1. PALS – 2010 Guidelines Helpful Information
Life Support Education

2. Pediatric Assessment Triangle
P A T
Appearance
Work of Breathing
Circulation

3. Pediatric assessment triangle

4. Pediatric Chain of Survival
Prevention
Early CPR
Prompt Access to EMS
Rapid Pediatric Advanced Life Support (PALS)
Integrated Post-Cardiac Arrest Care

5. SYSTEMATIC APPROACH Evaluate Identify Intervene Primary Assessment
Secondary Assessment
Focused Exam
SAMPLE History
Intervene
Diagnostic Tests
Tertiary Assessment

6. assessment

7. Airway & Respiratory Considerations
OPA – NPA – When do we use them
Signs of progressive Respiratory Failure - Respirations decreasing and more lethargic
Following Breathing Treatments – ABC’s
Indications for needle decompression
Treatment options for allergic reactions

8. AIRWAY MANAGEMENT Rescue Breathing
One (1) Rescue Breath every 3 – 5 Seconds
Pediatric Patient with a pulse but not breathing
BVM = 1 Breath every 3 – 5 seconds
Has an ET Tube = 1 Breath every 3 – 5 seconds
CPR with advanced airway –
Continuous Compressions and 1 breath every 6 – 8 seconds (8 – 10/minute)

9. ET Tube Sizes UN-Cuffed Age/4 + 4 Cuffed Age/4 + 3.5 Listen-------
Epigastric
AXilla
Lungs

10. breathing Diminished breath sounds
Diminished rise of the chest on one side
Respiratory distress with stridor (possible allergic reaction (Epi IM)
Barking cough (moderate stridor & retractions) (Nebulized Epi)

11. Airway & Respiratory Considerations
Oxygen should be administered to patients with low O2 saturations and increased work of breathing
Nebulized Epinephrine is for stridor, mild to moderate retractions, barking cough

12. Additional Information
Tracheal deviation – absence of breath sounds - Needle decompression
Following a seizure –
ABC’s manage airway/breathing
Equipment
Treat patient

13. Blood Pressure- Lower 5th percentile
Estimate of Minimum Systolic Blood Pressure
Age Minimum systolic blood pressure
0 to 1 month mm Hg
>1 month to 1 year mm Hg
1 to 10 years of age mm Hg + (2 x age in years)
>10 years of age mm Hg

14. Rhythm disturbances Hypovolemic – Fluid boluses
SVT- Vagal Maneuvers – Adenosine 0.1 mg/kg
Adenosine 0.2 mg/kg
Synchronized Cardioversion joules
Synchronized Cardioversion – 2 joules/kg

15. Bradycardia in Pediatrics
Initial thoughts - Oxygenation and Ventilation
CPR if HR <60/min with poor perfusion
despite oxygenation and ventilation
Expert Consultation
Epinephrine mg/kg every 3 – 5 minutes
May consider Atropine 0.02 mg/kg if vagal response
Consider pacing if not responding or heart blocks
Treat underlying cause (H’s & T’s)

16. Narrow Complex Tachycardia in Pediatrics
SVT (Supraventricular tachycardia)
Children - > 180
Infants - > 220
History – Level of Consciousness
Vagal Maneuvers
IV/IO Access
Adenosine 0.1 mg/kg (max 6mg)
0.2 mg/kg (max 12 mg) [second dose]
No Access or condition deteriorates –
Synchronized Cardioversion – 1 joule/kg
If condition continues – 2 joules/kg

17. Wide Complex Tachycardia in Pediatrics
History – Level of Consciousness
Consider Adenosine if time
Stable Patient –
Amiodarone 5 mg/kg over 20 to 60 min.
Expert Consultation
Unstable Patient –
Synchronized Cardioversion 0.5 – 1 joule/kg

18. Cardiac Arrest Scene Safety PPE
Establish Unresponsiveness and Lack of Normal Breathing
Sudden Collapse - Activate Emergency System
Get AED/Defibrillator
Check Pulse
Begin Chest Compressions
C – A – B
Activate EMS after 2 minutes of CPR if not already done
For victims of Sudden Collapse = Use AED as soon as it arrives !
If there are no Pediatric Pads – Use the Adult Pads

19. Cardiac Arrest Shockable Rhythm (VF/Pulseless VT)
Deliver 1 shock – 2-4 joules/kg
Resume CPR immediately (Chest Compressions)
IV/IO Access
Epinephrine mg/kg every 3 – 5 minutes
Consider advanced airway
Defibrillate at 4 joules/kg
Amiodarone – 5 mg/kg
May repeat 1 or 2 times
Consider Reversible Causes

20. Cardiac Arrest Non-Shockable Rhythm
CPR – starting with Chest Compressions
IV/IO Access
Epinephrine 0.01 mg/kg every 3 – 5 minutes
Consider advanced airway
CPR
Consider Reversible Causes

21. H’s & T’s Hypovolemia Hypoxia Hypoglycemia Hydrogen Ions (Acidosis)
Hypo/Hyperkalemia
Hypothermia
TRAUMA
Tension Pneumothorax
Tamponade – Cardiac
Toxins
Thrombosis – Pulmonary
Thrombosis – Coronary

22. IO Access DO NOT USE if: Fracture Crush injury Bone disease
Previous attempts

23. Ventilations during cpr
Compression to Ventilation Ratio
30:2 – 1 Rescuer CPR
15:2 – 2 Rescuer CPR
CPR with ETT in place
Continuous Chest Compressions
Ventilations – 1 Breath every 6 to 8 seconds
(8 – 10 breaths/minute)

24. Post Arrest Care Goals – Preserve neurologic function
Prevent secondary organ injury
Diagnose & Treat cause of illness
Enable patient to arrive at Pediatric Tertiary-Care facility in optimal physiologic state
Frequent assessment is necessary because of risk of deterioration
Maintain Oxygen saturation between 94 and 99% following ROSC

25. Capnography for ROSC
Capnography is used for verification of advance airway and for indication of return of spontaneous circulation (ROSC) during CPR.
[1 Minute Interval] 50
37.5 25
12.5
mm Hg
Capnography tracing displaying the PETCO2 in mm Hg on the vertical axis over time.
This patient is intubated and receiving CPR. Note that the ventilation rate is approximately 8 to 10 breaths per minute.
The initial PETCO2 is less than 12.5 mm Hg during the first minute, indicating very low blood fl ow.
The PETCO2 increases to between 12.5 and 25 mm Hg during the second and third minutes, consistent with the increase in blood flow with ongoing resuscitation. Return of spontaneous circulation (ROSC) occurs during the fourth minute.
ROSC is recognized by the abrupt increase in the PETCO2 (visible just after the fourth vertical line) to over 40 mm Hg, which is consistent with a substantial improvement in blood fl ow.

26. Defibrillation Example VF/Pulseless VT
2 – 4 Joules/kg
CPR
Epinephrine 0.01mg/kg every 3 – 5 minutes
Defibrillate 4 joules/kg
Epinephrine OR Amiodarone 5 mg/kg
Defibrillate 4 joules/kg up to 10 joules/kg or max adult dose
Consider Causes (H’s & T’s)

27. Why Adenosine may be helpful VT vs Pre-excited Atrial Fibrillation in a 9 year old

28. Two Major Causes of Death in Pediatric Trauma…….
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