PALS Study Guide - Quicklycertify
PEDIATRIC ADVANCED LIFE SUPPORT STUDYGUIDE
Table of ContentsUpdates to PALS in 2015. 3PALS Systematic Approach . 4First Impression . 4Evaluate-Identify-Intervene . 5Primary Assessment. 6Airway . 6Breathing . 7Circulation . 8Disability. 9Exposure . 9Secondary Assessment and Diagnostic Tests . 10Respiratory Distress/Failure . 11Causes of Respiratory Distress . 12Cardiac Arrest . 14Ventricular Fibrillation and Pulseless Ventricular Tachycardia . 14PEA and Asystole . 15Rapid Differential Diagnosis of Cardiac Arrest. 16Shock . 17Fluid Resuscitation. 18Return of Spontaneous Consciousness (ROSC) and Post Arrest Care . 19Postresuscitation Management . 20Transport to Tertiary Care Center . 21Bradycardia . 22Tachycardia . 23Tachycardia with Pulse and Poor Perfusion . 24Tachycardia with Pulse and Good Perfusion . 25PALS Tools . 26Broselow Pediatric Emergency Tape System . 26PALS Airways . 26Intraosseus Access . 27Team Dynamics/Systems of Care . 28
ECG Rhythms .Atrioventricular (Heart) Block . 29Pulseless Electrical Activity and Asystole . 30Ventricular Fibrillation and Pulseless Ventricular Tachycardia . 31Tachyarrhythmias . 32Resuscitation and Life Support Medications . 33
Updates to PALS in 2015As we learn more about resuscitation science and medicine, physicians and researchersrealize what works best and what works fastest in a critical, life-saving situation.Therefore, it is necessary to periodically update life-support techniques and algorithms.If you have previously certified in pediatric advanced life support, then you will probablybe most interested in what has changed since the latest update in 2015. The tablebelow also includes changes proposed since the last AHA manual was published.InterventionVolume for children withfebrile illnessAtropine for emergencytracheal intubationArterial blood pressuremonitoringAmiodarone and LidocaineTherapeutic hypothermiaBlood PressureCompressionsUpdates to the 2015 Guidelines2015 GuidelineRestrictive volumes of isotonic crystalloids2010 GuidelineAggressive volume resuscitationControversial for neonates; no minimum doseRoutine premedication prior to intubationIf in place, may be useful to adjust CPRNo guidelineAcceptable for shock-refractory VFib or PulselessVTachFever should be avoided after ROSC but use oftherapeutic hypothermia is controversialFluids and vasoactive agents to maintain systolicthblood pressure above the 5 percentile for age100 to 120 per minuteNo guidelineTherapeutic hypothermia should be usedNo guidelineAt least 100 per minute
PALiS Systematic ApproachThe PALS systematic approach is an algorithm that can be applied to every injured orcritically ill child.The first step is to determine if the child is in imminent danger of death, specificallycardiac arrest or respiratory failure. The PALS systematic assessment starts with aquick, first impression. The provider or rescuer makes it very quick assessment aboutthe child's condition.Is the child in imminent danger of death? Is there time to evaluate the child to identifyand treat possible causes for the current illness? Is the child conscious? Is shebreathing? What is her color? A conscious child who is breathing effectively can be managed inthe next steps of PALS, Evaluate-Identify-Intervene. A unconscious child who is breathing effectively can bemanaged in the next steps of PALS, Evaluate-IdentifyIntervene. A child who is not breathing adequately but who has a pulse 60 BPM should be treated with rescue breathing. A child who has a pulse 60 BPM should be treated withCPR and according to the cardiac arrest algorithm. A child who has a pulse 60 BPM should be treated withCPR and according to the cardiac arrest algorithm.
ify Assuming that the childdoes not need CPR,rescue breathing, ordefibrillation, the nextstep in this systematicapproach in PALS is acircular construct thatincludes evaluation,identification, andintervention. The provider will evaluate,identify, and intervene asmany times as necessary untilthe child either stabilizes orher condition worsens,requiring CPR and otherlifesaving measures. “Evaluate” pertains toevaluation of the child'sillness, but also to thesuccess or failure of theintervention. If the child’s condition worsens at any point, revert to CPR and emergency interventions asneeded. After Spontaneous Return of Circulation (ROSC), use the evaluate–identify–intervene sequence. The evaluate phase of the sequence includes Primary Assessment, Secondary Assessment, and DiagnosticTests that are helpful in pediatric life support situations.
Primary Assessment follows ABCDE: Airway, Breathing, Circulation, Disability, Exposure. While CPR currently uses theC-A-B approach orcompressions, airway,breathing, the PrimaryAssessment in PALS still beginswith Airway. If the child airway is open, youmay move onto the next step. However, if the airway is likely to becomecompromised, you may consider a basic or advanced airway. Often, in unresponsive patient or in someone who has a decreased level of consciousness, the airway willbe partially obstructed. This instruction does not come from a foreign object, but rather from the tissues inthe upper airway. You can improve a partially obstructed airway by performing a head tilt and chin lift. Ifthere is suspected trauma to the cervical spine, use a jaw thrust instead. A blocked airway would usually requires a basic or advanced airway.
The evaluation of breathing include several signs including breathing rate, breathing effort, motionof the chest and abdomen, breath sounds, and blood oxygenation levels. Normal breathing ratesvary by age and are shown in the table. The breathing rate higher or lower than the normal rangeindicates the need for intervention.Normal Respiratory Rate by AgeAgeRangeRate (BPM)0-12 months30-60Toddler1-3 years24-40Preschooler4-5 years22-34School Age6-12 years18-30Adolescent13-18 years12-16InfantNasal flaring, head bobbing, seesawing, and chest retractions are all signs of increased effort ofbreathing. The chest may show labored movement (e.g., using the chest accessory muscles),asymmetrical movement, or no movement at all.Stridor is a high-pitched breath sounds, usually heard on inspiration, that usually indicates ablockage in the upper airway. Rales or crackles often indicate fluid in the lower airway. Rhonchi arecoarse rattling sounds usually caused by fluid in the bronchi.Blood oxygen saturation below 90% indicate that an advanced airway, such as an endotrachealtube, is needed. Blood oxygenation can be 100% during cardiopulmonary arrest but should betitrated to between 94 and 99% after ROSC or in non-acute situations.
A heart rate that is either too fast or too slow can be problematic. In children, heart rateless than 60 bpm is equivalent to cardiac arrest. Diminished central pulses, such as inthe carotid, brachial, or femoral arteries, indicate shock. The same is true for capillaryrefill the takes longer than 2 seconds to return, cyanosis, and blood pressure that islower than normal for the child's age. Bradycardia and tachycardia that are interferingwith circulation and causing a loss of consciousness should be treated as cardiac arrestor shock, rather than as a bradycardia or tachycardia.Normal Blood Pressure by AgeNormal Heart Rate by AgeRangeRate (BPM)0-3 months80-2054 months - 2 years75-1902-10 years60-140Over 10 years50-100Low SystolicSystolic RangeDiastolic RangeBlood Pressureby Age1 Day60-7630-45 604 Days67-8435-53 601 month73-9436-56 701-3 months78-10344-65 704-6 months82-10546-68 707-12 months67-10420-60 722-6 years70-10625-65 70 (2 X age)7-14 years79-11538-78 70 (2 X age)15-18 years93-13145-85 90Age
Rapidly assess disability using the AVPU paradigm: Alert, Verbal, Pain, Unresponsive.AVPU , normal activity for the child’s age and usual statusResponds only to voiceResponds only to painDoes not respond to stimuli, even painA more thorough assessment would be the Pediatric Glasgow Coma Scale.Pediatric Glasgow Coma ScaleResponseScoreVerbal ChildPre-verbal ChildEye Opening4SpontaneouslySpontaneously3To verbal commandTo speech2To painTo pain1NoneNone5Oriented and talkingCooing and babbling4Confused but talkingCrying and irritable3Inappropriate wordsCrying with pain only2Sounds onlyMoaning with pain only1NoneNone6Obeys commandsSpontaneous movement5Localizes with painWithdraws when touched4Flexion and withdrawalWithdraws with pain3Abnormal flexionAbnormal flexion2Abnormal extensionAbnormal extension1NoneNoneVerbal ResponseMotor ResponseMild: 13-15Moderate: 9-12Severe: 3-8Exposure is included in the primary assessment to remind the provider to look forcauses of injury or illness that may not be readily apparent. To do this, the child'sclothes need to be removed in a ordered and systematic fashion. During the removal,the provider should look for signs of discomfort or distress that may point to an injuryin that region.The provider should look for and treat, at a minimum, hypothermia, hemorrhage,local and/or systemic infection, fractures, petechiae, bruising or hematoma.
When a child is experiencing an acutelylife-threatening event, such ascardiopulmonary failure, it isappropriate to treat the child with CPRand the appropriate arrest algorithm.When a child has a condition that maysoon become life-threatening or ifsomething does “not feel right”, continueusing the Primary Assessment sequenceof Evaluate-Identify-Intervene. If at anytime the child’s condition worsens, treatthe child with CPR and the appropriatearrest algorithm.When a child is ill but does not likely havea life-threatening condition, you mayUse SAMPLE in Secondary AssessmentSSigns/SymptomsFeverDecreased intakeVomiting/DiarrheaBleedingShortness of breathAltered mental st HistoryLLast MealEEvents/ExposuresMedication allergyEnvironmental allergyFood allergyPrescribedOver-the-counterNew meds?Last dose?Birth historyChronic health issuesImmunization statusSurgical historyBreast/bottle/solid?When? What? How much?New foods?History of present illnessOnset/time courseproceed to the Secondary Assessment. The Secondary Assessment includes a focushistory and focused physical examination looking for things that might causerespiratory or cardiovascular compromise.The focused physical examination may be quite similar to the Exposure phase of thePrimary Assessment, but will be guided by the data that the provider collects duringthe focused history. The focused history will also help determine which diagnostic testsshould be ordered.Key Diagnostic Tests Used in PALSTest/StudyIdentifiesPossible InterventionArterial Blood Gas (ABG)HypoxemiaIncrease OxygenationHypercarbiaIncrease VentilationAcidosisIncrease VentilationAlkalosisReduce VentilationArterial LactateMetabolic acidosis, Tissue hypoxiaShock AlgorithmCentral Venous Oxygen SaturationPoor O2 delivery (SVO2 70%)Shock AlgorithmCentral Venous PressureHeart contractility, othersVasopressors, Shock AlgorithmChest X-rayRespiratory conditionsSpecific to cause, Respiratory AlgorithmEchocardiogramHeart anatomy and functionSpecific to causeElectrocardiogramRhythm DisturbancesSpecific to causePeak Expiratory Flow RateRespiratory conditionsSpecific to cause, Respiratory AlgorithmVenous Blood Gas (VBG)AcidosisIncrease VentilationAlkalosisReduce Ventilation
Respiratory Distress/FailureCardiac arrest in children can occur secondary to respiratory failure, hypotensive shock,or sudden ventricular arrhythmia. In most pediatric cases, however, respiratory failure,shock, and even ventricular arrhythmia are preceded by a milder form of cardiovascularcompromise. For example, respiratory failure is usually preceded by some sort ofrespiratory distress. In fact, respiratory distress is the most common cause ofrespiratory failure and cardiac arrest in children. As you may expect, outcomes arebetter if one can intervene during respiratory distress rather than respiratory failure.Signs and Symptoms of Worsening Respiratory Distress,Sign/SxMildModerateSevereVerge of ArrestNoYesMarkedSeesawingActivityWalking, talkingTalking, will sitNo activity, infantwill not feedDrowsyAlertSlightly agitatedAgitatedMarkedly agitatedLethargicO2 Sat. 95%91 to 95% 90% 90%PaCO2 45 mmHg 45 mmHg 45 mmHg 45 mmHgNormal 60 mmHg 60 mmHg 60 mmHg Cyanosis CyanosisAccessoryMuscles UsePaO2PulseNormal100-200 BPM 200 BPM 100 BPMRespiratoryRateIncreasedIncreasedMarkedly IncreasedIncreased orDecreasedSpeaking?SentencesPhrasesWordsNot talkingAudibleLoudVery LoudNoneWheeze
Respiratory distress/failure is divided into four main etiologies for the purposes of PALS:upper airway, lower airway, lung tissue disease, and disordered control of breathing.Respiratory Distress Identification and ManagementType of Respiratory ProblemPossible CausesUpper AirwayAnaphylaxisCroupForeign body aspirationLower AirwayAsthmaBronchiolitisLung Tissue DisorderPneumoniaPulmonary edemaDisordered Control of BreathingIncreased intracranial pressureNeuromuscular diseaseToxic poisoningRespiratory Distress, Key Signs and SymptomsUpper AirwayObstructionLower AirwayObstructionAir MovementAirwayBreath SoundsHeart RateLung DiseaseDecreasedDisordered Controlof BreathingUnchanged ordecreasedMay or may not be fully patent in respiratory distress. Not patent in respiratory failure.Cough, hoarseness,stridorWheezingDiminished breathsounds, grunting,cracklesUnchangedIncreased in respiratory distressDecompensates rapidly to bradycardia as respiratory failure ensuesSkin Color andTemperatureLevel ofConsciousnessRespiratoryRate and EffortPale, cool, and clammy in respiratory distressVariesDecompensates rapidly to cyanosis as respiratory failure ensuesAgitation in respiratory distressDecompensates rapidly to decreased mentation, lethargy, and LOC as respiratory failure ensuesIncreased in respiratory distressDecompensates rapidly in respiratory failureVaries
Respiratory Distress ManagementRespiratory Distress Management by Type and CauseTypePossible CausesTreatmentUpper AirwayObstructionAnaphylaxisEpinephrineAlbuterol nebulizerWatch for and treat airway compromise, advanced airway as neededWatch for and treat shockCroupHumidified oxygenDexamethasoneNebulized epinephrine for moderate to severe croupKeep O2 sat 90%, advanced airway as neededForeign body aspirationDo not perform a blind finger sweep, remove foreign object if visibleInfant 1 year old: Back slaps/chest thrustsChild 1 year old: Abdominal thrustsLower AirwayObstructionAsthmaNebulized epinephrine or albuterolKeep O2 sat 90%, advanced airway or non-invasive positive pressureventilation as neededCorticosteroids PO or IV as neededNebulized ipratropiumMagnesium sulfate slow IV (moderate to severe asthma)Terbutaline SQ or IV (impending respiratory failure)BronchiolitisOral and nasal suctioningKeep O2 sat 90%, advanced airway as neededNebulized epinephrine or albuterolLung DiseasePneumoniaEmpiric antibiotics and narrow antibiotic spectrum based on culture resultsNebulized albuterol for wheezingReduce the work of breathing and metabolic demandKeep O2 sat 90%, advanced airway as neededContinuous positive airway pressure (CPAP)Pulmonary edemaReduce the work of breathing and metabolic demandKeep O2 sat 90%, advanced airway as neededDiuretics if cardiogenicCPAPDisorderedControl ofBreathingIncreased intracranialpressurePediatric neurological/neurosurgery consultHyperventilation as directedUse medications (e.g., mannitol) as directedNeuromuscular diseaseIdentify and treat underlying diseaseCPAP or ETT and mechanical ventilation as neededToxic poisoningIdentify toxin/poisonCall Poison Control: 1.800.222.1222Administer antidote/anti-venom when possibleMaintain patent airway, advanced airway as neededProvide suctioning
Cardiac ArrestCardiac arrest occurs when the heart does not supply blood to the tissues. Strictlyspeaking, cardiac arrest occurs because of an electrical problem (i.e.,arrhythmia). Shock (i.e., too little blood pressure/volume) and respiratory failuremay lead to cardiopulmonary failure and hypoxic arrest. Ventricular fibrillation and pulselessventricular tachycardia are shockable rhythms. The first shock energy is 2 J/kg. The second shock energy (and allsubsequent shocks) is 4 J/kg. All subsequent shocks are 4 J/kg or greater. The maximum energy is 10 J/kg or the adultdose(200Jforbiphasic,360Jformonophasic). Epinephrine(0.01mg/kgIV/IO)isgiven every 3 to 5 minutes (two 2minute cycles of CPR). Amiodarone (IV/IO)o 5 mg/kg boluso Can be given three times total Lidocaine may be used instead of AmiodaroneIf the arrest rhythm is no longershockable, move to PEA/Asystolealgorithm. If the patient regains consciousness, move to ROSC algorithm.
As long as the patient is in PEA orasystole, the rhythm is not shockable. Chest compressions/high-quality CPR shouldbe interrupted as little as possible duringresuscitation. After 2 min. of high-quality CPR, give0.01 mg/kg epinephrine IV/IO every3 to 5 minutes (two 2 minute cyclesof CPR). Remember, chest compressions are a means ofartificial circulation, which should deliver theepinephrinetotheheart.Withoutchestcompressions, epinephrine is not likely to beeffective. Chest compressions shouldcontinuedwhileepinephrineadministered.beis Rhythm checks every 2 min. Look for and treat reversible causes (Hs andTs). If the arrest rhythm becomes shockable, move to VFib/Pulseless VTach algorithm. If the patient regains circulation, move to ROSC algorithm.
Rapid Differential Diagnosis of Cardiac ArrestMany different disease processes and traumatic events can cause cardiac arrest, but inan emergency, it is important to be able to rapidly consider and eliminate or treat themost typical causes of cardiac arrest. To facilitate remembering the main, reversiblecauses of cardiac arrest, they can be organized as the Hs and the Ts.The HsSymptoms/Signs/TestsInterventionRapid heart rate, narrow QRS complex,Fluid resuscitationDecreased heart rateAirway management, oxygenHydrogen Ion(Acidosis)Low amplitude QRS complexHyperventilation, sodium bicarbHypoglycemiaFingerstick glucose testingIV DextroseHypokalemiaFlat T waves, pathological U waveIV MagnesiumHyperkalemiaPeaked T waves, wide QRS complexCalcium chloride, sodium bicarb,insulin/glucose, hemodialysisHypothermiaHistory of cold exposureRewarming w heart rate, narrow QRS complex, acute dyspnea,history of chest traumaThoracotomy, needledecompressionRapid heart rate and narrow QRS complexPericardiocentesisVariable, prolonged QT interval, neuro deficitsAntidote/antivenom (toxin-specific)Rapid heart rate, narrow QRS complexFibrinolytics, embolectomyHypovolemiaHypoxiaThe bosis(pulmonary)Thrombosis(coronary)ST segment elevation/depression, abnormal T wavesFibrinolytics, Percutaneousintervention
ShockThe goals of shock management include: Improving blood oxygenation Easing oxygen demand Improving volume and fluid distribution Normalizing electrolyte and metabolic disturbancesShock Identification and ManagementTreatment GoalKey Intervention (s)Improving blood oxygenationSupplemental O2 via face mask/non-rebreatherMechanical ventilation through advanced airwayPacked red blood cellsEasing oxygen demandReduce feverTreat painTreat anxietyNormalizing electrolyte and metabolic disturbancesTreat imbalances promptlyIV electrolytes for deficienciesVentilatory settings for acidosis/alkalosisGlucose for hypoglycemiaImproving volume and fluid distributionTreatment depends on type of shockTypes of Shock, Signs and utiveCardiogenicObstructiveToo little volumeVolume distributedto tissuesHeart problemCardiac outflowimpedimentVomiting/DiarrheaSepsisCongenital Heart DzCardiac TamponadeHemorrhageHead/Spine InjuryPoisoning MyocarditisTension PneumoDKAAnaphylaxisCardiomyopathyCongenital Heart DzArrhythmiaPulmonary EmbolusBurnsPoor Fluid easedNormal or DecreasedVariesVariesNormal/IncreasedNormal or creasedIncreased rateIncreased rateMarkedly increasedMarkedly increasedRate and EffortNo increased effort /- Increased effortefforteffortBreath SoundsNormal /- RalesSystolic BPPulse PressureHeart RatePeripheralPulsesCapillary RefillRales and gruntingMay be normal (compensated), but soon compromised without easedIncreasedIncreasedDistant heart soundsWeakBounding or WeakWeak or absentJugular vein distentionWeakDelayedVariesDelayedDelayedUrine OutputDecreasedConsciousnessIrritable and anxious, early. Altered mental status, later.
Fluid resuscitation in PALS depends on the weight of the child and the severity ofthe situation. While dehydration and shock are separate entities, the symptoms ofdehydration can help the provider to assess the level of fluid deficit and to track theeffects of fluid resuscitation. In the current guidelines, the clinician must fullyevaluate the child with febrile illness since aggressive fluid resuscitation withisotonic crystalloid solution may not be indicated.Signs and Symptoms of DehydrationDeficit ml/kg (% body wt.)CategorySigns/SxInfantsAdolescents50 (5%)30 (3%)Moderate100 (10%)50–60 (5–6%)Dry buccal mucosa, tachycardia, little or no urine output,lethargy, sunken eyes and fontanelles, loss of skin turgorSevere150 (15%)70–90 (7–9%)Same as moderate plus a rapid, thready pulse; no tears;cyanosis; rapid breathing; delayed capillary refill;hypotension; mottled skin; comaMildSlightly dry buccal mucosa, increased thirst, slightlydecreased urine outputInterventions by Shock TypeBroad pecific TypeManagementHemorrhagicFluid resuscitation, packed red blood cellsNon-hemorrhagicFluid resuscitationSepticSeptic Shock AlgorithmAnaphylacticEpinephrine IM, fluid resuscitationNeurogenicFluid resuscitation, pressorsBradyarrhythmiaBradycardia AlgorithmTachyarrhythmiaTachycardia AlgorithmHeart DiseaseFluid resuscitation, pressors, expert consultDuctus ArteriosisPGE1 (alprostadil), expert consultTension PneumoNeedle decompression, tube thoracostomyTamponadePericardiocentesisPulmonary EmbolismFluid resuscitation, fibrinolytics, expert consult
Fluid ResuscitationBroad TypeHypovolemicSpecific TypeVolumeRateHemorrhagic3 ml of crystalloid for each ml blood lostOver 5-10 minNon-hemorrhagic20 ml/kg bolus, repeat as neededOver 5-10 minDiabetic Ketoacidosis10-20 ml/kg bolus, repeat as neededOver 60 minDistributiveAll types20 ml/kg bolus, repeat as neededOver 5-10 minCardiogenicAll types5-10 ml/kg bolus, repeat as neededOver 10-20 minObstructiveTamponade20 ml/kg bolusOver 5-10 minPulmonary Embolism20 ml/kg bolus, repeat as neededOver 5-10 min
Return of Spontaneous Consciousness (ROSC) and Post Arrest Care In a successful resuscitation, there will be aspontaneous return of circulation. You can detect spontaneous circulation by feelinga palpable pulse at the carotid or femoral artery inchildren and the brachial artery in infants up to 1year. Even after Return of Spontaneous Circulation (ROSC),the patient still needs close attention and support. Thepatient is at risk for reentering cardiac arrest at anytime. Therefore, the patient should be moved to anintensive care unit. Titrate the patient's blood oxygen to between 94% and 99%.Wean down supplemental oxygen for blood oxygenation of100%. Does the person need an advanced airway? If so, it shouldbe placed. Also, apply quantitative waveform capnography,if available. Is the patient in shock? If not, monitor and move tosupportive measures. If shock is present, determine if itis hypotensive or normotensive. Identifyandtreatcauses(HsandTs).Fluidresuscitation according to cause of shock. Considervasopressors. Hypotensive ShockoooEpinephrine IV 0.1-1.0 mcg/kg/minDopamine IV 2-20 mcg/kg/minNorepinephrine IV 0.1-2 mcg/kg/min Normotensive ShockoooDobutamine 2-20 mcg/kg/minDopamine IV 2-20 mcg/kg/minEpinephrine IV 0.1-1.0 mcg/kg/mino50 mcg/kg IV over 10-60 minutes asloading dose, then 0.25-0.75 mcg/kg/minute IV infusion as maintenance dose
The child is still in a delicate condition. All major organ systems should be assessed andsupported. Maintenance fluids should be given. If the child has been resuscitated in thecommunity or at a hospital without pediatric intensive care facilities, arrange to havethe child moved to an appropriate pediatric hospital.Fluid MaintenanceBody Weight (kg)Hourly Maintainence Fluid Rate 10 kg4 mL/kg/hour10--- -20 kg40mL/hour 2 mL/kg/hour for each kg 10 20 kg60mL/hour 1 mL/kg/hour for each kg 20Postresusci
The evaluation of breathing include several signs including breathing rate, breathing effort, motion of the chest and abdomen, breath sounds, and blood oxygenation levels. Normal breathing rates vary by age and are shown in the table. The breathing rate higher or lower than the normal range indicates the need for intervention.
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HeartCode PALS is a computer-based self-learning system for the American Heart Association's PALS program. The HeartCode PALS program includes all of the exams required for successful completion of the cognitive portion of the AHA's PALS course: HeartCode PALS Cases, which are real-life, real-time simulations of different acute conditions.
The original PALS instrument was designed for use in kindergarten and first grade, but was expanded into separate PALS-K and PALS 1-3 instruments in response to the expansion of the EIRI to kindergarten through third grade in 2000. The specific purposes of PALS are to (a) screen and identify children who are relatively behind in their
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IU Health PALS Study Guide Preparing for your upcoming PALS Class REVSISED APRIL 2011 AS OF APRIL 1, 2011—WE ARE TEACHING THE 2010 AHA GUIDELINES. WE RECOMMEND REVIEWING THE NEW PALS ALGORYHMS PROVIDED FROM THE AHA WEB SITE. Children are often unable to describe how they feel physically. Young children may be
resuscitation drug pharmacology prior to taking a PALS course. Sources of PALS drug information include the student CD, the PALS Course Guide, the PALS Provider Manual, and the Handbook of Emergency Cardiovascular Care. This self-assessment is composed of 11 multiple choice questions. Select the best answer. 1
