Difference between revisions of "PALS (Main)"

(Created page with "==Background== ==Diagnosis== ==Work-Up== ==DDx== ==Treatment== ==Disposition== ==See Also== ==Source== Category:Peds")
 
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==Background==
 
==Background==
 +
hypotension is defined as a systolic blood pressure:
 +
�60 mm Hg in term neonates (0 to 28 days)
 +
�70 mm Hg in infants (1 month to 12 months)
 +
�70 mm Hg � (2 � age in years) in children 1 to 10 years
 +
�90 mm Hg in children �10 years of age
 +
 +
If the infant or child is not intubated, pause after 30 chest
 +
compressions (1 rescuer) or after 15 chest compressions (2
 +
rescuers) to give 2 ventilations (mouth-to-mouth, mouth-tomask,
 +
or bag-mask). Deliver each breath with an inspiratory
 +
time of approximately 1 second. If the infant or child is
 +
intubated, ventilate at a rate of about 1 breath every 6 to 8
 +
seconds (8 to 10 times per minute) without interrupting chest
 +
compressions
 +
 +
In the victim with a perfusing rhythm but absent or
 +
inadequate respiratory effort, give 1 breath every 3 to 5
 +
seconds (12 to 20 breaths per minute), using the higher rate
 +
for the younger child (Class I, LOE C). One way to achieve
 +
that rate with a ventilating bag is to use the mnemonic
 +
“squeeze-release-release” at a normal speaking rate.
 +
 +
Both cuffed and uncuffed endotracheal tubes are acceptable
 +
for intubating infants and children
 +
 +
 +
If an uncuffed endotracheal tube is used for emergency
 +
intubation, it is reasonable to select a 3.5-mm ID tube for infants
 +
up to one year of age and a 4.0-mm ID tube for patients between
 +
1 and 2 years of age. After age 2, uncuffed endotracheal tube
 +
size can be estimated by the following formula:
 +
Uncuffed endotracheal tube ID (mm)�4�(age/4)
 +
If a cuffed tube is used for emergency intubation of an infant
 +
less than 1 year of age, it is reasonable to select a 3.0 mm ID
 +
tube. For children between 1 and 2 years of age, it is
 +
reasonable to use a cuffed endotracheal tube with an internal
 +
diameter of 3.5 mm (Class IIa, LOE B).89,98–100 After age 2 it
 +
is reasonable to estimate tube size with the following formula
 +
(Class IIa, LOE B:89,98–101):
 +
Cuffed endotracheal tube ID (mm)�3.5�(age/4)
 +
 +
CPR Guidelines for Newborns With Cardiac
 +
Arrest of Cardiac Origin
 +
Recommendations for infants differ from those for the newly
 +
born (ie, in the delivery room and during the first hours after
 +
birth) and newborns (during their initial hospitalization and in
 +
the NICU). The compression-to-ventilation ratio differs
 +
(newly born and newborns – 3:1; infant two rescuer - 15:2)
 +
and how to provide ventilations in the presence of an
 +
advanced airway differs (newly born and newborns – pause
 +
after 3 compressions; infants – no pauses for ventilations).
 +
This presents a dilemma for healthcare providers who may
 +
also care for newborns outside the NICU. Because there are
 +
no definitive scientific data to help resolve this dilemma, for
 +
ease of training we recommend that newborns (intubated or
 +
not) who require CPR in the newborn nursery or NICU
 +
receive CPR using the same technique as for the newly born
 +
in the delivery room (ie, 3:1 compression-to-ventilation ratio
 +
with a pause for ventilation). Newborns who require CPR in
 +
other settings (eg, prehospital, ED, pediatric intensive care
 +
unit [PICU], etc.), should receive CPR according to infant
 +
guidelines: 2 rescuers provide continuous chest compressions
 +
with asynchronous ventilations if an advanced airway is in
 +
place and a 15:2 ventilation-to-compression ratio if no advanced
 +
airway is in place (Class IIb, LOE C). It is reasonable
 +
to resuscitate newborns with a primary cardiac etiology of
 +
arrest, regardless of location, according to infant guidelines,
 +
with emphasis on chest compressions
 +
 +
IO access is a rapid, safe, effective, and acceptable route for
 +
vascular access in children,172–179,181 and it is useful as the
 +
initial vascular access in cases of cardiac arrest
 +
 +
Therefore, regardless of the
 +
patient’s habitus, use the actual body weight for calculating
 +
initial resuscitation drug doses or use a body length tape with
 +
precalculated doses
 +
 +
Amiodarone
 +
Decrease the infusion rate if there is prolongation
 +
of the QT interval or heart block; stop the infusion if
 +
the QRS widens to �50% of baseline or hypotension develops.
 +
Amiodarone should not be administered together with another
 +
drug that causes QT prolongation, such as procainamide,
 +
without expert consultation.
 +
 +
Calcium administration is not recommended for pediatric cardiopulmonary
 +
arrest in the absence of documented hypocalcemia,
 +
calcium channel blocker overdose, hypermagnesemia, or
 +
hyperkalemia
 +
 +
Lidocaine decreases automaticity and suppresses ventricular
 +
arrhythmias,227 but is not as effective as amiodarone for
 +
improving ROSC or survival to hospital admission among adults
 +
 +
Procainamide
 +
Decrease the infusion rate if there is prolongation of the QT
 +
interval, or heart block; stop the infusion if the QRS widens
 +
to �50% of baseline or hypotension develops. Do not
 +
administer together with another drug causing QT prolongation,
 +
such as amiodarone, without expert consultation a
 +
 +
 +
Pulseless Arrest
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
 +
  
  

Revision as of 20:40, 24 June 2011

Background

hypotension is defined as a systolic blood pressure: �60 mm Hg in term neonates (0 to 28 days) �70 mm Hg in infants (1 month to 12 months) �70 mm Hg � (2 � age in years) in children 1 to 10 years �90 mm Hg in children �10 years of age

If the infant or child is not intubated, pause after 30 chest compressions (1 rescuer) or after 15 chest compressions (2 rescuers) to give 2 ventilations (mouth-to-mouth, mouth-tomask, or bag-mask). Deliver each breath with an inspiratory time of approximately 1 second. If the infant or child is intubated, ventilate at a rate of about 1 breath every 6 to 8 seconds (8 to 10 times per minute) without interrupting chest compressions

In the victim with a perfusing rhythm but absent or inadequate respiratory effort, give 1 breath every 3 to 5 seconds (12 to 20 breaths per minute), using the higher rate for the younger child (Class I, LOE C). One way to achieve that rate with a ventilating bag is to use the mnemonic “squeeze-release-release” at a normal speaking rate.

Both cuffed and uncuffed endotracheal tubes are acceptable for intubating infants and children


If an uncuffed endotracheal tube is used for emergency intubation, it is reasonable to select a 3.5-mm ID tube for infants up to one year of age and a 4.0-mm ID tube for patients between 1 and 2 years of age. After age 2, uncuffed endotracheal tube size can be estimated by the following formula: Uncuffed endotracheal tube ID (mm)�4�(age/4) If a cuffed tube is used for emergency intubation of an infant less than 1 year of age, it is reasonable to select a 3.0 mm ID tube. For children between 1 and 2 years of age, it is reasonable to use a cuffed endotracheal tube with an internal diameter of 3.5 mm (Class IIa, LOE B).89,98–100 After age 2 it is reasonable to estimate tube size with the following formula (Class IIa, LOE B:89,98–101): Cuffed endotracheal tube ID (mm)�3.5�(age/4)

CPR Guidelines for Newborns With Cardiac Arrest of Cardiac Origin Recommendations for infants differ from those for the newly born (ie, in the delivery room and during the first hours after birth) and newborns (during their initial hospitalization and in the NICU). The compression-to-ventilation ratio differs (newly born and newborns – 3:1; infant two rescuer - 15:2) and how to provide ventilations in the presence of an advanced airway differs (newly born and newborns – pause after 3 compressions; infants – no pauses for ventilations). This presents a dilemma for healthcare providers who may also care for newborns outside the NICU. Because there are no definitive scientific data to help resolve this dilemma, for ease of training we recommend that newborns (intubated or not) who require CPR in the newborn nursery or NICU receive CPR using the same technique as for the newly born in the delivery room (ie, 3:1 compression-to-ventilation ratio with a pause for ventilation). Newborns who require CPR in other settings (eg, prehospital, ED, pediatric intensive care unit [PICU], etc.), should receive CPR according to infant guidelines: 2 rescuers provide continuous chest compressions with asynchronous ventilations if an advanced airway is in place and a 15:2 ventilation-to-compression ratio if no advanced airway is in place (Class IIb, LOE C). It is reasonable to resuscitate newborns with a primary cardiac etiology of arrest, regardless of location, according to infant guidelines, with emphasis on chest compressions

IO access is a rapid, safe, effective, and acceptable route for vascular access in children,172–179,181 and it is useful as the initial vascular access in cases of cardiac arrest

Therefore, regardless of the patient’s habitus, use the actual body weight for calculating initial resuscitation drug doses or use a body length tape with precalculated doses

Amiodarone Decrease the infusion rate if there is prolongation of the QT interval or heart block; stop the infusion if the QRS widens to �50% of baseline or hypotension develops. Amiodarone should not be administered together with another drug that causes QT prolongation, such as procainamide, without expert consultation.

Calcium administration is not recommended for pediatric cardiopulmonary arrest in the absence of documented hypocalcemia, calcium channel blocker overdose, hypermagnesemia, or hyperkalemia

Lidocaine decreases automaticity and suppresses ventricular arrhythmias,227 but is not as effective as amiodarone for improving ROSC or survival to hospital admission among adults

Procainamide Decrease the infusion rate if there is prolongation of the QT interval, or heart block; stop the infusion if the QRS widens to �50% of baseline or hypotension develops. Do not administer together with another drug causing QT prolongation, such as amiodarone, without expert consultation a


Pulseless Arrest










Diagnosis

Work-Up

DDx

Treatment

Disposition

See Also

Source