Pediatric Advanced Life Support
* * 2007 * *

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Algorithm Guide

Here is a basic guide for the PALS algorithms. AHA guidelines are subject to frequent change. Kids are pretty easy, because most of the problems you will encounter are respiratory or fluid issues, not cardiac in origin.

Also, what do kids need more than anything . . . . AIR ! ! !

Respiratory Arrest with a Pulse

• Assess Airway, Breathing, and Circulation status
• Oxygenate, with BVM at first, then intubate when able.
• Determine cardiac rhythm with monitor, and establish an IV
• Look for cause.

VF/ Pulseless VT

• Assess Airway, Breathing, and Circulation status
  
  
• CPR,(Push hard, push fast)
  
  
• ET intubation, establish IV access, Monitor
• Electrical Intervention...
• Parmacologic intervention

  • Initiate CPR (Push hard, push fast)
    
    
  • Defib level-2J/KG ("CLEAR ! ! " before each shock)
    
    
  • Re-initiate CPR (Push hard, push fast)
    
    
  • Increase joule setting to4J/Kg, then repeat defibrillation if still unsuccessful
    
    
  • Re-initiate CPR (Push hard, push fast)
    
    
  • Check rhythm. If still in V-Fib, administer medication.
    
    
  • Epinephrine (1:10,000) 0.01 mg/kg IV, may repeat every 3-5 minutes
    
    
  • Repeat defibrillation if still unsuccessful
    
    
  • Re-initiate CPR (Push hard, push fast)
    
    
  • Check rhythm. If still in V-Fib, administer medication.
  • Amiodarone 5 mg/kg IV bolus, or
  • Lidocaine 1 mg/kg (as 75-100 mg) IV, or
  • Magnesium 25-50 mg/kg IV (for Torsades de Pointes)
    
    
  • May consider other therapies like
  • Vasopressors, Antiarrythmics, or buffers.
    
    
  • Repeat defibrillation if still unsuccessful

Bradycardia

• Assess Airway, Breathing, and Circulation status
• Oxygenate, determine cardiac rhythm with monitor, and establish an IV
• Assess for causes such as hypoglycemia, hypoxia, hypothermia, hypovolemia, etc.
  
  
• If inadequate perfusion, begin C.P.R.
• Parmacologic/Electrical Intervention

  
  

  Epinephrine 0.01mg/kg (1:10,000)IV/IO, repeated every 3-5 minutes
  

  Continue C.P.R.

  Atropine 0.02mg kg IV, with a minimal dose of 0.1mg.
  The max dose for a child is 0.5mg and for an adolescent, 1mg
  
  

  Consider transcutaneous pacing

Supraventricular Tachycardia (stable)

• Assess Airway, Breathing, and Circulation status
  
  
• Oxygenate, determine cardiac rhythm with monitor, and establish an IV
  
  
• Infant rates ususally > 220 bpm, children > 180.
  
  
• Vagal Maneuvers
  
  
• Adenosine- 0.1mg/kg rapid IV push then double if no change (Max first dose 6mg)
  
  
• If poor perfusion continues, consider sedation if possible and time warrants, then . . . . . . .
  
  
• Cardioversion with .5 to 1.0 joules/kg (may increase to 2 j/kg consecutively)

Supraventricular Tachycardia (unstable)

• Assess Airway, Breathing, and Circulation status
• Oxygenate, determine cardiac rhythm with monitor, and establish an IV
• Consider sedation meds such as:

  Valium

  OR

  Versed

• Immediate cardioversion at 0.5 to 1.0 joules/kg (may increase to 2 j/kg consecutively)

Ventricular Tachycardia- Stable

• Assess Airway, Breathing, and Circulation status
• Oxygenate, determine cardiac rhythm with monitor, and establish an IV
• Assess for cause rapidly !
• Pharmacologic Intervention

  
  
  • If unstable hemodynamically, premedicate with sedatives and go directly to
    
    
  • synchronized cardioversion at 0.5 -1.0 joules/kg.
    
    
  • Amiodarone 5 mg/kg IV bolus over 20-60 minutes or
  • Procainamide15 mg/kg IV bouls over 30-60 minutes or
  • Lidocaine 1 mg/kg IV bolus.
    
    
  • Wide complex tachycardia VT vs SVT of uncertain etiology treat it as VT, & IV Procainamide is the drug of choice, &  
    
    ** IV Verapamil is contraindicated !

Pulseless Electrical Activity

• This is more common in children
• Assess Airway, Breathing, and Circulation status
  
  
• Assess for Causes like hypovolemia, hypoglycemia, acidosis, hypoxia, etc.
  
• Begin CPR . . push hard and fast
• AdministerEpinephrine
  • If venous or intraosseous access give 10 mcg/kg (0.1 ml/kg)(1:10,000)
• Continue CPR . . push hard and fast
  
  
• Repeat the administration of Epinephrine
  • Administer 10 mcg/kg(0.1 ml/kg) (1:10,000)
    
    
  • Consider the use of other medications such as alkalising agents, and treat reversible causes such as hypolvolaemia.

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  Asystole

  
  • Assess Airway, Breathing, and Circulation status
  • Oxygenate, with BVM at first, then intubate when able.
    
  • Assess for Causes like hypovolemia, hypoglycemia, acidosis, hypoxia, etc.
    
  • Begin CPR . . push hard and fast
    
  • Monitor and confirm rythm in two leads.
    
  • Establish IV access or IO
    
  • Pharmacologic Intervention
    
  • Epinephrine0.01mg/kg (1:10,000)IV/IO
    
  • Continue CPR . . push hard and fast
  • Epinephrine0.1 mg/kg (1:1,000)IV/IO, repeated every 3-5 minutes

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