pals - fluids&medications

8/8/2019 PALS - Fluids&Medications

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FLUIDSFLUIDS

andand

MEDICATIONSMEDICATIONS



ObjectivesObjectives

of fluid administrationof fluid administration

Restore effective circulating volume inRestore effective circulating volume in

hypovolemia.hypovolemia.

Restore oxygenRestore oxygen--carrying capacity incarrying capacity in

hemorrhagic shock.hemorrhagic shock.

To correct metabolic imbalances.To correct metabolic imbalances.



ObjectivesObjectives

evaluation of acid base balanceevaluation of acid base balance

To determine the relative contributions of To determine the relative contributions of

respiratory and circulatory failure torespiratory and circulatory failure to

acidosis.acidosis.

To identify appropriate treatment for To identify appropriate treatment for documented respiratory or metabolicdocumented respiratory or metabolic

acidosis.acidosis.



O ect vesO ect ves

Medication AdministrationMedication Administration

during Resuscitationduring Resuscitation

Increase coronary and cerebral perfusion.Increase coronary and cerebral perfusion.

To stimulate spontaneous myocardialTo stimulate spontaneous myocardial

contractility.contractility.

To accelerate the heart.To accelerate the heart.

To suppress ventricular ectopy.To suppress ventricular ectopy.



Volume ExpansionVolume Expansion

Normal Saline or Lactated Ringer¶s. Normal Saline or Lactated Ringer¶s.

20 ml/kg in less than 20 minutes.20 ml/kg in less than 20 minutes.

IndicationIndication-- when a child demonstrates signswhen a child demonstrates signs

of shock.(eg.. mottled, pale color, cool skin,of shock.(eg.. mottled, pale color, cool skin,

diminished peripheral pulses).diminished peripheral pulses).

Note: Child with hypovolemia = 40/60 ml/kg Note: Child with hypovolemia = 40/60 ml/kg



EpinephrineEpinephrine

Sympathetic agonistSympathetic agonist

Natural occurring catecholamine. Natural occurring catecholamine.

Increase HR, BP, electrical activity,Increase HR, BP, electrical activity,

automaticity, vascular resistance, contractileautomaticity, vascular resistance, contractile

force.force.

IndicationsIndications -- cardiac arrest, symptomaticcardiac arrest, symptomatic bradycardia not responding to ventilations bradycardia not responding to ventilations



EPIEPI

indications continuedindications continued

Hypotension not related to volumeHypotension not related to volume

depletion.depletion.



EPIEPI

EpinephrineEpinephrine -- 0.01 mg/kg (0.1 ml/kg of 0.01 mg/kg (0.1 ml/kg of

1:10,000)1:10,000)

First DoseFirst Dose-- 0.01 mg/kg (0.1 ml of 1:10,000)0.01 mg/kg (0.1 ml of 1:10,000)

SecondSecond -- 0.1 mg/kg (0.1 ml of 1:1,000)0.1 mg/kg (0.1 ml of 1:1,000)



EPI continuedEPI continued

ETTETT -- 0.1 mg/kg (0.1ml/kg of 1:1,000)0.1 mg/kg (0.1ml/kg of 1:1,000)

diluted with 3diluted with 3--5 ml of normal saline5 ml of normal saline



AtropineAtropine

parasympatholytic parasympatholytic --accelerates sinus or accelerates sinus or

atrial pacemakersatrial pacemakers

DoseDose -- 0.02 mg/kg (max dose 1 mg child)0.02 mg/kg (max dose 1 mg child)

max single dose 0.5 mg for childmax single dose 0.5 mg for child

indicationsindications -- symptomatic bradycardiasymptomatic bradycardia

associated with poor perfusion or associated with poor perfusion or hypotension.hypotension.

Intubation attempts = hypoxemia = bradyIntubation attempts = hypoxemia = brady



Naloxone Naloxone

Narcotic antagonist Narcotic antagonist -- reverses the effects of reverses the effects of

narcotic poisonings, including respiratorynarcotic poisonings, including respiratory

depression,sedation, hypotension.depression,sedation, hypotension. DoseDose -- 0.1 mg/kg0.1 mg/kg

Even at high doses narcan is safeEven at high doses narcan is safe

use caution with addicted mothers =use caution with addicted mothers =withdraws and seizureswithdraws and seizures



DopamineDopamine

catecholaminecatecholamine

low doseslow doses -- increase renal, conary,cerebralincrease renal, conary,cerebral

blood flow (2 blood flow (2--5mcg/kg/min)5mcg/kg/min)

medium dosesmedium doses -- increase cardiac contractiltyincrease cardiac contractilty

without detectable changes in HR and BP.without detectable changes in HR and BP.

(5(5--10 mcg/kg/min)10 mcg/kg/min)

High dosesHigh doses -- vasoconstriction,increase BPvasoconstriction,increase BP

(10(10--20 mcg/kg/min)20 mcg/kg/min)



DopamineDopamine

DoseDose -- 6mg x child¶s body weight in kg6mg x child¶s body weight in kg

mix with 100 mlmix with 100 ml

1.0 mcg/kg/min1.0 mcg/kg/min



Sodium BicarbonateSodium Bicarbonate

only ph and Paco2 are important inonly ph and Paco2 are important in

determination of aciddetermination of acid--base balance. base balance.

May worsen intracellular acidosisMay worsen intracellular acidosis--impairingimpairing

myocardial performance and reducesmyocardial performance and reduces

coronary artery perfusion pressure.coronary artery perfusion pressure.

decreases fibrillation thresholddecreases fibrillation threshold



Sodium BicarbonateSodium Bicarbonate

DoseDose -- 1 mEq/ kg1 mEq/ kg

repeat at 0.5 mEq/kg (q 10 minutes)repeat at 0.5 mEq/kg (q 10 minutes)



THE ENDTHE END

pals - fluids&medications

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