DISCLAIMER The following information is provided by the American Heart Association This is a study guide to give providers a sense of what to focus their studies on Please review and study your American Heart Association ACLS Manual before attempting to complete the AHA ACLS Course ID: 910226
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Slide1
2020 PALS Review
(941) 363-1392 www.CMRCPR.com | FL
Slide2DISCLAIMER
The following information is provided by the American Heart Association.
This is a study guide to give providers a sense of what to focus their studies on.
Please review and study your American Heart Association ACLS Manual before attempting to complete the AHA ACLS Course.
Slide3Assessment
Pediatric patient’s are easy to treat!
*Remember a crying baby is the perfect patient.
3 keys to Pediatric patient’s
-Good Assessment
-Stay Calm
-BLS before ALS
Slide4AssessmentResponsive: (ABC’s) Airway, Breathing, Circulation
Unresponsive: (CAB) Circulation, Airway, Breathing.AVPU
Slide5Basic Life SupportResponsiveness
Pulse/Breathing within 10 secondsChest CompressionsRatioRate
Depth
Recoil?
Slide6Child Basic Life Support-1 year old until puberty, defines child.
-30:2 ratio for 1 person CPR.-Use 1 or 2 hands (2 inches or 5 cm depth).
-15:2 ratio for 2 person CPR.
-Main cause of cardiac arrest in children= lack of oxygen (choking, asthma, drowning).
-Witnessed= call for help, grab AED, then CPR.
-Unwitnessed= 5 cycles of CPR, then call for help.
Slide7Infant Basic Life Support-Newborn to 1 year old.
-Check for Responsiveness?-Pulse location?
-Compression depth?
-1 person CPR= 30:2- 2 fingers, below the nipple line, lower half of the breast bone.
-2 person CPR= 15:2- encircling technique using thumbs.
-100-120 BPM.
Slide8Basic Life SupportTypically will always analyze no shock!
Use the AED as soon as it arrivesWhat if AED does not give commands?Basic sequence of using an AED
Pediatric Pads are recommended, but when in doubt use the Adult Pads.
ROSC with continuous compressions while the AED is charging.
Reassessment every 2 minutes or 5-7 cycles.
Slide9Basic Life SupportVentilation
Maintain SAO2 of 94% to 99%OPA vs NPA BVM (2 rescuer only)
BVM rate (1 breath every 3-5s = 12-20 bpm)
Slide10Advanced Life Support
Please remember to think BLS before ALS!Unresponsive, pulseless, apneic?
Unresponsive, pulses, apneic?
Unresponsive, pulses, breathing?
AMS, pulses, breathing?
ETC……………..
Know causes (H and T’s )
Slide11Advanced Life Support
Stable vs UnstableStable:Alert
No signs of respiratory distress
Normal PMS
Systolic BP of 80 or >
Skin warm/dry/normal color
Strong Central Pulses
Slide12Advanced Life SupportStable vs Unstable
Unstable:Lethargic or AMS Significant respiratory distress or failure(<94% SAO2)
Weak and Thready Central Pulses
Slow Capillary refill (>
5 seconds)
Absent Peripheral Pulses
Systolic BP of < 80
Skin cool/diaphoretic/pale color
Slide13Advanced Life SupportVentilation
Maintain SAO2 of 94%-99%Complications of 100% Oxygen post cardiac arrest?Advanced Airways
Types (IE: ET tube)
Ventilations- 1 breath every 6 seconds = 10 bpm during arrest and normal BLS rate during RSI.
Continuous compressions during arrest
Reassessment of ET tube and complications?
Slide14Advanced Life Support
VentilationNormal ETCO2 of 35-45Typically lower (10-20) during cardiac arrest. ETCO2 less than 10 is a sign of poor perfusion and decreased CPP.
ETCO2 of “0” is a failed intubation
Exhaled CO2
Slide15Pediatric Emergencies
Breathing ProblemsShockPerfusing
Rhythms
Cardiac Arrest
Slide16Breathing Problems
*Wheezing- High pitched, inspiratory orexpiratory, Asthma
• Rhonchi- Course rattling (Death Rattle)
• Rails or
Crackles
- Fine or coarse, inspiratory,
Pneumonia, CHF
•
Stridor
- High pitched, inspiratory, foreign body
• Absent- No sounds…Not moving air- BAD
• Snoring- Might need to just open airway
Slide17Breathing Problems
• Respiratory Distress: Tachypnea, NasalFlaring,
Grunting
, Intercostal Retractions, increased effort.
•
Respiratory Failure
: Lethargy, Head Bobbing,
Inadequate oxygenation and ventilation,
Bradypnea
•
Respiratory Arrest
: Get control of airway
(Intubate)
Slide18Breathing Problems
• Upper Airway Obstruction -Choking -Allergic Reaction
-Croup
-
Eppiglotitis
• Lower Airway Obstruction
-Asthma
• Lung Tissue Disease
-CF,
Pneumonia
• Disordered Control of Breathing
-
Seizures
, head injury, etc.
Slide19Breathing Problem Treatments
*Child Choking-Abdominal Thrust. aka the “Heimlich” maneuver.
-Stand/Kneel behind victim, make a fist, place thumb above belly button. With other hand, cover closed fist and thrust in upward motion until object becomes dislodged.
-If victim becomes unresponsive, CALL for help and THEN start CPR.
Slide20Breathing Problem Treatments
*Infant Choking-Place infant, face down in forearm, stabilizing head. Provide 5 back thrusts between shoulder blades.
-Place other hand over back of head, turn infant over, provide 5 chests thrusts. (Same as CPR)
-Do this until object becomes dislodged.
-If infant becomes unresponsive, begin CPR.
Slide21Breathing Problem Treatments
*Allergic Reaction-Signs and symptoms of General vs Systemic?
-General Rx
-Benadryl: 1.0 mg/kg
-Steroid: 2.0 mg/kg
-Epinephrine: IM Q 0.01 mg/kg (1:1000)
-Systemic RX
-Epinephrine: IM 0.01 mg/kg (1:1000)
-Benadryl: 1.0 mg/kg
-Steroid: 2.0 mg/kg
Slide22Breathing Problem Treatments
*Croup-Barking Cough (Stridor)
-Hoarse Voice
-Respiratory Infection (
Diptheria
)
-Gather History (
Febrile,
recent illness,
etc
)
-Treatment
-Nebulized Epinephrine
-Steroid
Slide23Breathing Problem Treatments
*Epiglottitis-
Life-Threatening
-Caused by infection, burns,
obstruction,etc
-More common in Adults?
-Fever, Sore Throat, Difficulty Swallowing, Drooling
-Affects more males than females
*Treatment
-Antibiotics
-Do not Disturb
-Keep calm and prevent agitation
Slide24Breathing Problem Treatments
*Asthma-Asthma is a LOWER AIRWAY issue
- Attach High Flow O2
Sit the patient UPRIGHT
*Treatment
-Albuterol and/or Ipratropium
-Steroid: 2 mg/kg
-Consider
Epinepherine
for severe cases: 0.01 mg/kg (1:1000) IM.
Slide25Shock
• Cardiogenic (Heart Failure, Pulmonary Edema)• Hypovolemic
(Fluid Loss)
• Obstructive (PE, Tamponade,
Pneumo
)
•
Distributive/Septic
(Infection, Anaphylaxis)
Slide26Shock
• Compensated: Normal BP/ Tachycardia• Decompensated: Hypotension
, Bradycardia
• Decompensated Usually seen at 30% fluid loss
Slide27Shock
• Gain IV/IO access (Preferred Method?)• High Flow O2• 10-20ml/kg Isotonic fluids over 5-10 minutes
• Keep warm
• HYPOTENSION IS A
LATE SIGN
OF SHOCK!
Slide28Advanced Life SupportPefusing
Rhythms:Normal Sinus Rhythm Sinus Brady
Sinus Tach
SVT
Slide29Normal Sinus Rhythm
Slide30Sinus Bradycardia
Slide31Sinus Bradycardia
*Children-Heart rate typically <50/min
-Only treatable if showing signs of poor perfusion
-
Treatment:
-
Perfusing
:
Oxygen and Fluids
-
Poor Perfusion
:
1.
Epinephrine
- 0.01 mg/kg IV (1:10000)
Slide32Sinus Bradycardia
2. Atropine- 0.02mg/kg every 3-5 min (Max of 3mg)
Derived from the Nightshade Plant (deadly)
Dilates pupils, increases heart rate
Used to treat symptomatic bradycardia only
3.
CPR
*
Infant
• Less than 60 BPM for INFANTS
• Begin CPR
• Follow infant arrest algorithm
Slide33Sinus Tachycardia
Slide34Supra Ventricular Tachycardia
(SVT)
Slide35Supra Ventricular Tachycardia
(SVT)
Firing somewhere
above
the Ventricles
Treatable when Child has a sustained HR of 180 or > BPM per ACLS
Treatable when Infant has a sustained HR of 220 or > BPM per ACLS
Regular and
FAST!
If stable perform 12-lead! Use Valsalva Maneuver First (Think BLS)
Stable= Drugs.
Adenosine
0.1
mg/kg, 0.2 mg/kg, done.
Inhibits neurotransmitters
“Resets” heart
Asystole for 3-5 seconds
Causes a transient heart block in the AV node
Slide36Supra Ventricular Tachycardia
(SVT)
Unstable= Electricity. Synchronized Cardioversion.
Initial shock of 0.5-1 J/kg followed by 2 J/kg for any subsequent shocks.
MAKE SURE YOU PUSH SYNCH BUTTON!
Slide37Cardiac Arrest
Slide38Cardiac Arrest
*Think BLS before ACLS
-Early CPR and Defibrillation
-Most Pediatric Cardiac Arrest are
Asphyxial
-Use a systematic Approach to integrate ALS Skills and medications.
-Can be categorized into two groups: Shockable and Non-Shockable.
-Shockable: V-Fib and V-Tach w/o pulses
-Non-Shockable: PEA and Asystole
(Most Common)
Slide39Slide40Ventricular Fibrillation
(V-Fib)
Slide41Ventricular Fibrillation
(V-Fib)
Won’t have a pulse
Fine or coarse
Shock-able rhythm
Start at 2 J/kg and continue with 4 J/kg or greater on subsequent shocks, not to exceed 10 J/kg.
High Quality CPR
Slide42Ventricular Fibrillation
(V-Fib)
Epinephrine- 0.01mg/kg every 3-5 minutes (no MAX)
Hormone naturally occurring in the body
Affects the Sympathetic Nervous System
Increases coronary perfusion and maintains cerebral perfusion.
Constricts blood vessels, increases peripheral resistance
Increases Heart Rate (Inotropic effects and Chronotropic effects) (contractility and rate)
Amiodarone- 5 mg/kg (15mg/kg MAX) or Lidocaine- 1mg/kg
Slide43Ventricular Tachycardia
w/o pulses
Slide44Ventricular Tachycardia
w/o Pulses
Won’t have a pulse
Fine or coarse
Shock-able rhythm
Start at 2 J/kg and continue with 4 J/kg or greater on subsequent shocks, not to exceed 10 J/kg.
High Quality CPR
Epinephrine- 0.01 mg/kg every 3-5 minutes (no MAX)
Amiodarone- 5 mg/kg, then repeat x2 or Lidocaine- 1 mg/kg
Slide45Pulseless Electrical Activity
Slide46Pulseless Electrical Activity
Organized rhythm without a pulse.
Typically resembles Normal Sinus in origin.
NON- SHOCKABLE!
Remember H and T’s
High quality CPR
Remember Respiratory and to breath for the patient!
Epinephrine, 0.01 mg/kg
P
ush
E
pi
A
lways
Slide47Asystole
(Flat line)
Slide48Asystole
(Flat line)
Heart not producing
ANY
electrical activity
NON-Shockable Rhythm
Patient is DEAD
Treatment:
High quality CPR
Epinephrine- 0.01 mg/kg (no max)
Slide49H’s and T’s
Hypovolemia
Hypoxia
Hydrogen Ions (acidosis)
Hyper/Hypo
kalemia
Hypothermia
Toxins
Tamponade (cardiac)
Tension Pneumothorax
Thrombosis (coronary)
Thrombosis (Pulmonary)
Slide50ROSC: Post Cardiac Arrest
Optimize ventilation and oxygenation
Treat Hypotension
12-lead
Labs
Slide51THE END!
THANK YOU!!!