SAVING AMERICAN HEARTS Pediatric Advanced Life Support Study Guide Based on the American Heart Association 2010 Guidelines
American Heart Association Pediatric Advanced Life Support PALS Study Guide
FOUR TYPES OF RESPIRATORY DISORDERS
UPPER AIRWAY OBSTRUCTION
These children will present with stridor. The most important INITIAL medication is IM Epi, or an EPI pen. Give steroids if the child has a history of asthma. Provide oxygenation. If the oxygen sat continues to drop despite oxygen administration then preparations need to be made for BVM or intubation.
LOWER AIRWAY OBSTRUCTION
This is bronchiolitis or asthma. You’ll hear wheezes and a prolonged expiratory phase. Provide nebulizer treatments, steroids and support the oxygen needs.
LUNG TISSUE DISEASE
This is pneumonia, or aspiration pneumonia. Expect to hear crackles. The child will have a low oxygen saturation and resp effort will be increased. Provide oxygenation, antibiotics and antipyretics. Obtain cultures if the fever is over 101.
DISORDERED CONTROL OF BREATHING
This is an example of a post dictal child, a brain injury or neuro child, or even a child that has been sedated and doesn’t have control over their breathing. As long as their V/S are stable, simply monitor. The resp rate may only be 6, but if their sat is 99% on room air, just monitor.
FOUR TYPES OF SHOCK
Defined as cold and dusky hands and feet, murmur on auscultation, palpable liver and crackles to lung bases as the heart struggles to preserve the core and circulate the blood volume. Treatment includes antibiotics and fluids of ONLY 5-10ml/kg given very slowly. This will thin the blood and allow the sick heart to pump more efficiently clearing up the crackles in the lungs.
With septic shock, the child will have a very low BP, good cap refill, most likely a very high fever near or above 103. A child with a high fever who is on chemotherapy would be in septic shock with a very low BP. Treatment consists of supporting the airway, obtaining cultures, administering antibiotics and antipyretics and a fluid bolus of 20ml/kg given very quickly followed with vasopressors if the BP does not respond to the fluid bolus.
This could be due to a tension pneumothorax. This will cause an obstruction of the oxygen which can lead to shock. Treatment consists of immediate correction of the pneumothorax with needle decompression and preparation of a chest tube. If the child is on a ventilator, and the oxygen saturation is 68%,
Remember the D.O.P.E. mnemonic
D = Displacement (Check to see that the tube has not moved and is still at the previous cm marking at the lip O = Obstruction Listen for breath sounds. If any breath sounds are heard, the tube is not obstructed or you would hear no breath sounds at all. P= Pneumothorax Check to see if breath sounds are equal. Is the trachea deviated (Very late sign in children) and check to see if there is equal rise and fall of the chest. E = Equipment This step should be preformed FIRST. Disconnect the ventilator, attach BVM and bag the child. If the O2 sat does NOT rise, it is not an equipment problem.
This can be due to volume depletion caused by blood loss or by dehydration. Administer rapid fluid bolus of 20ml/kg over 5 minutes up to 3 times. If the BP does not respond then blood should be administered. A low blood pressure is a very late sign of shock in children. Children can maintain a normal blood pressure until they have lost 25% of their total blood volume.
Always keep children’s O2 Sat between 94-99% to prevent hyperoxia. If the child is on oxygen and the sat is 100%, then turn the oxygen down to achieve a sat of 94-99%.
From the age of puberty and under. If the child has a pulse of 60 or less, begin chest compressions and treat them as though they have no pulse. Administer EPI. Do not give Atropine to a child for bradycardia until they are beyond puberty.
If a child’s heart slows down or stops, it is because they can’t breath. If a child has been in respiratory distress for a few days, and the heart rate begins to drop, and resp rate begins to drop it’s because they are getting tired and are going to stop breathing. Begin ventilations with a BVM device.
The same goes for a child in respiratory distress for a few days. If they have been struggling to breathe and you suction away what little bit of air they were able to get in, their heart rate will drop. Simply bag them and replace the oxygen you took away.
When you place a pulse ox on a child, make sure that the heart rate on the pulse ox correlates with the heart rate on the monitor. If the monitor shows a heart rate of 200, and your pulse ox says the heart rate is 99, the pulse ox is not reliable. So if it says the O2 sat is 98%, it is not reliable and the child must be given oxygen.
The best way to establish vascular access in a child is IO Intraosseous.
The preferred vagal maneuver in children is ice to the face.
When performing cardioversion for an unstable tachycardia, begin with ½ to 1J/kg.
When defibrillating, begin with 2J/kg, then 4J/kg, 6J/kg, 8J/kg and finally 10J/kg which is the maximum. Repeat 10J/kg as needed.
The maximum time that should be spent checking for a pulse is 10 seconds.
In children 1 year and under, check a brachial pulse.
When using an AED, if pediatric pads are not available, you may use adult pads. For a child, place them in the same place you would an adult. If it is an infant, always place one pad in the center of the chest, and one on the back directly behind the one on the chest.
As soon as an AED arrives, use it. Be sure to turn it on FIRST.
When performing CPR alone, everyone is 30 compressions and 2 breaths regardless of age.
If the child is under puberty, and there are 2 rescuers, the ratio changes to 15:2.