PALS

Normal HR

• newborn to 3 mo: 85-205 bpm
• 3 mo to 2 years: 100-190 bpm
• 2-10 yo: 60-140 bpm
• > 10 yo: 60-100 bpm

Ventricular Tachycardia / Ventricular Fibrillation

• 1.) Start CPR (give 02, attach monitor/defibrillator)
  • – shock the patient
• 2. CPR for 2 min
  • a. Get IV/IO access
• 3. Is rhythm shockable?
  • – YES = SHOCK given;
  • – CPR for 2 min
  • – Administer Epinephrine 0.01mg/kg every 3-5 min; consider advanced airway
• 4. Is rhythm shockable?
  • – YES → Shock
  • – Amiodarone 5 mg/kg bolus
  • – treat reversible causes
  • – if shockable again, give 2nd Epi
• Pulse and VT:
  • 1. Adenosine 0.1 mg/kg
    = push
    
  • – if that doesn’t help, synch cardiovert
    
  • 2. Amiodarone 5 mg/kg over 20 min to 1 hour

Shock amount for defibrillation

• – 1st shock = 2 J/kg
  
• – 2nd shock = 4 J/kg
  
• – Subsequent shocks ≥ 4 J/kg
  
• – Maximum = 10 J/kg or adult dose

Cardioversion J vs Defibrillation J

• Cardioversion: 0.5-1 J/kg
  
  • synchronized cardioversion for:
    • – Unstable SVT
      
    • – VT with pulses
      
    • – Afib
      
    • – Aflutter
• Defibrillation: 2-4 J/kg

ET tube size

• 16 + age / 4

Oxygen

• High flow O2 is considered:
  • > 10 mL, O2 flow exceeds the patient inspiratory flow
    
  • – i.e. nonbreathing mask with reservoir
• Low flow O2 is considered:
  • < 10 L/min
    
  • – patient inspiratory flow exceeds O2 flow
    
  • – Ie nasal cannula, simple O2 mask

Asystole / PEA

• 1. CPR for 2 min (IO/IV access)
  • – Epi every 3-5 minutes
  • – Consider advanced airway
• 2. Shockable rhythm?
  • – Yes –> Shock + CPR
  • – No –> CPR for 2 min and treat reversible causes
• 3. Shockable rhythm?
  • – if asysotle/PEA continue CPR
  • – Organized rhythm, check pulse
  • – ROSC: pulse present, post cardiac arrest care

SVT

• HR for SVT in::
  • – Infant: 220 bpm+
    
  • – Adults: 150 bpm +
    
  • – Kids: 180+
• Tx:
  • ONLY way to tell: Symptomatic and…
    
  • BP
    
    • – 1 mo – 1 yo = at least 70
      
    • – 1 yr – 10 yr = 70+age x 2
      
    • – birth – 1 mo = 60 sys
      
  • Adenosine 0.1 mg/kg, (max dose of 6 mg)
    
    • – 2nd dose: 0.2 mg/kg IV (max dose of 12 mg)

OPA vs NPA

• a. OPA (oropharyngeal airway) = only for the unconscious victim without gag reflex
  
• b. NPA (nasopharyngeal airway) = for conscious or semiconscious victim

Hypovolemic shock

• Tx:
  • 20 ml/kg bolus of NS
    
  • 1. Give based on look of child:
    
    • – If no BP = push as fast as possible
      
    • – If BP still ok = push over 10 minutes

Cardiogenic shock

• Def:
  • A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions.
• Tx:
  • 20 ml/kg bolus of NS
    
  • – give based on look of child
    
  • – If no BP = push as fast as possible
    
  • – If BP is still good –> push over 10 min

Distributive shock

• A condition that occurs when there is widespread dilation of the small arterioles, small venules, or both.
• Types:
  • a. Sepsis
    
  • b. Neurogenic
    
  • c. Allergic

Obstructive shock

• Shock that occurs when there is a block to blood flow in the heart or great vessels, causing the insufficient blood supply to the body’s tissues.
• Types:
  • i. Tamponade
    
  • ii. Pneumothorax
    
  • iii. PE
    
  • iv. Ductal dependent lesion (ie PDA won’t close)

Compensated shock

• when the patient is developing shock but the body is still able to maintain perfusion
• Signs:
  • a. Tachycardia
    
  • b. Increased RR
    
  • c. Altered mental status
    
  • d. Change in pulses
    
  • e. Prolonged capillary refill
    
  • f. Skin color changes
    
  • g. Skin temperature

Anaphylaxis treatment

• IM epi (auto injector)
  
• Albuterol
  
• Antihistamines
  
• Corticosteroids

Asthma treatment

• Albuterol +/- ipratropium
  
• Corticosteroids
  
• SC epi
  
• Mg Sulfate
  
• Terbutaline

Bronchiolitis treatment

• Nasal suctioning
  
• Bronchodilator trial

Croup treatment

• Nebulized epi
  
• Corticosteroids

Pulmonary edema with ARDS treatment

• – Noninvasive OR invasive ventilatory support w/ PEEP
  
• – Consider vasoactive support
  
• – Consider diuretic