scene Safety PPE Establish Unresponsiveness and Lack of Normal Breathing Sudden Collapse - Activate Emergency System Get AED/Defibrillator Check Pulse Begin Chest Compressions C – A – B Activate EMS after 2 minutes of CPR if not already done For victims of Sudden Collapse = Use AED as soon

as it arrives ! If there are no Pediatric Pads – Use the Adult Pads

Cardiac Arrest

Shockable Rhythm (VF/Pulseless VT) Deliver 1 shock – 2-4 joules/kg Resume CPR immediately (Chest Compressions) IV/IO Access Epinephrine 0.01 mg/kg every 3 – 5 minutes Consider advanced airway Defibrillate at 4 joules/kg Amiodarone – 5 mg/kg

May repeat 1 or 2 times Consider Reversible Causes

Cardiac Arrest

Non-Shockable Rhythm CPR – starting with Chest Compressions IV/IO Access Epinephrine 0.01 mg/kg every 3 – 5 minutes Consider advanced airway CPR Consider Reversible Causes

H’s & T’s Hypovolemia Hypoxia Hypoglycemia Hydrogen Ions (Acidosis) Hypo/Hyperkalemia Hypothermia TRAUMA Tension Pneumothorax Tamponade – Cardiac Toxins Thrombosis – Pulmonary Thrombosis – Coronary

IO Access

DO NOT USE if: Fracture Crush injury Bone disease Previous attempts

VENTILATIONS DURING CPR

Compression to Ventilation Ratio 30:2 – 1 Rescuer CPR

15:2 – 2 Rescuer CPR

CPR with ETT in place Continuous Chest Compressions Ventilations – 1 Breath every 6 to 8 seconds

(8 – 10 breaths/minute)

POST ARREST CARE

Goals – Preserve neurologic function Prevent secondary organ injury Diagnose & Treat cause of illness Enable patient to arrive at Pediatric Tertiary-Care

facility in optimal physiologic state

Frequent assessment is necessary because of risk of deterioration

Maintain Oxygen saturation between 94 and 99% following ROSC

CAPNOGRAPHY FOR ROSCCAPNOGRAPHY FOR ROSC

Capnography is used for verification of advance airway and for indication of return of spontaneous circulation (ROSC) during CPR.

5037.52512.50

mm

Hg

[1 Minute Interval]

DEFIBRILLATION EXAMPLEVF/PULSELESS VT

2 – 4 Joules/kg CPR Epinephrine 0.01mg/kg every 3 – 5 minutes CPR Defibrillate 4 joules/kg CPR Epinephrine OR Amiodarone 5 mg/kg CPR Defibrillate 4 joules/kg up to 10 joules/kg or max adult

dose CPR Consider Causes (H’s & T’s)

WHY ADENOSINE MAY BE HELPFUL VT VS PRE-EXCITED ATRIAL FIBRILLATIONIN A 9 YEAR OLD

TWO MAJOR CAUSES OF DEATH IN PEDIATRIC TRAUMA…….

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