Difference between revisions of "PALS (Main)"

(PALS: Tachycardia)
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==2010 AHA Recommendations==
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''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]]==
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==Algorithms==
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*[[BLS]]
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*[[Pediatric Pulseless Arrest]]
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*[[PALS: Bradycardia]]
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**Use [[Pediatric Pulseless Arrest]] algorithm if no pulse = PEA
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*[[PALS: Tachycardia]]
  
==Advanced Airway==
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==See Also==
*Cuffed and uncuffed ETT are acceptable
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*[[AHA Recommendation Changes by Year]]
**Uncuffed
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*[[Airway Sizes (Peds)]]
***<1yo - 3.5mm ETT
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*[[Synchronized Cardioversion]]
***1-2yo - 4mm ETT
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*[[Post Cardiac Arrest]]
***>2yo - 4 + (age/4)
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*[[ACLS (Main)]]
**Cuffed
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*[[ACLS (Treatable Conditions)]]
***<1yo - 3mm ETT
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*[[Neonatal Resuscitation]]
***1-2yo - 3.5mm ETT
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*[[Newborn Resuscitation]]
***>2yo - 3.5 + (age/4)
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*[[Pediatric Vital Signs]]
  
==Pulseless Arrest==
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==References==
===Asystole and PEA===
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<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
 
 
 
==[[PALS: Tachycardia|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]]
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[[Category:Critical Care]]
[[Category:Peds]]
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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