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Paediatric Advanced Life Support Guide

118 CHAPTER 4 Paediatrics 4Paediatric advanced life support Defi nition Application of advanced skills to support vital organ function. Presentation Asystolic arrest, rarely VF/VT, in response to hypoxia or vagal stimulation. Cardiac arrest in children is usually secondary to hypoxia—not an acute primary event. Immediate management (See Fig. 4.4, PALS algorithm, p119.) Discontinue all vagal stimuli initial management is as BLS (see p108 and Fig. 4.2) After establishing CPR and calling for help, assess rhythm using cardiac monitor/defi brillator: infants may need pads or paddles front and back of chest child pads should be placed just below the right clavicle and in left axillary line Rhythm is often ‘non-shockable’ (PEA/asystole) but may be ‘shockable’ (VF/pulselessVT). Non-shockable (PEA/asystole): drugs should be given IV/IO rather than by tracheal route adrenaline 10 μg/kg IV/IO (0.1 mL/kg of 1 in 10 000) or 100 μg/kg via ETT (0.1 mL/kg of 1 in 1000) repeat cycles of 10 μg/kg adrenaline/3–5 min CPR Shockable (VF/pulseless VT): give one defi brillatory shock (4 J/kg) resume CPR immediately for 2 min without reassessing rhythm or feeling for a pulse then pause briefl y to check the monitor if still in VF/VT give a second shock (4 J/kg) and resume CPR immediately repeat cycles of defi brillation, CPR, and 10 μg/kg adrenaline every 3–5 min a standard AED may be used for children >8 yr (and if no other defi b available >1 yr) no evidence for or against AED use in <1yr. During CPR—consider reversible causes: hypoxia hypovolaemia hypo/hyperkalaemia hypothermia tension pneumothorax tamponade toxic/drug ingestion thromboemboli • • • • • • • • • • • • • • • • • • • • • •118 CHAPTER 4 Paediatrics 4Paediatric advanced life support Defi nition Application of advanced skills to support vital organ function. Presentation Asystolic arrest, rarely VF/VT, in response to hypoxia or vagal stimulation. Cardiac arrest in children is usually secondary to hypoxia—not an acute primary event. Immediate management (See Fig. 4.4, PALS algorithm, p119.) Discontinue all vagal stimuli initial management is as BLS (see p108 and Fig. 4.2) After establishing CPR and calling for help, assess rhythm using cardiac monitor/defi brillator: infants may need pads or paddles front and back of chest child pads should be placed just below the right clavicle and in left axillary line Rhythm is often ‘non-shockable’ (PEA/asystole) but may be ‘shockable’ (VF/pulselessVT). Non-shockable (PEA/asystole): drugs should be given IV/IO rather than by tracheal route adrenaline 10 μg/kg IV/IO (0.1 mL/kg of 1 in 10 000) or 100 μg/kg via ETT (0.1 mL/kg of 1 in 1000) repeat cycles of 10 μg/kg adrenaline/3–5 min CPR Shockable (VF/pulseless VT): give one defi brillatory shock (4 J/kg) resume CPR immediately for 2 min without reassessing rhythm or feeling for a pulse then pause briefl y to check the monitor if still in VF/VT give a second shock (4 J/kg) and resume CPR immediately repeat cycles of defi brillation, CPR, and 10 μg/kg adrenaline every 3–5 min a standard AED may be used for children >8 yr (and if no other defi b available >1 yr) no evidence for or against AED use in <1yr. During CPR—consider reversible causes: hypoxia hypovolaemia hypo/hyperkalaemia hypothermia tension pneumothorax tamponade toxic/drug ingestion thromboemboli • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

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4 views2 pages

Paediatric Advanced Life Support Guide

118 CHAPTER 4 Paediatrics 4Paediatric advanced life support Defi nition Application of advanced skills to support vital organ function. Presentation Asystolic arrest, rarely VF/VT, in response to hypoxia or vagal stimulation. Cardiac arrest in children is usually secondary to hypoxia—not an acute primary event. Immediate management (See Fig. 4.4, PALS algorithm, p119.) Discontinue all vagal stimuli initial management is as BLS (see p108 and Fig. 4.2) After establishing CPR and calling for help, assess rhythm using cardiac monitor/defi brillator: infants may need pads or paddles front and back of chest child pads should be placed just below the right clavicle and in left axillary line Rhythm is often ‘non-shockable’ (PEA/asystole) but may be ‘shockable’ (VF/pulselessVT). Non-shockable (PEA/asystole): drugs should be given IV/IO rather than by tracheal route adrenaline 10 μg/kg IV/IO (0.1 mL/kg of 1 in 10 000) or 100 μg/kg via ETT (0.1 mL/kg of 1 in 1000) repeat cycles of 10 μg/kg adrenaline/3–5 min CPR Shockable (VF/pulseless VT): give one defi brillatory shock (4 J/kg) resume CPR immediately for 2 min without reassessing rhythm or feeling for a pulse then pause briefl y to check the monitor if still in VF/VT give a second shock (4 J/kg) and resume CPR immediately repeat cycles of defi brillation, CPR, and 10 μg/kg adrenaline every 3–5 min a standard AED may be used for children >8 yr (and if no other defi b available >1 yr) no evidence for or against AED use in <1yr. During CPR—consider reversible causes: hypoxia hypovolaemia hypo/hyperkalaemia hypothermia tension pneumothorax tamponade toxic/drug ingestion thromboemboli • • • • • • • • • • • • • • • • • • • • • •118 CHAPTER 4 Paediatrics 4Paediatric advanced life support Defi nition Application of advanced skills to support vital organ function. Presentation Asystolic arrest, rarely VF/VT, in response to hypoxia or vagal stimulation. Cardiac arrest in children is usually secondary to hypoxia—not an acute primary event. Immediate management (See Fig. 4.4, PALS algorithm, p119.) Discontinue all vagal stimuli initial management is as BLS (see p108 and Fig. 4.2) After establishing CPR and calling for help, assess rhythm using cardiac monitor/defi brillator: infants may need pads or paddles front and back of chest child pads should be placed just below the right clavicle and in left axillary line Rhythm is often ‘non-shockable’ (PEA/asystole) but may be ‘shockable’ (VF/pulselessVT). Non-shockable (PEA/asystole): drugs should be given IV/IO rather than by tracheal route adrenaline 10 μg/kg IV/IO (0.1 mL/kg of 1 in 10 000) or 100 μg/kg via ETT (0.1 mL/kg of 1 in 1000) repeat cycles of 10 μg/kg adrenaline/3–5 min CPR Shockable (VF/pulseless VT): give one defi brillatory shock (4 J/kg) resume CPR immediately for 2 min without reassessing rhythm or feeling for a pulse then pause briefl y to check the monitor if still in VF/VT give a second shock (4 J/kg) and resume CPR immediately repeat cycles of defi brillation, CPR, and 10 μg/kg adrenaline every 3–5 min a standard AED may be used for children >8 yr (and if no other defi b available >1 yr) no evidence for or against AED use in <1yr. During CPR—consider reversible causes: hypoxia hypovolaemia hypo/hyperkalaemia hypothermia tension pneumothorax tamponade toxic/drug ingestion thromboemboli • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

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118 CHAPTER 4 Paediatrics

4Paediatric advanced life support


Defi nition
Application of advanced skills to support vital organ function.
Presentation
Asystolic arrest, rarely VF/VT, in response to hypoxia or vagal stimulation.
Cardiac arrest in children is usually secondary to hypoxianot an acute
primary event.
Immediate management
(See Fig. 4.4, PALS algorithm, p119.)
Discontinue all vagal stimuli
initial management is as BLS (see p108 and Fig. 4.2)
After establishing CPR and calling for help, assess rhythm using
cardiac monitor/defi brillator:
infants may need pads or paddles front and back of chest
child pads should be placed just below the right clavicle and in left
axillary line
Rhythm is often non-shockable (PEA/asystole) but may be
shockable (VF/pulselessVT).
Non-shockable (PEA/asystole):
drugs should be given IV/IO rather than by tracheal route
adrenaline 10 g/kg IV/IO (0.1 mL/kg of 1 in 10 000) or 100 g/kg
via ETT (0.1 mL/kg of 1 in 1000)
repeat cycles of 10 g/kg adrenaline/35 min CPR
Shockable (VF/pulseless VT):
give one defi brillatory shock (4 J/kg)
resume CPR immediately for 2 min without reassessing rhythm or
feeling for a pulse
then pause briefl y to check the monitor
if still in VF/VT give a second shock (4 J/kg) and resume CPR
immediately
repeat cycles of defi brillation, CPR, and 10 g/kg adrenaline every
35 min
a standard AED may be used for children >8 yr (and if no other
defi b available >1 yr)
no evidence for or against AED use in <1yr.
During CPRconsider reversible causes:
hypoxia
hypovolaemia
hypo/hyperkalaemia
hypothermia
tension pneumothorax
tamponade
toxic/drug ingestion
thromboemboli

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