Pediatric Advanced Life Support

Pediatric Advanced Life Support

1Make Checks available to: Life Support EducationAgendaDAY 1Course introductions and overviewReview new 2011 updatesBLS primary survey videoPALS secondary survey videoCPR and AED practice, ETCO2 monitoring (group 1)Airway devices and intubation (group 2)Bradycardia station (group 1)Asystole/PEA station (group2)Patient assessment VideoRespiratory emergencies (group 1)VF/VT station (group 2)

DAY 2TachycardiasShocksLead II rhythm reviewTeam resuscitation concept videoAlgorithm reviewMega-code review/practiceTesting and MegacodeRemediation

IntroductionPALS is designed to give the learner the ability to assess and quickly respond to pediatric emergencies including respiratory arrest and cardiac arrest. The course is two days and encompasses a written exam and a core scenario that must be passed with at least an 84%. First hour of class we will be going over a pre-test.

PALS Over View: AHA guidelines Purpose of PALSAcquire the ability to recognize an infant or child whom requires advanced life supportLearn to apply the Assess, Categorize, Decide and Act model of assessmentLearn the importance and technique for quality and effective CPR and advanced life supportLearn effective team coordination and team member roles in resuscitationKey Points of Importance of PALSThe first step in cardiac arrest is preventionIf cardiac arrest does occur, effective high quality CPR is the most important aspect in successful resuscitationStudies show that poor skills by healthcare workers lead to increased incidences of death and brain deathAll PALS students must perform effective and quality CPR throughout the course

WATCH PALS INTRODUCTION ON VIDEO*NEW 2011 CPR UPDATE CHANGES: BLS

If there's a palpable pulse >60, but the patient shows inadequate breathing, give rescue breaths at a rate of 1220 breaths/minute (one breath every three to five seconds) using the higher rate for younger children

If the pulse is 10 kg (approximately one year). Infant size should be used for infants 0.09) tachycardia, hemodynamically stable: Adenosine may be considered if the rhythm is regular and monomorphic and is useful to differentiate SVT from VT. Consider cardioversion using energy described for SVT. Expert consultation is strongly recommended prior to administration of amiodarone or procainamide. If hemodynamically unstable, cardioversion is recommended.

SVTStable: Vagals first, then Adenosine 0.1, 0.2mg/kg, Then cardiovert as last resort 0.5-1J/kgUnstable: Cardiovert

VT with pulse:Stable: Adenosine .1, .2, Amiodarone 5mg/kg over 60 min, then cardioversion if needed. Unstable: Cardioversion

VT/VF: no pulse , defib ASAP, CPR, Epi, after third shock Amiodarone*NEW 2011 CPR UPDATE CHANGES: PALSRoutine calcium administration is not recommended for pediatric cardiopulmonary arrest in the absence of documented hypocalcemia, calcium channel blocker overdose, hypermagnesemia or hyperkalemia.

Etomidate has been shown to facilitate endotracheal intubation in infants and children with minimal hemodynamic effect but is not recommended for routine use in pediatric patients with evidence of septic shock.

Although there have been no published results of prospective randomized pediatric trials of therapeutic hypothermia, based on adult evidence, therapeutic hypothermia (to 3234C) may be beneficial for adolescents who remain comatose after resuscitation from sudden, witnessed, out-of-hospital VF cardiac arrest. Therapeutic hypothermia (to 3234C) may also be considered for infants and children who remain comatose after resuscitation from cardiac arrest.

Whenever possible, provide family members with the option of being present during resuscitation of an infant or child.

CPR Practice and Competency Testing

Single person resuscitation (30:2 ratio, 100 compressions a minute, 2 minute cycles)Two person resuscitation (15:2 ratio)Use of Bag/Mask (remember, always bag a patient whom becomes distressed and cyanotic on the ventilatior)

CPR Practice and Competency TestingCompression techniques (one hand method, two hand, two finger or encircling thumb technique)

Watch video on CPR practice, we will be practicing CPR soonOverview of PALS CPRHigh Quality CPRCompression rate of at least 100 per minutePush hard and fastCompression depth 1/3 AP diameter of the chest, 1 inches in infants and 2 inches in pediatrics Allow proper chest recoil after each compression to allow for proper cardiac outputMinimize interruptions for continuous brain and organ perfusion Avoid excessive ventilation to prevent impendence of venous return back to the heart and gastric insufflation

Overview of PALS CPRAEDPaddle size: Use the largest electrodes that will fit on the childs chest without touching, leaving about 3 cm between electrodes. Adult size (810 cm) electrodes should be used for children >10 kg (approximately one year). Infant size should be used for infants 2 seconds is a useful indicator of moderate dehydration when combined with a decreased urine output, absent tears, dry mucous membranes, and a generally ill appearance. It is influenced by ambient temperature, lighting, site, and age.

Management of ShockTachycardia also results from other causes (eg, pain, anxiety, fever).Pulses may be bounding in anaphylactic, neurogenic, and septic shock.In compensated shock, blood pressure remains normal; it is low in decompensated shock. Hypotension is a systolic blood pressure less than the 5th percentile of normal for age, namely: