Difference between revisions of "PALS (Main)"

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Revision as of 05:43, 12 January 2012

Recommendations

  • Use Heimlich for >1yr; back/chest thrusts for <1yr
  • Treat shock w/ initial 20cc/kg bolus
    • Repeat boluses up to total of 60 mL/kg; thereafter pressors should be started
  • Do not routinely hyperventilate even in cases of head injury
  • Provide family w/ option of being present during resuscitation
  • IO is useful as initial vascular access
  • Self-Adhering Electrodes
    • Use largest size that will fit on child’s chest w/o touching
    • When possible leave 3cm between electrodes
    • Adult size for >10kg; infant size for <10kg
  • Hypotension is defined as sys BP:
    • <60 (0 to 28 days)
    • <70 (1mo - 12mo)
    • <70 + (2 X age in yr) (1-10yr)
    • <90 (≥10yr)

BLS

  • Compressions
    • Push hard (≥ 1/3 chest diameter) and fast (≥100/min)
  • Ventilations
    • NO perfusing rhythm
      • 15:2 ratio when do not have advanced airway
        • Do not overventilate! (leads to decr venous return)
        • Deliver breath with inspiratory time of 1s
      • 8-10 breaths per min when intubated
    • YES perfusing rhythm
      • Give rescue breaths 12-20 per min (“squeeze-release-release”)

Advanced Airway

  • Cuffed and uncuffed ETT are acceptable
    • Uncuffed
      • <1yo - 3.5mm ETT
      • 1-2yo - 4mm ETT
      • >2yo - 4 + (age/4)
    • Cuffed
      • <1yo - 3mm ETT
      • 1-2yo - 3.5mm ETT
      • >2yo - 3.5 + (age/4)

Pulseless Arrest

Asystole and PEA

  • Give Epi 0.01 mg/kg (0.1 mL/kg 1:10,000) (max 1mg) q3-5min
  • Rhythm check q2min
  • Consider H's and T's
    • Hypovolemia
    • Hypoxia
    • Hydrogen ion
    • Hypo/hyperkalemia
    • Hypothermia
    • Tension pneumo
    • Tamponade
    • Toxins
    • Thrombosis, pulmonary
    • Thrombosis, coronary

VF/Pulseless VT

  • Shock as quickly as possible and resume CPR immediately
    • First shock 2 J/kg
    • Second shock 4 J/kg
    • Subsequent shocks ≥ 4 J/kg (max 10 J/kg)
  • Give Epi if (shock + 2min CPR) fails to convert rhythm
  • Perform pulse check/shock if appropriate q2min
  • Give antiarrhythmic if (2nd shock +2min CPR) again fails
    • 1st line: Amiodarone
      • 5 mg/kg (max 300mg)
      • May repeat twice up to 15mg/kg
    • 2nd line: Lidocaine
      • 1 mg/kg
    • Magnesium
      • 25-50mg/kg (max 2g) IV
      • Only for polymorphic V-tach

Bradycardia

  • Algorithm assumes pulse and poor perfusion (low BP, AMS, shock)
    • Start CPR if HR <60/min w/ poor perfusion
      • Recheck after 2min; if poor perfusion persists:
        • Give Epi 0.01 mg/kg (0.1 mL/kg 1:10,000)
        • Give Atropine 0.02mg/kg
          • Only if due to incr vagal tone or AV block (not hypoxia)
        • Transcutaneous pacing
          • Consider if bradycardia is due to complete heart block

Tachycardia

  • Algorithm assumes pulse and adequate perfusion

Narrow-Complex

  • Sinus tachycardia - treat underlying cause
  • Supraventricular
    • Vagal stimulation (if will not delay meds/cardioversion)
      • Infants/young children: apply ice to face
      • Older children: Carotid sinus massage / Valsalva
    • Synchronized cardioversion
      • Use if unstable or adenosine ineffective
      • Give 0.5-1 J/kg; if unsuccessful increase to 2 J/kg
        • Give 2nd shock consider amiodarone OR procainamide before 3rd shock
          • Amiodarone 5 mg/kg over 20-60min
          • Procainamide 15 mg/kg over 30-60min
    • Adenosine
      • 0.1 mg/kg; immediately flush w/ 5cc NS

Wide-Complex

  • Adenosine for differentiating SVT from VT
    • Consider only if rhythm is regular and QRS monomorphic
  • Synchronized cardioversion
    • Give 0.5-1 J/kg; if unsuccessful increase to 2 J/kg
    • Give 2nd shock consider amiodarone OR procainamide before 3rd shock
      • Amiodarone 5 mg/kg over 20-60min
      • Procainamide 15 mg/kg over 30-60min

Source

AHA 2010 Guidelines for PALS