Difference between revisions of "PALS (Main)"

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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)
*[[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]]
*[[Airway Sizes (Peds)]]
***<1yo - 3.5mm ETT
*[[Synchronized Cardioversion]]
***1-2yo - 4mm ETT
*[[Post Cardiac Arrest]]
***>2yo - 4 + (age/4)
*[[ACLS (Main)]]
*[[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==
===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
**Hydrogen ion
**Tension pneumo
**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
***25-50mg/kg (max 2g) IV
***Only for polymorphic V-tach
*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]]==
AHA 2010 Guidelines for PALS
AHA 2010 Guidelines for PALS
[[Category:Critical Care]]

Latest revision as of 17:10, 27 June 2016