PALS - Nhcps
2020-2025Guidelines andStandardsPALSPediatric AdvancedLife SupportProvider HandbookBy Dr.1PALS – Pediatric Advanced Life SupportKarl Disque
Copyright 2021 Satori Continuum PublishingAll rights reserved. Except as permitted under the U.S. Copyright Act of 1976, no part of this publicationcan be reproduced, distributed, or transmitted in any form or by any means, or stored in a databaseor retrieval system, without the prior consent of the publisher.Satori Continuum Publishing1810 E Sahara Ave. Suite 1507Las Vegas, NV 89104Printed in the United States of AmericaEducational Service DisclaimerThis Provider Handbook is an educational service provided by Satori Continuum Publishing. Use of thisservice is governed by the terms and conditions provided below. Please read the statements belowcarefully before accessing or using the service. By accessing or using this service, you agree to be boundby all of the terms and conditions herein.The material contained in this Provider Handbook does not contain standards that are intended to beapplied rigidly and explicitly followed in all cases. A health care professional’s judgment must remaincentral to the selection of diagnostic tests and therapy options of a specific patient’s medical condition.Ultimately, all liability associated with the utilization of any of the information presented here restssolely and completely with the health care provider utilizing the service.Version 2021.012PALS – Pediatric Advanced Life Support
TABLE of CONTENTSChapter1 Introduction to PALS . . . . . . . 52 The Resuscitation Team . . . . . . . 63 Basic Life Support . . . . . . . 8BLS for Children (One year to puberty) – 9One-Rescuer BLS for ChildrenTwo-Rescuer BLS for ChildrenBLS for Infants (0 to 12 months) – 10One-Rescuer BLS for InfantsTwo-Rescuer BLS for InfantsSelf-Assessment for BLS – 134 Pediatric Advanced Life Support . . . . . . . 14Normal Heart Anatomy and Physiology – 14PALS—A Systematic Approach – 15Initial Diagnosis and Treatment – 16AirwayBreathingCirculationDisabilitySecondary Diagnosis and Treatment – 19Life-Threatening Issues – 20Self-Assessment for PALS – 215 Resuscitation Tools . . . . . . . 22Medical Devices – 22Intraosseous AccessBag-Mask VentilationEndotracheal IntubationBasic Airway AdjunctsBasic Airway TechniqueAutomated External Defibrillator (AED)Pharmacological Tools – 28Self-Assessment for Resuscitation Tools – 296 Respiratory Distress/Failure . . . . . . . 30Recognizing Respiratory Distress/Failure – 30Causes of Respiratory Distress/FailureResponding to Respiratory Distress/Failure – 32Self-Assessment for Respiratory Distress/Failure – 347 Bradycardia . . . . . . . 35Recognizing Bradycardia – 35Responding to Bradycardia – 36Self-Assessment for Bradycardia – 383PALS – Pediatric Advanced Life Support
TABLE of CONTENTSChapter8 Tachycardia . . . . . . . 39Recognizing Tachycardia – 39Narrow QRS ComplexWide QRS ComplexResponding to Tachycardia – 42Self-Assessment for Tachycardia – 43. . . . . . . 449 ShockRecognizing to Shock – 44Hypovolemic ShockDistributive ShockCardiogenic ShockObstructive ShockResponding to Shock – 47Hypovolemic ShockDistributive ShockCardiogenic ShockObstructive ShockSelf-Assessment for Shock – 4910 Cardiac Arrest . . . . . . . 50Recognizing Cardiac Arrest – 50Pulseless Electrical Activity and AsystoleVentricular Fibrillation and Pulseless Ventricular TachycardiaResponding to Cardiac Arrest – 5211 Pediatric Post-Resuscitation Care . . . . . . . 55Respiratory System – 55Cardiovascular System – 56Neurological System – 56Renal System – 57Gastrointestinal System – 57Hematological System – 57Self-Assessment for Pediatric Post Resuscitation Care – 5912 PALS Essential . . . . . . . 6013 Additional Tools . . . . . . . 61144MediCode – 61CertAlert – 61Review Questions . . . . . . . 62PALS – Pediatric Advanced Life Support
1CHAPTERINTRODUCTIONTO PALSThe goal of Pediatric Advanced Life Support (PALS) is to save a life. For a child or infant experiencingserious injury or illness, your action can be the difference between life and death. PALS is a series ofprotocols to guide responses to life-threatening clinical events. These responses are designed to besimple enough to be committed to memory and recalled under moments of stress. PALS guidelineshave been developed from thorough review of available protocols, patient case studies, and clinicalresearch; and they reflect the consensus opinion of experts in the field. The gold standard in theUnited States and many other countries is the course curriculum published by the InternationalLiaison Committee on Resuscitation (ILCOR). Approximately every five years the ILCOR updates theguidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC).This handbook is based on the most recent ILCOR publication of PALS and will periodically comparethe previous and the new recommendations for a more comprehensive review.Any provider attempting to performPALS is assumed to have developedand maintained competence withnot only the materials presentedin this handbook, but also certainphysical skills, including Basic LifeSupport (BLS) interventions. SincePALS is performed on children andinfants, PALS providers shouldbe proficient in BLS for these agegroups. While we review the basicconcepts of pediatric CPR, providersare encouraged to keep theirphysical skills in practice and seekadditional training if needed.5PALS – Pediatric Advanced Life SupportProper utilization of PALS requires rapid and accurateassessment of the child or infant’s clinical condition andselection and delivery of the appropriate intervention forthe given situation. This not only applies to the provider’sinitial assessment of a child or an infant in distress, but alsoto the reassessment throughout the course of treatmentutilizing PALS guidelines.PALS protocols assume that the provider may not have allof the information needed from the child or the infant or allof the resources needed to properly use PALS in all cases.For example, if a provider is utilizing PALS on the side of theroad, they will not have access to sophisticated devices tomeasure breathing or arterial blood pressure. Nevertheless,in such situations, PALS providers have the framework toprovide the best possible care in the given circumstances.PALS algorithms are based on current understanding of bestpractice to deliver positive results in life-threatening casesand are intended to achieve the best possible outcome forthe child or the infant during an emergency.
2CHAPTERTHERESUSCITATIONTEAMThe ILCOR guidelines for PALS highlights the importance of effective team dynamics duringresuscitation. In the community (outside a health care facility), the first rescuer on the scene may beperforming CPR alone; however, a pediatric arrest event in a hospital may bring dozens of people tothe patient’s room. It is important to quickly and efficientlyorganize team members to effectively participate in PALS.Clear communication between teamThe ILCOR supports a team structure with each providerleaders and team membersassuming a specific role during the resuscitation. Thisis essential.consists of a team leader and several team members (Table 1).TEAM LEADER Organizes the group Understand their role Monitors performance Be willing, able, and skilledto perform the role Able to perform all skills Directs team members Provides feedback on groupperformance after theresuscitation effortsTable 16TEAM MEMBERPALS – Pediatric Advanced Life Support Understand the PALSsequence Committed to the team’ssuccess
THE RESUSCITATIONTEAM2It is important to know your own clinical limitations. Resuscitation is the time for implementingacquired skills, not trying new ones. Clearly state when you need help and call for help early in thecare of the person. Resuscitation demands mutual respect, knowledge sharing, and constructivecriticism. After each resuscitation case, providers should spend time reviewing the process andproviding each other with helpful and constructive feedback. Ensuring an attitude of respect andsupport is crucial and aids in processing the inevitable stress that accompanies pediatricresuscitation (Figure 1).Figure 1Closed-LoopCommunication7TEAM LEADER GIVESCLEAR ASSIGNMENTTO TEAM MEMBERTEAM LEADER LISTENSFOR CONFIRMATIONTEAM MEMBERRESPONDS VERBALLYWITH VOICE ANDEYE CONTACTTEAM MEMBERREPORTS WHEN TASKIS COMPLETE ANDREPORTS THE RESULTPALS – Pediatric Advanced Life Support
3CHAPTERBASIC LIFESUPPORTThis handbook covers PALS andonly briefly describes BLS. All PALSproviders are assumed to be ableto perform BLS appropriately. Itis essential that PALS providers beproficient in BLS first. High-qualityBLS is the foundation of PALS.Basic Life Support (BLS) utilizes CPR and cardiacdefibrillation when an Automated External Defibrillator(AED) is available. BLS is the life support method usedwhen there is limited access to advanced interventionssuch as medications and monitoring devices. In general,BLS is performed until the emergency medical services(EMS) arrives to provide a higher level of care. In everysetting, high-quality CPR is the foundation of both BLSand PALS interventions. High-quality CPR gives the childor the infant the greatest chance of survival by providingcirculation to the heart, brain, and other organs until returnof spontaneous circulation (ROSC).Differences in BLS for Infants and BLS for ChildrenINFANTS (0 to 12 months)CHILDREN ( 1 year to puberty)According to the 2020 CPR guidelines, for all ages of children, the new ratio ofcompressions to ventilations should be 15:2.Check for infant’s pulse using the brachialartery on the inside of the upper arm betweenthe infant’s elbow and shoulder.Check for child’s pulse using the carotidartery on the side of the neck or femoralpulse on the inner thigh in the creasebetween the leg and groin.Perform compressions on the infant using twofingers (if you are by yourself) or two thumbswith hands encircling the infant’s chest (withtwo rescuers).Perform compressions on a child using one ortwo-handed chest compressions depending onthe size of the child.Compression depth should be one-third of thechest depth; for most infants, this isabout 1.5 inches (4 cm).Compression depth should be one-third ofthe chest depth; for most children, this is2 inches (5 cm).If you are the only person at the scene and find an unresponsive infant or child, perform CPR fortwo minutes before you call EMS or go for an AED.If you witness a cardiac arrest in an infant or child, call EMS and get an AED before starting CPR.Table 28PALS – Pediatric Advanced Life Support
BASIC LIFESUPPORT3BLS FOR CHILDREN (1 YEAR TO PUBERTY)BLS for both children and infants is almost identical. For example, if two rescuers are available toperform CPR, the compression to breath ratio is 15:2 for both children and infants.ONE-RESCUER BLS FOR CHILDRENIf you are alone with a child, do the following:1.Tap their shoulder and talk loudly to the child to determine if they are responsive.2.I f the child does not respond and is not breathing (or is only gasping for breath), yell for help.If someone responds, send the second person to call 911 and to get an AED.3. ssess if they are breathing while feeling for the child’s carotid pulse (on the side of the neck)Aor femoral pulse (on the inner thigh in the crease between their leg and groin) for no morethan 10 seconds.4.I f you cannot feel a pulse (or if you are unsure), begin CPR by doing 15 compressionsfollowed by two breaths. If you can feel a pulse but the pulse rate is less than 60 beats perminute, you should begin CPR. This rate is too slow for a child.5. fter doing CPR for about two minutes (usually about ten cycles of 15 compressions and twoAbreaths) and if help has not arrived, call EMS while staying with the child. The ILCORemphasizes that cell phones are available everywhere now and most have a built-inspeakerphone. Get an AED if you know where one is.6. se and follow AED prompts when available while continuing CPR until EMS arrives or untilUthe child’s condition normalizes.TWO-RESCUER BLS FOR CHILDRENIf you are not alone with a child, do the following:91.Tap their shoulder and talk loudly to the child to determine if they are responsive.2.I f the child does not respond and is not breathing (or is only gasping for breath), send thesecond rescuer to call 911 and get an AED.3. ssess if they are breathing while feeling for the child’s carotid pulse (on the side of the neck)Aor femoral pulse (on the inner thigh in the crease between their leg and groin) for no morethan 10 seconds.4.I f you cannot feel a pulse (or if you are unsure), begin CPR by doing 15 compressionsfollowed by two breaths. If you can feel a pulse but the rate is less than 60 beats per minute,begin CPR. This rate is too slow for a child.5. hen the second rescuer returns, begin CPR by performing 15 compressions by one rescuerWand two breaths by the second rescuer.6. se and follow AED prompts when available while continuing CPR until EMS arrives or untilUthe child’s condition normalizes.PALS – Pediatric Advanced Life Support
BLS FOR INFANTS (0 TO 12 MONTHS)BLS for both children and infants is almost identical. The maindifferences between BLS for children and BLS for infants are (Table 2): Check the pulse in the infant using the brachial artery on theinside of the upper arm between the infant’s elbow and shoulder. During CPR, compressions can be performed on aninfant using two fingers (with one rescuer) or with twothumb-encircling hands (if there are two rescuers and rescuer’shands are big enough to go around the infant’s chest) (Figure 2).Figure 2 Compression depth should be one-third of the chest depth; formost infants, this is about 1.5 inches (4 cm). In infants, primary cardiac events are not common. Usually, cardiac arrest will be preceded byrespiratory problems. Survival rates improve as you intervene with respiratory problems as earlyas possible. Keep in mind that prevention is the first step in the Pediatric Chain of Survival.ONE-RESCUER BLS FOR INFANTSIf you are alone with an infant, do the following:1.Tap the bottom of their foot and talk loudly to the infant todetermine if they are responsive.2.If the infant does not respond, and they are not breathing (or ifthey are only gasping), yell for help. If someone responds, sendthe second person to call EMS and to get an AED.3.Assess if they are breathing while feeling for the infant’s femoralor brachial pulse for no more than 10 seconds (Figure 3a).4.If you cannot feel a pulse (or if you are unsure), begin CPR bydoing 15 compressions followed by two breaths. If you can feela pulse but the rate is less than 60 beats per minute, begin CPR.This rate is too slow for an infant. To perform CPR on an infantdo the following (Figure 3b):ABa. Be sure the infant is face-up on a hard surface.b. Using two fingers, perform compressions in the center ofthe infant’s chest; do not press on the end of the sternumas this can cause injury to the infant.c. Compression depth should be about 1.5 inches (4 cm) anda rate of 100 to 120 per minute.5.6.10After performing CPR for about two minutes (usually aboutten cycles of 15 compressions and two breaths) if help hasnot arrived, call EMS while staying with the infant. The ILCORemphasizes that cell phones are available everywhere now andmost have a built-in speakerphone. Get an AED if you know where one is.Figure 3Use and follow AED prompts when available while continuing CPR until EMS arrives or untilthe infant’s condition normalizes.PALS – Pediatric Advanced Life Support
BASIC LIFESUPPORT3TWO-RESCUER BLS FOR INFANTSIf you are not alone with the infant, do the following:111.Tap the bottom of their foot and talk loudly at the infant to determine if they are responsive.2.If the infant does not respond and is not breathing (or is only gasping), send the second rescuerto call 911 and get an AED.3.Assess if they are breathing while simultaneously feeling for the infant’s brachial pulse for 5but no more than 10 seconds.4.If you cannot feel a pulse (or if you are unsure), begin CPR by doing 15 compressionsfollowed by two breaths. If you can feel a pulse but the rate is less than 60 beats per minute,begin CPR. This rate is too slow for an infant.5.When the second rescuer returns, begin CPR by performing 15 compressions by one rescuerand two breaths by the second rescuer. If the second rescuer can fit their hands around theinfant’s chest, perform CPR using the two thumb-encircling hands method. Do not press onthe bottom end of the sternum as this can cause injury to the infant.6.Compressions should be approximately 1.5 inches (4 cm) deep and at a rate of 100 to 120 perminute.7.Use and follow AED prompts when available while continuing CPR until EMS arrives or untilthe infant’s condition normalizes.PALS – Pediatric Advanced Life Support
Pediatric BLS AlgorithmUNRESPONSIVEWITHOUTNORMAL RESPIRATIONSCriteria for high-quality CPR: Rate 100 to 120 compressions per minute Compression depth one-third diameterof chest Allow chest recoil NCYRESPONSERESPONSE TOR Minimize chest compression interruptions Do NOT over-ventilateDEFINITEPULSE Administer one breath every threeseconds Add compressions if pulse remainsless than 60 per minute with poorperfusion despite adequateoxygenation and ventilation Assess pulse every two minutesAssess pulse:DEFINITEPULSEWITHIN 10SECONDSNO PULSEBegin cycles of 15compressions andtwo breathsAED/DEFIBRILLATORARRIVESASSESS FORSHOCKABLERHYTHMAdminister one shock andresume CPR immediatelyfor two minutesFigure 412PALS – Pediatric Advanced Life SupportYESNO Resume CPR immediatelyfor two minutes Assess rhythm every twominutes Continue until moreadvanced help arrives oruntil the child shows signsof return to circulation
SELF-ASSESSMENT FOR BLS1. ou respond to a child or an infant that is found down. What is the next action afterYdetermining unresponsiveness?a.b.c.d.2.Which of the following describes the brachial pulse location?a.b.c.d.3.Wrist - thumb sideElbow - inside near forearmUpper arm - insideNeck - either side of the tracheaWhat is the two-rescuer CPR compression to breath ratio for children and infants?a.b.c.d.4.Apply AED.Tell a bystander to call 911.Look for a parent.Provide rescue breaths.30:215:230:515:5 ffective communication is key in all resuscitation attempts. Which of the following areEcomponents of effective team communication?a.b.c.d.Knowledge sharingClear communicationMutual respectAll of the aboveANSWERS1.BEarly activation is key. Send any available bystanders to call 911. Many pediatric cardiac arrestsituations are the result of a respiratory problem, and immediate intervention can be life-saving.2. CThe brachial pulse is located in the upper arm.3. B15:2 is the ratio now for all scenarios for children and infants.4. DAdditional components include clear messages, knowing one’s limitations, constructiveintervention, reevaluation, and summarizing.13PALS – Pediatric Advanced Life Support
4CHAPTERPEDIATRICADVANCEDLIFE SUPPORTNORMAL HEART ANATOMY AND PHYSIOLOGYUnderstanding normal cardiac anatomyand physiology is an important componentof performing PALS. The heart is a hollowmuscle comprised of four chamberssurrounded by thick walls of tissue(septum). The atria are the two upperchambers, and the ventricles are the twolower chambers. The left and right halvesof the heart work together to pump bloodthroughout the body. The right atrium (RA)and the right ventricle (RV) pumpdeoxygenated blood to the lungs whereit becomes oxygenated. This oxygen-richblood returns to the left atrium (LA) andthen enters the left ventricle (LV). The LV isthe main pump that delivers the newlyoxygenated blood to the rest of the body.QRSComplexRPPRSegmentSTSegmentTQBlood leaves the heart through a largePR IntervalSvessel known as the aorta. Valves betweeneach pair of connected chambers preventthe backflow of blood. The two atriaQT Intervalcontract simultaneously, as do theFigure 5ventricles, making the contractions of theheart go from top to bottom. Each beatbegins in the RA. The LV is the largest and thickest-walled of the four chambers, as it is responsiblefor pumping the newly oxygenated blood to the rest of the body. The sinoatrial (SA) node in the RAcreates the electrical activity that acts as the heart’s natural pacemaker. This electrical impulse thentravels to the atrioventricular (AV) node, which lies between the atria and ventricles. After pausingthere briefly, the electrical impulse moves on to the His–Purkinje system, which acts like wiring toconduct the electrical signal into the LV and RV. This electrical signal causes the heart muscle tocontract and pump blood.By understanding the normal electrical function of the heart, it will be easy to understandabnormal functions. When blood enters the atria of the heart, an electrical impulse that is sent outfrom the SA node conducts through the atria resulting in atrial contraction.14PALS – Pediatric Advanced Life Support
PEDIATRIC ADVANCEDLIFE SUPPORT4This atrial contraction registers on an electrocardiogram (ECG) strip as the P wave. This impulse thentravels to the AV node, which in turn conducts the electrical impulse through the Bundle of His,bundle branches, and Purkinje fibers of the ventricles causing ventricular contraction. The timebetween the start of atrial contraction and the start of ventricular contraction registers on an ECGstrip as the PR interval. The ventricular contraction registers on the ECG strip as the QRS complex.Following ventricular contraction, the ventricles rest and repolarize, which is registered on the ECGstrip as the T wave. The atria also repolarize, but this coincides with the QRS complex, and therefore,cannot be observed on the ECG strip. Together a P wave, QRS complex, and T wave at properintervals are indicative of normal sinus rhythm (NSR) (Figure 5). Abnormalities that are in theconduction system can cause delays in the transmission of the electrical impulse and are detected onthe ECG. These deviations from normal conduction can result in dysrhythmias such as heart blocks,pauses, tachycardias and bradycardias, blocks, and dropped beats. These rhythm disturbances willbe covered in more detail further in the handbook.A SYSTEMATIC APPROACHWhen you find an unresponsive child orinfant, it is often not possible toimmediately deduce the etiology. You willwant to act quickly, decisively, and applyinterventions that fit the needs of theindividual at that moment. In order to achievethis, PALS was designed for providers to take acomprehensive approach.While there are various causes for a child oran infant to become unresponsive, thecentral issues that need to be addressedinclude keeping blood pumping through thevasculature (perfusion) and supplying oxygento the lungs (oxygenation). When the child orinfant is experiencing poor perfusion andoxygenation, CPR manually takes over for theheart and lungs. If they are still adequatelymaintaining perfusion and oxygenation butare unresponsive, then rapid diagnosis andtreatment may be possible without CPR.YESIS THECHILD/INFANTRESPONSIVE?YESDIAGNOSEAND TREATNOIS ATHINGIS THERE ANADEQUATEPULSE?NOFigure 6STARTCPRIt is important to differentiate normal breathing from gasping (agonal breathing). Gasping isconsidered ineffective breathing.Likewise, not all pulses are adequate. The rule of thumb is that at least 60 beats per minute is requiredto maintain adequate perfusion in a child or an infant.The assessment must be carried out quickly. There is a low threshold for administering ventilationand/or compressions if there is evidence that the child or infant cannot do either effectively ontheir own.If the problem is respiratory in nature (ineffective breathing with adequate pulses), theninitiation of rescue breathing is warranted. If breathing is ineffective and pulses areinadequate, begin high-quality CPR immediately. It is important to understand that any casecan change at any time, so you must reevaluate periodically and adjust the approach totreatment accordingly. Use CPR to support breathing and circulation until the cause has beenidentified and effectively treated.15PALS – Pediatric Advanced Life Support
INITIAL DIAGNOSIS AND TREATMENTIf you have reached the initial diagnosis and treatment phase of care, the child or infant is not inimmediate danger of death. While this means that you likely have a brief period to find the cause ofthe problem and intervene with appropriate treatment, it does not mean that a life-threatening eventis impossible. Always be vigilant for any indication to initiate high-quality CPR and look forlife-threatening events such as respiratory distress, a change in consciousness, or cyanosis.The ILCOR recommends following the ABCDE method when making an initial assessment (Figure ure 7AIRWAYAssess the airway andmake a determinationbetween one of threepossibilities (Table 3).Once an airway hasbeen established andmaintained, move onto breathing.Is the airway open? This means open andunobstructed If yes, proceed to BreathingCan the airway be keptopen manually? Jaw-Lift/Chin-Thrust Nasopharyngeal ororopharyngeal airwayIs an advanced airwayrequired? Endotracheal intubation Cricothyrotomy, if necessaryTable 3BREATHINGIf the child or infant is notbreathing effectively, it is alife-threatening event andshould be treated asrespiratory arrest.However, abnormal yetmarginally effectivebreathing can be assessedand managed (Table 4).Is breathing too fastor too slow?Is there increasedrespiratory effort?Is an advanced airwayrequired? Tachypnea has an extensivedifferential diagnosis Bradypnea can be a sign ofimpending respiratory arrest Signs of increased respiratory effortinclude nasal flaring, rapidbreathing, chest retractions,abdominal breathing, stridor,grunting, wheezing, and crackles Endotracheal intubation Cricothyrotomy, if necessaryTable 416PALS – Pediatric Advanced Life Support
PEDIATRIC ADVANCEDLIFE SUPPORT4CIRCULATIONAssessment of circulation in pediatrics involves more than checking the pulse and blood pressure.The color and temperature of the skin and mucous membranes can help to assess effectivecirculation. Pale or blue skin indicates poor tissue perfusion. Capillary refill time is also a usefulassessment in pediatrics. Adequately, perfused skin will rapidly refill with blood after it is squeezed(e.g. by bending the tip of the finger at the nail bed). Inadequately perfused tissues will take longerthan two seconds to respond. Abnormally, cool skin can also suggest poor circulation.The normal heart rate and blood pressure in pediatrics are quite different than in adults and changewith age. Likewise, heart rates are slower when children and infants are asleep. Most centers willhave acceptable ranges that they use for normal and abnormal heart rates for a given age. While youshould follow your local guidelines, approximate ranges are listed in (Table 5).Table 517AGENORMALHEART RATE(AWAKE)NORMALHEART OLIC)Neonate85-19080-16060-7530-45 60One Month85-19080-16070-9535-55 70Two Months85-19080-16070-9540-60 70Three Months100-19075-16080-10045-65 70Six Months100-19075-16085-10545-70 70One Year100-19075-16085-10540-60 72Two Years100-14060-9085-10540-65 74Child(2 to 10 years)60-14060-9095-11555-75 70 (age x 2)Adolescent(over 10years)60-10050-90110-13065-85 90PALS – Pediatric Advanced Life Support
DISABILITYMay be sleepy, but still interactiveAWAKEIn PALS, disability refers toperforming a rapidneurological assessment. Agreat deal of information canbe gained from determiningthe level of consciousness ona four-level scale. Pupillaryresponse to light is also a fastand useful way to assessneurological function.RESPONDS TO VOICERESPONDS TO PAINUNRESPONSIVECan only be aroused by talkingor yellingCan only be aroused byinducing painCannot get the patient to respondTable 6Neurologic assessments include the AVPU (alert, voice, pain, unresponsive) response scale and theGlasgow Coma Scale (GCS). A specially-modified GCS is used for children and infants and takesdevelopmental differences into account (Tables 6 and 7).Glasgow Coma Scale for Children and InfantsAREA ASSESSEDEye-openingVerbalresponse Next: ExposureMotorresponseTable 718INFANTSCHILDRENSCOREOpen spontaneouslyOpen spontaneously4Open in response to verbal stimuliOpen in response to verbal stimuli3Open in response to pain onlyOpen in response to pain only2No responseNo response1Coos and babblesOriented, appropriate5Irritable criesConfused4Cries in response to painInappropriate words3Moans in response to painIncomprehensible words ornonspecific sounds2No responseNo response1Moves spontaneously andpurposefullyObeys commands6Withdraws to touchLocalizes painful stimulus5Withdraws in response to painWithdraws in response to pain4Responds to pain with decorticateposturing (abnormal flexion)Responds to pain with flexion3Responds to pain with decerebrateposturing (abnormal extension)Responds to pain with extension2No responseNo response1PALS – Pediatric Advanced Life Support
PEDIATRIC ADVANCEDLIFE SUPPORT4EXPOSUREExposure is classically most important when you are responding to a child or infant who may haveexperienced trauma; however, it has a place in all PALS evaluations. Exposure reminds the providerto look for signs of trauma, burns, fractures, and any other obvious sign that might provide a clue asto the cause of the current problem. Skin temperature and color can provide information about thechild or infant’s cardiovascular system, tissue perfusion, and mechanism of injury. If time allows, thePALS provider can look for more s
Las Vegas, NV 89104 Printed in the United States of America . Self-Assessment for BLS - 13 Pediatric Advanced Life Support . . . . . . . 14 Normal Heart Anatomy and Physiology - 14 . serious injury or illness, your action can be the difference between life and death. PALS is a series of
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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.
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PALS: A reading strategy for grades K-1. Retrieved on July 31, 2015. PALS Activities for First-Grade Students The first-grade teachers at Washington Elementary are excited to learn that PALS for first-grade is highly structured: The lessons are sequential, and the skills learned are cumulative. Additionally, it picks up where K-PALS leaves off.
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HeartCode PALS, the official AHA eLearning program, offers an alternative to the classroom-based AHA PALS course. HeartCode PALS offers a convenient method for obtaining an American Heart Association PALS course completion card, while practicing critical thinking skills and team dynamics to help improve the quality of patient care.
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with an illustration of a sword and the main road located to the west of Sutton 6 7 Part of Thomas Jeffrey’s 1771 map of Yorkshire 6 8 Locations of the geophysical survey grid and the excavation trench 7 9 Results of the electrical earth resistance survey of the area across Old London Road, Towton 8 10 Results of geophysical survey shown superimposed over an aerial photograph 9 11 Electrical .
