Difference between revisions of "PALS (Main)"

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==Background==
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''See [[critical care quick reference]] for drug doses by weight.''
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
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==Algorithms==
compressions (1 rescuer) or after 15 chest compressions (2
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*[[BLS]]
rescuers) to give 2 ventilations (mouth-to-mouth, mouth-tomask,
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*[[Pediatric Pulseless Arrest]]
or bag-mask). Deliver each breath with an inspiratory
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*[[PALS: Bradycardia]]
time of approximately 1 second. If the infant or child is
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**Use [[Pediatric Pulseless Arrest]] algorithm if no pulse = PEA
intubated, ventilate at a rate of about 1 breath every 6 to 8
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*[[PALS: Tachycardia]]
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==
 
==See Also==
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*[[AHA Recommendation Changes by Year]]
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*[[Airway Sizes (Peds)]]
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*[[Synchronized Cardioversion]]
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*[[Post Cardiac Arrest]]
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*[[ACLS (Main)]]
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*[[ACLS (Treatable Conditions)]]
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*[[Neonatal Resuscitation]]
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*[[Newborn Resuscitation]]
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*[[Pediatric Vital Signs]]
  
==Source==
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==References==
 
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<references/>
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AHA 2010 Guidelines for PALS
  
[[Category:Peds]]
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[[Category:Critical Care]]
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[[Category:Cardiology]]
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[[Category:Pediatrics]]
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[[Category:EMS]]

Latest revision as of 17:10, 27 June 2016