Many key issues in the review of the pediatric advanced life support literature resulted in refinement of existing recommendations rather than in new. Paediatric Advanced Life Support. Introduction paediatric guidelines for have been made for simplification and to minimise Guideline Changes. Complete PALS algorithms for Professionally organized Pediatric Advanced Life Support interventions and medications.
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The writing group reaffirmed the pediatric advanced life support guideline recommendation that either lidocaine or amiodarone may be. MeSH Words: Cardiopulmonary resuscitation, American Heart Association, pediatric advanced life support, neonatal advanced life support, basic life support . SOCIETY GUIDELINE LINKS · SUMMARY AND RECOMMENDATIONS (See " Pediatric basic life support for health care providers" and "Advanced cardiac life Part Pediatric Advanced Life Support: American Heart Association.
Call us at Or mail support acls. Version control: These guidelines are current until they are replaced on October This page is a free resource to the public to demonstrate these AHA algorithms. See our website terms.
Compatible part number: We now sell laminated 8. The primary assessment in pediatric patients is key. The focus is on identifying and stopping life threatening issues before they deteriorate.
This algorithm provides a step by step analysis of the pediatric patient that ensures that serious signs and symptoms do not go unnoticed. Throughout the following algorithm compressions are continuous except where noted otherwise, such as during defibrillation.
Bradycardia is almost always symptomatic in infants and pediatrics. Many times it can represent a life threatening illness or injury.
Initial trials of therapeutic hypothermia TH in adults following cardiac arrest showed improvement in survival and neurological outcome. There was a tendency toward better outcomes at the lower temperature ranges. There was no difference in the incidence of infection, bleeding, or serious arrhythmias between the two groups hence TH appears to be safe.
Following a period of mild hypothermia, rewarm the child slowly at 0. Neonatal, child and adult data show that both hyperglycaemia and hypoglycaemia are associated with poor outcome after cardiorespiratory arrest but it is uncertain if this is causative or merely an association. Closely monitor plasma glucose concentrations in any ill or injured child including after cardiorespiratory arrest.
Do not give glucose-containing fluids during CPR except for treatment of hypoglycaemia.
Hyperglycaemia and hypoglycaemia should be avoided following ROSC but tight glucose control has not shown survival benefits when compared with moderate glucose control in adults and increased the risk of hypoglycaemia in neonates, children and adults.
Many parents would want to be present during a resuscitation attempt; they can see that everything possible is being done for their child.
Reports show that being at the side of the child is comforting to the parents or carers and helps them to gain a realistic view of attempted resuscitation and death. Bereaved families who have been present in the resuscitation room show less anxiety and depression several months after the death. A dedicated staff member should be present with the parents at all times to explain the process in an empathetic and sympathetic manner. They can also ensure that the parents do not interfere with the resuscitation process or distract the resuscitation team.
If the presence of the parents is impeding the progress of the resuscitation, they should be gently asked to leave. When appropriate, physical contact with the child should be allowed.
The resuscitation team leader should decide when to stop the resuscitation; this should be expressed with sensitivity and understanding. After the event, debriefing of the team should be conducted, to express any concerns and to allow the team to reflect on their clinical practice in a supportive environment. Search our Site Keywords.
Paediatric Life Support
Guidelines and guidance Introduction Adult basic life support and automated external defibrillation Adult advanced life support Paediatric basic life support Paediatric advanced life support Resuscitation and support of transition of babies at birth Prehospital resuscitation In-hospital resuscitation Post-resuscitation care Prevention of cardiac arrest and decisions about CPR Peri-arrest arrhythmias Education and implementation of resuscitation Contributors and conflict of interest G video summaries ABCDE approach.
Membership Full membership Associate membership Apply for membership. Adult advanced life support Adult basic life support and automated external defibrillation Education and implementation of resuscitation In-hospital resuscitation Paediatric advanced life support Paediatric basic life support Peri-arrest arrhythmias Post-resuscitation care Prehospital resuscitation Prevention of cardiac arrest and decisions about CPR Resuscitation and support of transition of babies at birth.
Adult Life Support. Paediatric Life Support. Newborn Life support.
Algorithms for Pediatric Advanced Life Support 2016
Free publications. Newsletter - Issue Course publications. Associate membership Full membership. Add to My Basket. Paediatric advanced life support. Systematic reviews with grading of the quality of evidence and strength of recommendations. Summary of changes in paediatric advanced life support since the Guidelines In managing the seriously ill child: If there are no signs of septic shock, children with a febrile illness should receive fluid with caution followed by reassessment.
In some forms of septic shock, restricted fluid therapy with isotonic crystalloid may be more beneficial than the liberal use of fluids. For cardioversion of a supraventricular tachycardia SVT , the initial dose has been revised to 1 J kg In the paediatric cardiac arrest algorithm: Many of the features are common with adult practice. In post-resuscitation care: Prevent fever in children who have return of spontaneous circulation ROSC from an out-of-hospital cardiac arrest.
Targeted temperature management of children post-ROSC should comprise treatment with either normothermia or mild hypothermia. Introduction The causes of cardiorespiratory arrest in children differ from those in adults in that most paediatric arrests arise from decompensated respiratory or circulatory failure i. A irway Ac for airway and cervical spine stabilisation for the injured child.
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B reathing. C irculation with haemorrhage control in the injured child. D isability level of consciousness and neurological status. The sequence of actions in cardiopulmonary resuscitation CPR 1.
Establish basic life support see paediatric BLS section 2. Oxygenate, ventilate, and start chest compression: Ensure a patent airway by using an airway manoeuvre described in the Paediatric basic life support section. Intubate the trachea only if this can be performed by an experienced operator with minimal interruption to chest compressions.
Tracheal intubation will both control the airway and enable chest compression to be given continuously, thus improving coronary perfusion pressure.
Use a compression rate of — min If the child has been intubated and compressions are uninterrupted, ensure that ventilation is adequate and use a slow ventilation rate of approximately 10—12 min Attach a defibrillator or monitor: Assess and monitor the cardiac rhythm. If using a defibrillator, place one defibrillator pad or paddle on the chest wall just below the right clavicle, and one in the mid-axillary line.
Pads for children should be 8—12 cm in size, and 4.
In infants and small children it may be best to apply the pads to the front and back of the chest if they cannot be adequately separated in the standard positions. The defibrillator pads may be used to assess the rhythm, when in monitoring mode.
Assess rhythm and check for signs of life: Look for signs of life, which include responsiveness, coughing, spontaneous movements and normal breathing.
Assess the rhythm on the monitor: Non-shockable asystole or PEA: This is the more common finding in children. Perform continuous CPR: Continue to ventilate with high-concentration oxygen. If ventilating with bag-mask give 15 chest compressions to 2 ventilations. If the patient is intubated, chest compressions can be continuous as long as this does not interfere with satisfactory ventilation.
Once the child's trachea has been intubated and compressions are uninterrupted use a ventilation rate of approximately 10—12 min Once there is return of spontaneous circulation ROSC , the ventilation rate should be 12—20 min Measure end-tidal carbon dioxide CO 2 to monitor ventilation and ensure correct tracheal tube placement.
Paediatric advanced life support
Give adrenaline: If vascular access has been established, give adrenaline 10 mcg kg -1 0. If there is no circulatory access, obtain intraosseous IO access. Continue CPR, only pausing briefly every 2 min to check for rhythm change. Give adrenaline 10 mcg kg -1 every 3—5 min i. Consider and correct reversible causes 4Hs and 4Ts: It is seen more often in the intensive care unit and cardiac ward.
Charge the defibrillator while another rescuer continues chest compressions. Once the defibrillator is charged, pause the chest compressions, quickly ensure that all rescuers are clear of the patient and then deliver the shock.
This should be planned before stopping compressions. Give 1 shock of 4 J kg -1 if using a manual defibrillator.
If using an AED for a child of less than 8 years, deliver a paediatric-attenuated adult shock energy. If using an AED for a child over 8 years, use the adult shock energy.
Algorithms for Pediatric Advanced Life Support 2016
Resume CPR: Without reassessing the rhythm or feeling for a pulse, resume CPR immediately, starting with chest compression. Consider and correct reversible causes 4Hs and 4Ts. Continue CPR for 2 min, then pause briefly to check the monitor: Give adrenaline 10 mcg kg -1 and amiodarone 5 mg kg -1 after the third shock, once chest compressions have resumed.
Repeat adrenaline every alternate cycle i. Repeat amiodarone 5 mg kg -1 one further time, after the fifth shock if still in a shockable rhythm.
Continue giving shocks every 2 min, continuing compressions during charging of the defibrillator and minimising the breaks in chest compression as much as possible. After each 2 min of uninterrupted CPR, pause briefly to assess the rhythm: If asystole: If organised electrical activity is seen , check for signs of life and a pulse: If there is ROSC, continue post-resuscitation care. Give an amiodarone bolus unless two doses have already been given and start a continuous infusion of the drug.
Important note Uninterrupted, high quality CPR is vital. Chest compression and ventilation should be interrupted only for defibrillation. Chest compression is tiring for providers and the team leader should repeatedly assess and feedback on the quality of the compressions.
To prevent fatigue, change providers should every two minutes.
This will mean that the team can deliver effective high quality CPR so improving the chances of survival. Figure 1. Paediatric advanced life support algorithm A4-size algorithm: Explanatory notes Tracheal tubes Recent studies continue to show no greater risk of complications for children younger than 8 years when cuffed, rather than uncuffed, tracheal tubes are used in the operating room and intensive care unit.
Capnography Monitoring end-tidal CO 2 with waveform capnography reliably confirms tracheal tube placement in a child weighing more than 2 kg with a perfusing rhythm and must be used after intubation and during transport of an intubated child. Drugs used in CPR Adrenaline This is an endogenous catecholamine with potent alpha, beta 1 , and beta 2 adrenergic actions.
Magnesium This is a major intracellular cation and serves as a cofactor in many enzymatic reactions.
Calcium Calcium plays a vital role in the cellular mechanisms underlying myocardial contraction. It produces a negative inotropic effect on an ischaemic myocardium.
It presents a large, osmotically active, sodium load to an already compromised circulation and brain. It produces a shift to the left in the oxygen dissociation curve, further inhibiting release of oxygen to the tissues. Fluids in CPR Hypovolaemia is a potentially reversible cause of cardiac arrest. Post-resuscitation care Oxygen In neonates there is evidence that hyperoxaemia can be detrimental and room air is recommended for use during initial resuscitation of the newborn see Resuscitation and support of transition of babies at birth www.Early postresuscitation hypotension is associated with increased mortality following pediatric cardiac arrest.
In the infant or child with symptoms it is of the utmost importance. If central venous access is unavailable likely at the time of cardiac arrest and so it has to be given peripherally, flush it liberally with 0. A irway Ac for airway and cervical spine stabilisation for the injured child. Look for signs of life, which include responsiveness, coughing, spontaneous movements and normal breathing.
Other supraglottic airways SGA e. It presents a large, osmotically active, sodium load to an already compromised circulation and brain. In the paediatric cardiac arrest algorithm: