PALS - Cardiac Arrest Flashcards
The steps in the algorithm are exactly the same between Adults (ACLS Cardiac Arrest) and Peds (PALS Cardiac Arrest). There are just different techniques and doses for chest compressions, breaths, shocks, and meds.
I will ONLY make cards about the differences! Otherwise, know it is the same as adults!
INFANT Chest compression technique: 2-finger compressions or thumb-encircling compressions?
Below is C&P’d from my INFANT chest compressions BLS card. I’m thinking that in the OR (PALS, not BLS) we’ll do Thumb Encircling Compressions since they’re more effective.
Single rescuer = 2-Finger Compression Technique:
- Two fingers center of chest, at or just below nipple line
- ≥ 1/3 the depth of the chest (~1.5 inches / 4 cm).
- single rescuer = 30:2 compression to breath ratio
Two rescuers = 2 Thumb Encircling Compression Technique:
- Thumb side by side on lower sternum
- Squeeze front and back and allow complete chest recoil
- two-person rescuer = 15:2 compression to breath ratio (30:2 for ADULTS)
CHILD (not infant) chest compression technique: one-handed or two-handed?
For most child cardiac arrest victims, the compression technique will be the same as for adults. However, for a small child, 1-handed compressions may be adequate strength to attain the correct compression depth. You can determine your hand count compression technique by ascertaining how much force will be required to compress at least 1/3 the depth of the chest (about 2 inches / 5 cm).
Peds Compression:Ventilation ratios:
- BLS (on the street) 1 rescuer
- BLS (on the street) 2 rescuer
- PALS (in the OR) NO advanced airway
- PALS (in the OR) YES advanced airway
BLS (on the street) 1 rescuer = 30:2, YES pause compressions for breaths
BLS (on the street) 2 rescuer = 15:2, YES pause compressions for breaths
PALS (in the OR) NO advanced airway = 15:2, YES pause compressions for breaths
PALS (in the OR) YES advanced airway = 20-30 breaths per min (one breath every 2-3 seconds), NO pause compressions for breath. Note this is the SAME number of breaths/min for rescue breathing during peds BLS WITH a pulse!
Endotracheal administration of drugs
Epinephrine ET dose is ten times the IV/IO dose.
ET dose is usually 2 to 3 times the IV/IO dose
To administer a drug through the ET tube, PAUSE COMPRESSIONS during instillation and follow with minimum 5mL NS FLUSH with smaller volume in neonate. Follow with 5 RAPID POSITIVE PRESSURE BREATHS.
Lipid soluble drugs work in ETT, including but not limited to:
- epinephrine
- lidocaine
- atropine
- naloxone
- vasopressin
AED Pads and energy dosing in kids
- Over 8 years old: Standard AED with adult pad-cable system.
Between 1-8 years old: AED with attenuated does if available.
Less than 1 year old: Use a a manual defibillator if available or attenuated dose if available.
Exact Shock Energy for Defibrillation
First shock 2 J/kg
Second shock 4 J/kg
Subsequent shocks ≥4 J/kg, maximum 10 J/kg or adult dose
so a 10kg baby: 20J first, 40J second, no more than 100J in a single shock
IV/IO Epinephrine dosing
IV or Intraosseous: 10mcg/kg, with a max dose 1mg (adult dose)
- repeat q3-5min on own timer just like adults
- Just like adults, start immediately if it’s a non-shockable rhythm, and start after 2nd shock if it’s a shockable rhythm
Endotracheal Epi Dosing
through ETT: 100mcg/kg (10x IV/IO dosing)
IV/IO Amio dose
5mg/kg bolus. May repeat up to 3 total doses for reractory VF/pulseless VTIV
Just like adults, starts after 3rd shock
So a 10kg baby gets 50mg, no more than 150mg total
IV/IO Lidocaine
1 mg/kg loading dose
Just like adults, starts after 3rd shock
Torsades de Pointes treatment
Magnesium 25 to 50 mg/kg IO/IV, maximum dose 2 g
The 70kg adult dose is 2g, which is 28mg/kg (2000mg/70kg = 28mg/kg), or basically 25mg/kg. So if I can’t remember the peds dose then just do the math of an average size adult getting the standard 2mg dose.
MAIN H & T you’re thinking about with children
HYPOXIA
