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An Overview 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 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. 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. Rhythm Disturbances I. Parts of the defibrillator 1. Power button 2. Energy selector 3. Paddles 4. Charge button (machine & paddles) 5. Shock button (machine & paddles) 6. Sync Rhythm Disturbances II. Identifying rhythm Non-shockable Asystole PEA Rhythm Disturbances II. Identifying rhythm Shockable Rhythm (1) Defibrillate: Ventricular Tachycardia Ventricular Fibrillation 2 to 4 J/kg Rhythm Disturbances II. Identifying Rhythm Shockable Rhythm (2) Synchronized Cardioversion: Supraventricular Tachycardia 0.5 to 1 J/kg 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 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 Osteogenesis imperfecta 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 Team Dynamics Role Responsibilities Team Leader Directs the resuscitation Monitors performance of tasks Models excellent team behavior Airway Checks O2 setup Administer oxygen Inserts OPA or NPA Performs BMV Inserts NG / OG tube Prepares / performs ET intubation IV / IO Gains IV / IO access Prepares drugs & fluids Administers drugs & fluids Compressor Performs chest compression If chest compressions are not needed during a case, team member may obtain equipment, fluids and drugs or assist the observer Monitor / defibrillator Establishes ECG monitoring, checks pulse, operates monitor/defibrillator Observer / recorder Monitors performance of the team 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. Pediatric Assessment General Assessment Primary Assessment Secondary Assessment Tertiary Assessment Pediatric Assessment General Assessment Primary Assessment Secondary Assessment Tertiary Assessment General Assessment Pediatric Assessment Triangle (PAT) Appearance Work of Breathing Circulation General Assessment Appearance Muscle tone Interaction Consolability Look / gaze Speech / cry General Assessment Work of Breathing Increased work of breathing nasal flaring retractions Decreased or absent respiratory effort Abnormal sounds wheezing grunting stridor General Assessment Circulation Abnormal skin color pallor mottling Bleeding Pediatric Assessment General Assessment Primary Assessment Secondary Assessment Tertiary Assessment Primary Assessment Airway Breathing Exposure Circulation Disability 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 Primary Assessment Breathing Respiratory rate respiratory effort Tidal volume Airway and lung sounds Pulse oximetry Primary Assessment Circulation Assess cardiovascular function by: Skin color and temperature Heart rate Heart rhythm Blood pressure Pulses (peripheral and central) Capillary refill time Primary Assessment Circulation Assess end-organ function by: Brain perfusion (mental status) Skin perfusion Renal perfusion (urine output) Primary Assessment Disability AVPU Pediatric Response Scale Glasgow Coma Scale (GCS) Pupillary response to light Primary Assessment Exposure Rash Temperature Evidence of trauma Pediatric Assessment General Assessment Primary Assessment Secondary Assessment Tertiary Assessment Secondary Assessment Signs & Symptoms Events Last Food/Fluid intake Allergy Medications Past Medical History Secondary Assessment Signs & Symptoms Breathing difficulty Fever Diarrhea, vomiting Bleeding Fatigue Time course of symptoms Secondary Assessment Allergy Medications Food Latex Secondary Assessment Medications Last dose and time Secondary Assessment Past Medical History Birth history Underlying problems Past surgeries Immunization status Secondary Assessment Last Meal Time and nature of food / drinks Secondary Assessment Events Leading to current illness Treatment during interval from onset Pediatric Assessment General Assessment Primary Assessment Secondary Assessment Tertiary Assessment Tertiary Assessment Respiratory abnormalities ABG / VBG Pulse Oximetry, CXR, PEFR Circulatory abnormalities ABG / VBG Serum lactate CVP Monitoring CXR Echocardiography