Before you can hit the "Manual" button, the display on the defibrillator reads "shock advised." Should you blindly follow the machine's instructions or verify the findings clinically? How many joules should you deliver? Should you start cardiopulmonary resuscitation (CPR)? If so, what is the appropriate ratio of breaths-to-chest compressions?Īt 14:55 on your next shift, you get a call to pick up a 3-week-old baby from a community ER who is in unstable supraventricular tachycardia (SVT). Are these real or are they an artifact caused by the bumpy road? At this point you plug in the pediatric defibrillator pads and palpate for pulses. You note 4- to 8-beat runs of VT on your monitor.
Later you are in the back of the ambulance, en route to your pediatric intensive care unit.
#30 INCH CHILD BROSELOW TAPE COLOR SKIN#
When you arrive, you find an intubated patient with mottled, cool skin and 1+ pulses. One round of epinephrine was administered, and one shock was delivered at 2 J/kg for pulseless ventricular tachycardia (VT). Bagvalve- mask ventilations and chest compressions were initiated. The 9-1-1 response team found a pulseless and apneic patient. Is there a medication that can be delivered via the ET tube that will help reverse pulmonary hemorrhage and hypotension?Īt 18:00 that same day you are in an ambulance going to pick up a 9-year-old boy with "congenital heart disease" who suddenly collapsed at home. You have no intravenous (IV) or intraosseous (IO) access yet. Blood is spewing out of the endotracheal (ET) tube. Her problem is described simply as "respiratory distress." Upon arrival, you find a hypoxic, hypotensive patient who is being intubated. It's 11:00, and you are called to pick up an 11-year-old girl from an outside hospital.
#30 INCH CHILD BROSELOW TAPE COLOR PDF#
Practice Recommendations (key points from the issue)Ĭlick here to download a PDF of the Evidence-Based Practice Recommendations for this issue. While the last 25 years have undeniably seen advances in the understanding and management of pediatric cardiopulmonary failure, many questions remain unanswered and progress must continue to be made. It is with this mindset that we will be able to respond intelligently and physiologically to life-threatening situations and to ask questions that will further our body of knowledge regarding the resuscitation of the pediatric patient. 3 We, as medical professionals, should have a deeper understanding of how and why PALS works and of its strengths and weaknesses. One study demonstrated an improvement of pediatric survival from respiratory failure and shock from 10% to 85%. 1 The authors of the PALS guidelines promote an “assess-categorize-decide-act” approach and present an organized pedagogical approach to pediatric resuscitation. The program is intended to guide healthcare providers through the stabilization or transport phases of a pediatric emergency, either in or out of the hospital. The goal of PALS, which was developed by the American Heart Association, is to present a systematic approach to recognizing, treating, and improving the outcomes of seriously ill and injured children. But is there evidence that PALS works? Who comes up with these guidelines and how do they do it? How do these guidelines work and what happens after the initial resuscitation steps have been completed? Most of us blindly accept the PALS guidelines as being true and unquestioningly commit them to memory. Nearly all pediatricians avail themselves to pediatric advanced life support (PALS) training and certification.
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