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Information about PALS_06

Published on January 12, 2009

Author: aSGuest10230


Pediatric Advanced Life Support : Pediatric Advanced Life Support Jan Bazner-Chandler CPNP, CNS, MSN, RN Pediatric Advanced Life Support : Pediatric Advanced Life Support Guidelines established in 1983 by the American heart Association. Pediatric Advanced Life Support: A Review of the AHA Recommendations, American Family Physician, October 15, 1999. Http:// American Heart Association : American Heart Association Pediatric Advanced Life Support Published online November 28, 2005 Article can be found at: JAOA : JAOA Review of guidelines for Pediatric Advanced Life Support – short version of AHA Quick review of AHA guidelines Students Nurse Concerns : Students Nurse Concerns You will need to learn the basics as outlined in the PALS article 1995 AHA guidelines are expected standards of a practicing pediatric nurse. You will need to know basic CPR guidelines and have a current CPR card prior to starting the clinical rotation. Cardiopulmonary Arrest : Cardiopulmonary Arrest In most infants and small children respiratory arrest precede cardiac arrest. 92% of children with respiratory arrest only have no subsequent neurologic impairment. Respiratory Arrest : Respiratory Arrest Early recognition and intervention prevents deterioration to cardiopulmonary arrest and probable death. Only 10% of children who progress to cardiopulmonary arrest are successfully resuscitated. Assessment : Assessment 30 second rapid cardiopulmonary assessment is structured around ABC’s. Airway Breathing Circulation Airway : Airway Airway must be clear and patent for successful ventilation. Position Clear of foreign body Free from injury Intubate if needed. Breathing : Breathing Breathing is assessed to determine the child’s ability to oxygenate. Assessment: Respiratory rate Respiratory effort Breath sounds Skin color Impending Respiratory Failure : Impending Respiratory Failure Respiratory rate less than 10 or greater than 60 is an ominous sign of impending respiratory failure. Circulation : Circulation Circulation reflects perfusion. Shock is a physiologic state where delivery of oxygen and substrates are inadequate to meet tissue metabolic needs. Circulatory Assessment : Circulatory Assessment Heart rate is the most sensitive parameter for determining perfusion and oxygenation in children. Heart rate needs to be at least 60 beats per minute to provide adequate perfusion. Heart rate greater than 140 beats per minute needs to be evaluated. Circulatory Assessment : Circulatory Assessment Pulse quality reflects cardiac output. Capillary refill measures peripheral perfusion. Temperature and color of extremities proximal versus distal. Circulatory Assessment : Circulatory Assessment Urinary output Adequate kidney perfusion 1- 2 ml of urine per kg / hour Level of Consciousness / LOC Blood Pressure : Blood Pressure 25% of blood volume must be lost before a drop in blood pressure occurs. Minimal changes in blood pressure in children may indicate shock. Management : Management Oxygen Cardiac Monitoring Pulse oximetry Inaccurate when peripheral perfusion is impaired. Airway Management : Airway Management Bag-valve-mask with bradypnia or apnea Intubation as needed Suctioning to remove secretions Bag-valve-mask : Bag-valve-mask New Guidelines – Airway Management : New Guidelines – Airway Management Failure to maintain the airway is leading cause of preventable death in children. New PALS focuses on basic airway techniques. Laryngeal mask airway. LMA –Laryngeal Mask Airway : LMA –Laryngeal Mask Airway LMA : LMA Disadvantages: Inability to prevent aspiration. Inability to serve as route for administering medications. Endotracheal Tube Intubation : Endotracheal Tube Intubation New guidelines: Secondary confirmation of tracheal tube placement. Use of end-tidal carbon dioxide monitor or colorimetric device Vascular Access : Vascular Access After airway and oxygenation needs met. Crystalloid solution Normal saline or Lactated ringers 20ml/kg bolus over 20 minutes Vascular Access – New Guidelines : Vascular Access – New Guidelines New guidelines: in children who are six years or younger after 90 seconds or 3 attempts at peripheral intravenous access – Intraosseous access recommended. Gastric Decompression : Gastric Decompression Gastric decompression with a nasogastric or oral gastric tube is necessary to ensure maximum ventilation. Air trapped in stomach can put pressure on the diaphragm impeding adequate ventilation. Undigested food can lead to aspiration. Cardiopulmonary Failure : Cardiopulmonary Failure Child’s response to ventilation and oxygenation guides further interventions. If signs of shock persists: Inotropic agents such as epinephrine are given. Epinephrine : Epinephrine Indications: Bradycardia Shock (cardiogenic, septic, or anaphylactic) Hypotension IV or through the endotracheal tube New Guideline Epinephrine : New Guideline Epinephrine Still remains primary drug for treating patients for cardiopulmonary arrest, escalating doses are de-emphasized. Neurologic outcomes are worse with high-dose epinephrine. 2 New Medications for PALS : 2 New Medications for PALS Vasopressin – causes systemic vasoconstriction – used to increase blood flow to brain and heart during CPR. Need to be studied further. Amiodarone – antiarrhythmic agent – used in ventricular fibrillation and ventricular tachycardia. Given 5 mg/kg over 20 minutes. Bradycardia : Bradycardia Bradycardia is the most common dysrhythmia in the pediatric population. Epinephrine is drug of choice – dose is 0.01 to 0.03 mg/kg/dose Atropine if epinephrine is ineffective. Sodium Bicarbonate : Sodium Bicarbonate In instances where the child is acidotic, sodium bicarbonate may be administered IV. The drug is not as stable in the pediatric population but is often used during the resuscitative phase of CPR. Glucose Levels : Glucose Levels Monitor serum glucose levels Replace with 10 % dextrose in the neonate 25% glucose in the child Ventricular Tachycardia : Ventricular Tachycardia Ventricular tachycardia is usually secondary to structural cardiac disease. Amiodarone – 5 mg/kg over 20 minutes Cardioversion Defibrillator Guidelines : Defibrillator Guidelines AHA recommends that automatic external defibrillation be use in children with sudden collapse or presumed cardiac arrest who are older than 8 years of age or more than 25 kg and are 50 inches long. Electrical energy is delivered by a fixed amount range 150 to 200. Post-resuscitation Care : Post-resuscitation Care Re-assessment of status is ongoing. Laboratory and radiologic information is obtained. Etiology of respiratory failure or shock is determined. Transfer to facility where child can get maximum care. BLS Updates 2006 : BLS Updates 2006 Unresponsive infant less than 1 year and children 1 year to puberty Open airway Give 2 breaths (if not breathing) Begin compressions – 30 – (if no pulse) Activate EMS system AED after 5 cycles of CPR Tilt Head to Sniff Position : Tilt Head to Sniff Position Witnessed Collapse of Child : Witnessed Collapse of Child Activate EMS AED before CPR Compression 30 to 2 breaths – hand placement at nipple line 2 rescue 15 to 2 – if infant circle chest and use thumbs Choking Infant : Choking Infant 5 back slaps 5 Chest thrusts Heimlich for Infants : Heimlich for Infants Clearing the Mouth : Clearing the Mouth

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