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Pediatric Advanced Life Support (PALS) Science Update 2015

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What’s New in PALS for 2015?

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Child and Infant CPR • CPR remains ____________________________________________ (Compressions, Airway, Breathing • Chest compression rate change from “at least 100” to ____________________________________________ to 120 • Recognizes that CPR can be initiated while calling 911 via a cell phone • Emphasizes checking a pulse while simultaneously checking for breathing • ___________ seconds or less

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Child and Infant CPR • Continues to emphasize the importance of high quality chest compression with limited interruptions (< 10 seconds) • Now has separate algorithms for single and multiple rescuers • Pulse sites • Infant: ____________________________________________ • Pedi: ____________________________________________

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Child and Infant CPR • ________________ ratio for single rescuer • ________________ ratio for 2 rescuers • For infant, use 2 hands encircling technique • 3:1 Compression to ventilation remains for neonates • Utilize AED as soon as it arrives (no 2 minutes of CPR first) • If pediatric pads unavailable, use ____________________________________________ pads

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Child and Infant CPR • Allow full chest ____________________________________________ after each compression • If alone with no help available, perform ____________ minutes of CPR before leaving patient to call for help

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Post Resuscitation • Following ROSC in children, O2 sats should be maintained between ____________ and ____________ % • NOT ____________ % • Obtain by adjusting oxygen flow

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PALS Review

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Defibrillation Settings • ____________________________________________ J/Kg for initial setting • Rounded to closest appropriate setting • At least ___________J/kg for second and all subsequent settings.

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Initial Impression Done simply by observation when approaching the patient:

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• Look for: • ____________________________________________ • ____________________________________________ • Color 11

Evaluate/Identify/Intervene • Sequence used when caring for a seriously sick or injured child • Evaluate: ____________________________________________ assessment, secondary assessment, diagnostic tests • Identify: cause, condition, ____________________________________________ threats • Intervene: ____________________________________________ according to findings

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Primary Assessment (ABCDE’s) • A: Airway: • Open and clear, lung sounds • B: Breathing: • rate, effort, ____________________________________________ • C: Circulation: • rate and ____________________________________________ , capillary refill, skin color and temperature

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Primary Assessment (ABCDE’s) • D: ____________________________________________ • Quick evaluation of neurological function: LOC (AVPU), muscle tone, seizures, pupils • E: ____________________________________________ • Remove clothing if indicated • Observe for exposures to toxins (rashes, whelps, etc

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Secondary Assessment • Focused ____________________________________________ (SAMPLE) • Focused ____________________________________________ exam • Diagnostic tests • EKG, Bgl, O2 sats, etc

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Pulse Oximetry in Pediatrics • A child may be in respiratory distress despite ____________________________________________ pulse ox readings • If the pulse oximeter does NOT match the pulse rate, the reading is ____________________________________________ and oxygen should be applied • Falling and/or low pulse ox reading, despite supplemental oxygen, can indicate progression into respiratory ____________________________________________

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Respiratory Emergencies Classifications • Respiratory Distress: ____________________________________________ oxygenation and/or ventilation • Normal or ____________________________________________ heart rate • Respiratory Failure: ____________________________________________ oxygenation and/or ventilation

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• ____________________________________________ heart rate • Low O2 sat readings despite supplemental O2 • Respiratory Arrest: decreasing to ceasing of heart rate 17

Respiratory Emergencies • Nebulized (Racemic) Epinephrine is the drug of choice for croup • Croup causes ____________________________________________ respiratory obstruction • Croup is characterized by stridor and characteristic cough • Seizures can disrupt respirations by causing ____________________________________________ control of breathing • Respiratory distress caused by lung tissue disease is most likely to produce ____________________________________________

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Respiratory Emergencies • Lung tissue disease can lead to ____________________________________________ oxygen saturation • Grunting and retractions indicate a need for immediate intervention • ____________________________________________ indicates need to reposition head and insert airway adjunct (OPA or NPA) • Upper airway obstruction • Inspiratory ____________________________________________ is very common • Increased inspiratory effort

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Respiratory Emergencies • In pediatrics, with prolonged expiratory time, the obstruction and wheezing is normally in the ____________________________________________ airways • The shorter the expiratory time, the higher the obstruction • Most allergic reactions result in ____________________________________________ airway obstruction

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Artificial Ventilations • Ventilate perfusing pediatrics at a rate of ___________-____________ per minute • Do NOT ____________________________________________

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Suctioning When suctioning a patient, watch for: • O2 Sat readings to ____________________________________________ • Falling heart rate • If either of these occur, administer ____________________________________________ and ensure adequate ventilation • If either does not return to normal, ventilate the patient with supplemental oxygen

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IV Fluids • Fluid resuscitation is normally with an isotonic crystalloid (LR or NS) • Neonates (