Presentation on theme: "Pediatric Advanced Life Support"— Presentation transcript:
1 Pediatric Advanced Life Support Jan Bazner-ChandlerCPNP, CNS, MSN, RN
2 American Heart Association Pediatric Advanced Life SupportGuidelines first published in 1997Revisions made in 2005
3 Students Nurse Concerns You will need to learn the basics as outlined in the PALS 2005 GuidelinesAHA guidelines are expected standards of a practicing pediatric nurse.You will need to know basic CPR guidelines and have a current CPR card prior to starting the clinical rotation.
4 Cardiopulmonary Arrest In most infants and small children respiratory arrest precedes cardiac arrest.
5 Causes of Cardiac Arrest in Children Bronchospasm / respiratory infectionBurnsDrowningDysrhythmiasForeign Body AspirationGastroenteritis (vomiting and diarrhea)SepsisSeizuresTrauma
6 Pediatric Cardiac Arrest Pediatric cardiopulmonary arrest results when respiratory failure or shock is not identified and treated in the early stages.Early recognition and intervention prevents deterioration to cardiopulmonary arrest and probable death.
7 Cardiac Arrest Pediatric cardiac arrest is: Uncommon Rarely sudden cardiac arrest caused by primary cardiac arrhythmias.Most often asphyxial, resulting from the progression of respiratory failure or shock or both.
9 Respiratory ArrestEarly recognition and intervention prevents deterioration to cardiopulmonary arrest and probable death.Only 10% of children who progress to cardiopulmonary arrest are successfully resuscitated.
10 Respiratory FailureA respiratory rate of less than 10 or greater than 60 is an ominous sign of impending respiratory failure in children.
11 Assessment30 second rapid cardiopulmonary assessment is structured around ABC’s.AirwayBreathingCirculation
12 BreathingBreathing is assessed to determine the child’s ability to oxygenate.Assessment:Respiratory rateRespiratory effortBreath soundsSkin color
13 Airway Airway must be clear and patent for successful ventilation. PositionSuctionAdministration of oxygenBag-mask ventilation
17 Endotracheal Tube Intubation New guidelines:Secondary confirmation of tracheal tube placement.Use of end-tidal carbon dioxide monitor or colorimetric device
18 Circulation Circulation reflects perfusion. Shock is a physiologic state where delivery of oxygen and substrates are inadequate to meet tissue metabolic needs.
19 Circulation Assessment Heart rate (most accurate assessment)Blood pressureEnd organ profusionUrine output (1-2 mL / kg / hour)Muscle toneLevel of consciousness
20 Circulatory Assessment Heart rate is the most sensitive parameter for determining perfusion and oxygenation in children.Heart rate needs to be at least 60 beats per minute to provide adequate perfusion.Heart rate greater than 140 beats per minute at rest needs to be evaluated.
21 Blood Pressure25% of blood volume must be lost before a drop in blood pressure occurs.Minimal changes in blood pressure in children may indicate shock.
22 Vascular Access – New Guidelines New guidelines: in children who are six years or younger after 90 seconds or 3 attempts at peripheral intravenous access – Intraosseous vascular access in the proximal tibia or distal femur should be initiated.
26 IV Solutions Crystalloid solution Normal saline 20ml/kg bolus over 20 minutesLactated ringers
27 Gastric Decompression Gastric decompression with a nasogastric or oral gastric tube is necessary to ensure maximum ventilation.Air trapped in stomach can put pressure on the diaphragm impeding adequate ventilation.Undigested food can lead to aspiration.
28 Accurate OutputInsert foleyOutput 1-2 mL / kg / hour
29 Cardiopulmonary Failure Child’s response to ventilation and oxygenation guides further interventions.
30 Arrhythmias Bradycardia Pulseless Arrest – ventricular fibrillation Asystole – no pulseTachycardia with poor perfusionTachycardia with adequate perfusion
31 Bradycardia The most common dysrhythmia in the pediatric population. Etiology is usually hypoxemiaInitial management: ventilation and oxygenation.If this does not work IV or IO epinephrine 0.1 mg / kg
32 Pulseless Arrest – Asystole ABC: Start CPRGive oxygen when availableAttach monitor / defibrillatorCheck rhythm / check pulseIf asystole give epinephrine 0.01 mg / kg of 1:10,000Resume CPR may repeat every 3-5 minutes until shockable rhythm is seen
33 AsystoleNo RhythmNo rateNo P waveNo QRS comples
34 Pulseless Arrest – VF and Pulseless VT ABCs: start CPRGive oxygen as soon as availableAttach monitor / defibrillatorCheck rhythm: VF / VTGive one shock at 2 J/kgIf still VF / VTGive 1 shock at 4 J/kgGive Epinephrine 0.01 mg/kg of 1:10,000
43 EpinephrineAction: increase heart rate, peripheral vascular resistance and cardiac output; during CPR increase myocardial and cerebral blood flow.Dosing: 0.01 mg / kg 1: 10,0000
44 Amiodarone Used in atrial and ventricular antiarrhythmic Action: slows AV nodal and ventricular conduction, increase the QT interval and may cause vasodilation.Dosing: IV/IO: 5 mg / kg bolus
45 Adenosine Drug of choice of symptomatic SVT Action: blocks AV node conduction for a few seconds to interrupt AV node re-entryDosingFirst dose: 0.1 mg/kg max 6 mgSecond dose: 0.2 mg/kg max 12 mg
46 Glucose 10% to 25% strength Action: increases glucose in hypoglycemia Dosing: 0.5 – 1 g/kg
47 Naloxone Opiate antagonist Action: reverses respiratory depression effects of narcoticsDosing: IV/IO0.1 mg/kg < 5 years0.2 mg/kg > 5 years
48 Sodium bicarbonate pH buffer for prolonged arrest, hyperkalemia Action: increases blood pH helping to correct metabolic acidosis
49 Dobutamine Synthetic catecholamine Action: increases force of contraction and heart rate; causes mild peripheral dilation; may be used to treat shockDosing: IV/IO: 2-20 mcg/kg/min infusion
50 Dopamine Catecholamine May be used to treat shock; effects are dose dependentIncreases force of contraction and cardiac output, increases peripheral vascular resistance, BP and cardiac outputDosing: IV/IO infusion: 2-20 mcg/kg/min
51 Defibrillator Guidelines AHA recommends that automatic external defibrillation be use in children with sudden collapse or presumed cardiac arrest who are older than 8 years of age or more than 25 kg and are 50 inches long.Electrical energy is delivered by a fixed amount range 150 to 200. (2-4J/kg)
52 Post-resuscitation Care Re-assessment of status is ongoing.Laboratory and radiologic information is obtained.Etiology of respiratory failure or shock is determined.Transfer to facility where child can get maximum care.