Pediatric Advanced Life Support
I. Cardiopulmonary assessment A. Airway (A) assessment. The airway should be assessed and cleared.
B. Breathing (B) assessment determines the respiratory rate, respiratory effort, breath sounds (air entry) and skin color. A respiratory rate of less than 10 breaths per minute or greater than 60 breaths per minute is a sign of impending respiratory failure.
C. Circulation ©) assessment should quantify the heart rate and pulse. Ininfants, chest compressions should be initiated if the heart rate is less than 80 beats per minute (bpm). In children, chest compressions should be initiated if the heart rate is less than 60 bpm.
II. Respiratory failure
A. An open airway should be established. Bag-valvemask ventilation should be initiated if the respiratory rate is less than 10 breaths per minute. Intubation is necessary if prolonged ventilation is required. Matching the endotracheal tube to the size of the nares or fifth finger provides an estimate of tube size.
B. Vascular access should be obtained. Gastric decompression with a nasogastric or oral gastric tube is necessary in endotracheally intubated children and in children receiving bag-valve-mask ventilation.
III. Shock
A. If the child is in shock, oxygen administration and monitoring are followed by initiation of vascular access. Crystalloid (normal saline or lactated Ringer’s) solutions are used for rapid intravenous fluid boluses of 20 mL/kg over less than 20 minutes until the shock is resolved.
B. Shock secondary to traumatic blood loss may require blood replacement if perfusion parameters have not normalized after a total of 40 to 60 mL/kg of crystalloid has been administered.
C. Children in septic shock and cardiogenic shock should initially receive crystalloid solution (boluses of 20 mL/kg). Epinephrine should be considered if septic or cardiogenic shock persists after intravenous volume has been repleted (repletion requires 40 to 60 mL/kg of crystalloid).
IV. Cardiopulmonary failure A. Oxygen is delivered at a concentration of 100%. B. Intubation is completed. If signs of shock persist, crystalloid replacement is initiated with boluses of 20 mL/kg over less than 20 minutes. Inotropic agents are added if indicated.
0 comments:
Post a Comment