Paediatric Advanced Life Support (PALS)

Summary

This video provides a detailed overview of pediatric advanced life support (ALS) from an Oskie perspective. It builds upon the basics of pediatric basic life support (BLS) and covers critical elements of ALS, including defibrillation, advanced airway management, IV/IO cannulation, drug administration, and rhythm checks. The script emphasizes the importance of minimal CPR interruption and safe, effective techniques. Through practical demonstrations and explanations, viewers are guided on handling pediatric resuscitations, ensuring correct procedures for each step, and making key decisions like airway management or cannulation. The video encourages using the Resuscitation Council guidelines for clinical scenarios.

Takeaways

• 😀 Ensure adherence to pediatric advanced life support (ALS) guidelines and use them for all clinical situations.
• 😀 Pediatric basic life support (BLS) provides the foundation for ALS, including scene assessment, airway management, and CPR.
• 😀 Key ALS components include defibrillation, advanced airway management, IV/IO cannulation, and drug administration with careful timing.
• 😀 CPR should never be interrupted for longer than 5 seconds during resuscitation according to research council guidelines.
• 😀 In defibrillation, pads should be placed correctly, rhythm should be checked immediately, and CPR must continue while charging the defibrillator.
• 😀 Use a stepwise approach to airway management starting with simple maneuvers, progressing to OPA, NPA, and intubation when necessary.
• 😀 For pediatric intubation, the procedure should follow correct technique and tube placement should be confirmed by visual checks and capnography.
• 😀 In pediatric patients, IO cannulation is preferred over IV cannulation for faster vascular access in emergencies.
• 😀 Adrenaline and amiodarone should be administered at age-appropriate doses based on the patient's size and weight.
• 😀 Be aware of reversible causes of cardiac arrest and treat them based on established ALS algorithms and clinical guidelines.

Q & A

What is the purpose of the video?

The purpose of the video is to provide guidance on pediatric advanced life support (ALS) from the perspective of an Oskie, emphasizing essential skills such as defibrillation, airway management, and drug administration. It is not a substitute for clinical guidelines but focuses on key ALS criteria for Oskie preparation.

What is the role of CPR during pediatric ALS?

CPR plays a critical role throughout pediatric ALS, with the guideline being that CPR should not be interrupted for more than five seconds. This is vital during defibrillation, airway management, and other interventions, ensuring that circulation is maintained throughout the resuscitation process.

Why is it important to attach the defibrillator pads correctly?

Correct pad placement is crucial because it ensures effective defibrillation. If the pads are not placed properly, the shock may not be delivered to the heart in the most effective way, reducing the chances of successful resuscitation.

What is the first step when encountering a pediatric patient in cardiac arrest?

The first step is scene assessment and initial approach. This involves checking the patient's response (verbal and physical), assessing the airway, and determining whether the patient is breathing and has a pulse.

How should airway management be approached in pediatric ALS?

Airway management in pediatric ALS follows a stepwise approach, starting with basic maneuvers like head tilt-chin lift or jaw thrust. If necessary, an OPA or MPA may be used, and endotracheal intubation should be performed with proper technique and checks for placement, including auscultation and capnography.

When should intraosseous (IO) cannulation be preferred over intravenous (IV) access?

IO cannulation should be preferred when rapid vascular access is needed, as it is often quicker and more effective than IV cannulation, especially in pediatric patients where veins can be difficult to access. IO access should be used unless a suitable IV site is immediately apparent.

How is drug administration in pediatric ALS different from adult ALS?

In pediatric ALS, drug dosages are age and weight-dependent, unlike adult ALS where the dosages are standardized. The timing of drug administration also depends on whether the rhythm is shockable or non-shockable.

What should be considered when identifying the rhythm during defibrillation?

Correct rhythm identification is essential to determine whether the rhythm is shockable or non-shockable. Shockable rhythms include ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), while non-shockable rhythms include asystole and pulseless electrical activity (PEA).

What are the key principles in pediatric intubation?

Key principles in pediatric intubation include correct positioning of the patient (e.g., sniffing the morning air position), selecting the right equipment (e.g., size six ET tube for a seven-year-old), and performing the procedure under direct vision. It is also essential to verify tube placement using chest rise and fall, auscultation, and capnography.

Why is a supraglottic airway like the i-gel recommended in pediatric ALS?

A supraglottic airway such as the i-gel is recommended in pediatric ALS because it is easier to insert and offers a more reliable airway than intubation, especially in emergency situations. It is particularly useful in cases where intubation may be challenging or when a more experienced clinician is not available.