PEDIATRIC ADVANCED LIFE SUPPORT

1. PEDIATRIC ADVANCED LIFE SUPPORT An Overview

2. Objectives: • To present the course objective of PALS • To briefly review BLS • To give an overview of Rhythm Disturbances • To review types of vascular access • To know team dynamics in resuscitation • To present the pediatric assessment overview

3. Pediatric Advanced Life Support • 2006 American Heart Association • Designed for healthcare providers who initiate and direct advanced life support beyond BLS through the stabilization or transport phases of a pediatric emergency, either in or out of hospital. • Enhance skills in the evaluation & management of an infant or child with respiratory compromise, circulatory compromise, or cardiac arrest.

4. PALS • Active participation in simulated core cases, designed to reinforce important concepts, including: • Identification & treatment medical conditions that place a child at risk for cardiac arrest • The systematic approach to pediatric assessment • The assess-categorize-decide-act approach to assessment and management of a seriously ill infant or child • PALS algorithms & flow charts • Effective resuscitation team dynamics • The goal of the PALS Provider Course is to improve the quality of care provided to seriously ill or injured children, resulting in improved outcome.

5. Rhythm Disturbances • Parts of the defibrillator 1. Power button 2. Energy selector 3. Paddles 4. Charge button (machine & paddles) 5. Shock button (machine & paddles) 6. Sync

6. Rhythm Disturbances II. Identifying rhythm Non-shockable Asystole PEA

7. Rhythm Disturbances II. Identifying rhythm Shockable Rhythm (1) Defibrillate: 2 to 4 J/kg Ventricular Tachycardia Ventricular Fibrillation

8. Rhythm Disturbances II. Identifying Rhythm Shockable Rhythm (2) Synchronized Cardioversion: 0.5 to 1 J/kg Supraventricular Tachycardia

9. Rhythm Disturbances III. Steps: 1. Identify rhythm 2. Select energy 3. Clear (1) I’m clear (2) You’re clear (3) Everybody clear (4) Oxygen away (5) Verify rhythm 4. Deliver shock

10. Vascular Access • Intravenous route • Intraosseous route • Use IO needle w/ stylet or rigid needle • Sites: anterior tibia, distal femur, medial malleolus, ASIS • For drugs and fluids • Can be established in all age groups • Can be achieved in 30 to 60 seconds • Preferred over the ET route for medications • Any drug that can be administered IV can be given through IO • Contraindications: • Fracture in extremity • Previous insertion attempt in extremity that entered the marrow space • Infection overlying bone • Osteogenesisimperfecta

11. Team Dynamics • Elements: 1. Closed-loop communication 2. Clear messages 3. Clear roles and responsibilities 4. Knowing one’s limitations 5. Knowledge sharing 6. Constructive intervention 7. Reevaluation and summarizing 8. Mutual respect

12. Team Dynamics

13. Pediatric Assessment • Objectives: • To be familiar with the systematic assessment of a seriously ill or injured child; • To review the recognition of the signs of respiratory distress, respiratory failure, and shock & to know when to refer in these instances.

14. Pediatric Assessment • General Assessment • Primary Assessment • Secondary Assessment • Tertiary Assessment

15. Pediatric Assessment • General Assessment • Primary Assessment • Secondary Assessment • Tertiary Assessment

16. General Assessment • Pediatric Assessment Triangle (PAT) Appearance Work of Breathing Circulation

17. General Assessment • Appearance • Muscle tone • Interaction • Consolability • Look / gaze • Speech / cry

18. General Assessment • Work of Breathing • Increased work of breathing • nasal flaring • retractions • Decreased or absent respiratory effort • Abnormal sounds • wheezing • grunting • stridor

19. General Assessment • Circulation • Abnormal skin color • pallor • mottling • Bleeding

20. Pediatric Assessment • General Assessment • Primary Assessment • Secondary Assessment • Tertiary Assessment

21. Primary Assessment Airway Breathing Exposure Circulation Disability

22. Primary Assessment • Airway • Look for movement of the chest or abdomen • Listen for breath sounds and air movement • Feel for the movement of air at the nose and mouth

23. Primary Assessment • Breathing • Respiratory rate • respiratory effort • Tidal volume • Airway and lung sounds • Pulse oximetry

24. Primary Assessment • Circulation • Assess cardiovascular function by: • Skin color and temperature • Heart rate • Heart rhythm • Blood pressure • Pulses (peripheral and central) • Capillary refill time

25. Primary Assessment • Circulation • Assess end-organ function by: • Brain perfusion (mental status) • Skin perfusion • Renal perfusion (urine output)

26. Primary Assessment • Disability • AVPU Pediatric Response Scale • Glasgow Coma Scale (GCS) • Pupillary response to light

27. Primary Assessment • Exposure • Rash • Temperature • Evidence of trauma

28. Pediatric Assessment • General Assessment • Primary Assessment • Secondary Assessment • Tertiary Assessment

29. Secondary Assessment Signs & Symptoms Allergy Events Medications Past Medical History Last Food/Fluid intake

30. Secondary Assessment • Signs & Symptoms • Breathing difficulty • Fever • Diarrhea, vomiting • Bleeding • Fatigue • Time course of symptoms

31. Secondary Assessment • Allergy • Medications • Food • Latex

32. Secondary Assessment • Medications • Last dose and time

33. Secondary Assessment • Past Medical History • Birth history • Underlying problems • Past surgeries • Immunization status

34. Secondary Assessment • Last Meal • Time and nature of food / drinks

35. Secondary Assessment • Events • Leading to current illness • Treatment during interval from onset

36. Pediatric Assessment • General Assessment • Primary Assessment • Secondary Assessment • Tertiary Assessment

37. Tertiary Assessment • Respiratory abnormalities • ABG / VBG • Pulse Oximetry, CXR, PEFR • Circulatory abnormalities • ABG / VBG • Serum lactate • CVP Monitoring • CXR • Echocardiography