EPALS KEY REVISION NOTES
Notes in reference to, and any quotes are from:
European Paediatric Advanced Life Support (EPALS). 5th Ed. Resuscitation Council UK. 2021. London
1
ANATOMICAL DIFFERENCES
(PAEDS VS ADULTS
Children have narrower, smaller airways, which
are more susceptible to swelling.
Airways are cylindrical shaped. Foreign bodies are
likely to be trapped in the narrowest part.
Large tongue.
2
PHYSIOLOGICAL DIFFERENCES
High HR is the main means to achieve cardiac
output, so bradycardia is serious.
Mean arterial BP is a better indicator of tissue
perfusion than systolic BP.
3 Trouble with adrenaline?
1:10,000 = 1g adrenaline in a 10,000
birth and 10kg at 1 year.
Energy (joules) = 4J x kg
WET FLAG
Weight (kg) = Age +4 x2. Use this for those above 1. For infants, they are approx 3kg at
mL solution - - but it’s presented in Tube = Age/4+4 (internal diameter)
10ml, so it’s actually 0.1mg per mL = Fluids = Multiply the kg by 10.
100mcg per mL. So a child weighing Adrenaline 1:10,000 = divide kg by 10. This gives you the mL.
18kg should have 1.8mL (divide by 10) Glucose 10% = 2ml x kg
adrenaline, which is 0.18mg (0.1mg *Made in reference to EPALS book (reference above) and [Link] (Ben Sharif).
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per mL), which is 180mcg. :)
TYPES OF SHOCK
Hypovolaemic, distributive, cardiogenic, obstructive
(e.g. tension pneumothorax/tamponade, dissociative
(anaemia/carbon monoxide poisoning).
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RESPIRATORY FAILURE
Failure of the respiratory system to maintain an arterial 02
level or c02 level on room air.
This is defined as failure of the Pa02 to be >9kpa (90%
spo2) and the Pac02 to be <6.5kpa
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WARNING SIGNS OF RESPIRATORY FAILURE. THESE ARE SIGNS
OF DECOMPENSATION.
Decreased LOC
Floppy
Reduced respiratory effort
Cyanosis
Sweating
Bradycardia
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CARDIORESPIRATORY FAILURE
Tachycardia - HR >180 before 1 year; >160 after 1
year
Decreased central pulses
Absent peripheral pulses
Bradycardia (pre-terminal) <100 newborn
BLS KEY POINTS
Head tilt to neutral in an infant; to ‘sniffing’ in a child + gradually increase to
reach effective point.
CC depth 1/3 + never more than the adult 6cm depth
2 finger technique in infants or thumb encircling technique
1 handed CC in a child (over 1 year).
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For pulses, palpate the brachial pulse in an infant, and the carotid in a child;
can also use the femoral in both age groups.
Number of ventilations: infants 25 breaths; children 20 breaths; 8-12 years old
15 breaths; over 12, 10-12 (adult number). Ask for 20-25 for young children (~1
every 3 seconds).
EPALS KEY REVISION NOTES #2
Notes in reference to, and any quotes are from:
European Paediatric Advanced Life Support (EPALS). 5th Ed. Resuscitation Council UK. 2021. London
1
CHOKING KEY TERMS
Back blows, then abdominal thrusts are chest
thrusts in an infant.
ARRTHYMIA ALGORITHM
*IN PAEDS, THERE IS ONE ALGORITHM THAT COVERS BOTH BRADYS AND TACHYS
2
Decompensated signs = reduced LOC, tachypnoea, brady/tachy, BP <5th centile, CRT >2
seconds, weak/impalpable pulses.
If decompensated + brady, oxygenate.
If HR <60 + unconscious, start chest compressions.
Give atropine if no response to oxygenation. Also indicated when increased vagal tone is the
cause of the bradycardia e.g. induced by tracheal intubation/suctioning.
If tachy + decompensated, cardiovert for SVT or VT. Give adenosine or amiodarone before
the 3rd shock.
SVT DEFINITION
3 >220min in an infant
>180 min in a child
Abrupt onset
SINUS TACHY DEFINITION
Up to 220 for an infant
Up to 180 for a child
Gradual onset
Treat the cause
4
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COMMON CAUSES OF BRADYS
Hypoxia
Vagal stimulation
Hypothermia and hypoglycemia may also be causes.
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VAGAL MANOUVRES
Consider use of a cold flannel, or the Valsalva
technique in older children.
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CROUP
Give dexamethasone up to 3 doses
Nebulised adrenaline may then also be given, 3-
5ml of 1:1000 for severe distress.
Nebulised steroids e.g. budesonide as well.
EPIGLOTTITIS
Don’t look in the throat if you suspect this.
Request senior support.
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EPALS KEY REVISION NOTES #3
Notes in reference to, and any quotes are from:
European Paediatric Advanced Life Support (EPALS). 5th Ed. Resuscitation Council UK. 2021. London
1
BACTERIAL TRACHEITIS
Common aged 3-8 years
Consider in cases of upper airway obstruction
not responding to croup management.
Give broad spectrum abx.
ASTHMA 2
ABG if decompensating
intubation if severe hypoxia, arrest, reduced LOC
Give steroids
Give an anticholinergic e.g. ipratropium
Give magnesium as a slow bolus
Give aminophylline if life-threatening
ANAPHYLAXIS
3 Always check the most up-to-
date guideline before
administrating drugs. These
doses are also on the
IM dose 100-150mcg (0.10-0.15ml) <6 months
6 months-6 years 150mcg IM
6-12 years 300mcg
12+ adult dose.
Mast cell tryptase confirms diagnosis (don’t delay treatment).
In refractory treatment, give an adrenaline infusion alongside fluid bolus. Use
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anaphylaxis 2021 algorithm. a non-glucose containing crystalloid e.g. Hartmann’s.
SIGNS OF CONGENITAL CARDIAC PROBLEMS
Murmur
Cardiac failure
Poor systemic perfusion.
5
IN SEPSIS....
Careful with fluid management
Abx within 1 hour
Consider hot/cold sepsis signs + fluid refractory shock
6
FOR SEIZURES
Lorazepam 0.1mg kg
Treat BM <3 with dextrose
*Don’t forget to check your doses in the latest
guidelines.
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IN DKA
Careful with fluid management
Dehydration degree is pH dependent.
Consider in BM >11, pH <7.3, weight loss, confusion, abdo pain,
reduced RR, polyuria, bicarb <15, ketones >3
Treat fluid deficit + correct over 48h.
HYPERKALAEMIA
Mild >5.5 asymptomatic. Give salbutamol, furosemide, calcium resonium
Moderate 6-7. asymptomatic. Give insulin/dextrose.
Severe >7, symptomatic. Give calcium gluconate, bicarb if acidosis,
hydrocortisone if adrenal insufficiency.
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EPALS KEY REVISION NOTES #4
Notes in reference to, and any quotes are from:
European Paediatric Advanced Life Support (EPALS). 5th Ed. Resuscitation Council UK. 2021. London
1
TRAUMA POINTS WORTH CONSIDERING
Decerebrate vs decorticate
Neg ultrasound examination does not rule out severe internal bleeding.
Consider 30 degree elevation. Neutral position.
MAP maintainance.
In drownings, remove horizontally.
In jaw thrust manouvres, 'opening the airway takes priority, and therefore,
some slight head extension may be necessary; very gently increase the
amount of extension until the airway is just open.'
NEWBORN LIFE SUPPORT
Dry, wrap, stimulate, warmth.
2
Assess colour, tone, breathing, HR.
No response/breathing/circulation? Open airway. 5 inflation breaths with air.
Reassess for increase in HR or chest movement. Adjust and repeat inflation
breaths if no chest movement. Once chest is moving, ventilate.
If after 30 seconds HR is less than 60 or not detectable, give 3:1 chest
compressions: ventilations with 100% 02. Consider intubation.
Reassess every 30 seconds.
Vascular access, drugs, other causes.
CUSHING’S TRIAD
3 Raised ICP
High BP
Bradycardia
Sighing respirations
4
Positioning is a later sign
6 PS
Pain
Position
Paralysis
Paresthesia
Priapism
5
Ptosis
AMPLE
Remember the old acronym:
Allergies
Medications
Past Medical Hx
Last meal
Environment (event) (history)
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PRETERM
<32 weeks
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BRONCHIOLITIS
'Admission to hospital is recommended if:
Apnoea (observed or reported)
Persistent oxygen saturation of less than 92% when breathing air
Inadequate oral fluid intake (50-75% of usual volume, taking account of
risk factors and using clinical judgement)
Severe respiratory distress [...] respiratory rate of over 70 breaths min'
TRAUMA: C-SPINE COLLARS
'There is also no proof of their added value in terms of preventing
further c-spine injury, especially if the collar does not fit well'
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'Therefore, the standard use of collars is no longer advised. Collars
might still have a place during the extrication of a severely injured child
or later in the definitive care of a child with a proven c-spine injury'; if
using check it regularly