PALS (Main): Difference between revisions

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==2010 AHA Recommendations==
''See [[critical care quick reference]] for drug doses by weight.''
*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]]==
==Algorithms==
*[[BLS]]
*[[Pediatric Pulseless Arrest]]
*[[PALS: Bradycardia]]
**Use [[Pediatric Pulseless Arrest]] algorithm if no pulse = PEA
*[[PALS: Tachycardia]]


==Advanced Airway==
==See Also==
*Cuffed and uncuffed ETT are acceptable
*[[AHA Recommendation Changes by Year]]
**Uncuffed
*[[Airway Sizes (Peds)]]
***<1yo - 3.5mm ETT
*[[Synchronized Cardioversion]]
***1-2yo - 4mm ETT
*[[Post Cardiac Arrest]]
***>2yo - 4 + (age/4)
*[[ACLS (Main)]]
**Cuffed
*[[ACLS (Treatable Conditions)]]
***<1yo - 3mm ETT
*[[Neonatal Resuscitation]]
***1-2yo - 3.5mm ETT
*[[Newborn Resuscitation]]
***>2yo - 3.5 + (age/4)
*[[Pediatric Vital Signs]]


==Pulseless Arrest==
==References==
===Asystole and PEA===
<references/>
*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|PALS: 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
AHA 2010 Guidelines for PALS


[[Category:Airway/Resus]]
[[Category:Critical Care]]
[[Category:Peds]]
[[Category:Cardiology]]
[[Category:Pediatrics]]
[[Category:EMS]]

Revision as of 17:10, 27 June 2016