CPRCPR

1.1. What is the correct What is the correct compression/ventilation ratio for all compression/ventilation ratio for all ages?ages?

2.2. Is there an exception to this rule?Is there an exception to this rule?

CPRCPR

1.1. 30:230:2

2.2. Yes—15:2 for infants and children Yes—15:2 for infants and children with 2 health care providerswith 2 health care providers

CPRCPR

Interruptions to chest compressions Interruptions to chest compressions should be limited to how long?should be limited to how long?

CPRCPR

<10 seconds (unless necessary to <10 seconds (unless necessary to intubate or perform another intubate or perform another “advanced” skill)“advanced” skill)

CPRCPR

Why is it important to allow for Why is it important to allow for complete chest recoil when complete chest recoil when performing compressions?performing compressions?

CPRCPR

It maximizes venous return of blood to It maximizes venous return of blood to the heartthe heart

ACLSACLS

List at least 5 signs or symptoms you would associate with “symptomatic” bradycardia.

ACLSACLS

• Chest pain

• SOB

• “Wet” lung sounds (why?)

• Cool, clammy skin

• Decreased LOC

• Hypotension

• Weakness or fatigue

ACLSACLS

List 5 signs or symptoms you would associate with “symptomatic” tachycardia.

ACLSACLS

• Chest pain• SOB• “Wet” lung sounds (why?)• Cool, clammy skin• Decreased LOC• Hypotension• Weakness or fatigue

Does this list look familiar?!

ACLSACLS

What is the treatment regimen (including doses) for symptomatic bradycardia?

ACLSACLS

• ABC’s (don’t forget them!)

• O2, IV, monitor

• TCP (increase mA until capturing)

• Atropine (0.5 mg doses up to 3 mg. max)

• Dopamine (2-10 mcg/kg/min)

• Epi (2-10 mcg/min)

ACLSACLS

List 5 H’s to consider as reversible causes

ACLSACLS

• Hypovolemia

• Hypoxia

• Hypo/hyperkalemia

• Hypoglycemia

• Hypothermia

• Hydrogen ion (acidosis)

ACLSACLS

What is the treatment plan (including doses) for narrow complex regular tachycardia with pulses?

ACLSACLS

• ABC’s

• O2, IV, monitor

• Vagal maneuvers

• Adenosine (6 mg, followed by 12 mg, and another 12 mg)

• Cardioversion if patient is symptomatic

ACLSACLS

List 5 T’s to consider as reversible causes

ACLSACLS

• Toxins

• Tamponade

• Tension pneumothorax

• Thrombosis (coronary or pulmonary)

• Trauma

ACLSACLS

After determining that a patient is pulseless and not breathing and in VF/VT, list the treatment sequence

ACLSACLS

• 1 shock

• CPR x2 minutes

• Intubation and IV if not already done

• Epi 1 mg or Vasopressin 40 U

• Re-analyze rhythm and shock PRN

• Amio 300 mg or lidocaine 1.5 mg/kg

ACLSACLS

After determining that a pulseless, non-breathing patient is in asystole, list the treatment sequence

ACLSACLS

• Intubation and IV if not already done

• CPR x2 minutes

• Epi 1 mg or Vasopressin 40 U

• Atropine 1 mg (up to 3 total doses)

• Check EKG cables and leads, complex size

• Consider termination of efforts

PALS

What is the defibrillation dosing sequence for pediatric patients?

PALS

2 joules/kg, followed by 4 joules/kg, followed by 4 joules/kg

PALS

What is the “normal” fluid bolus to use for hypotensive infants or children?

PALS

20 cc/kg

PALS

What is the formula for determining “normal” BP for children over age 1?

PALS

(Age [in years] x 2) + 70

PALS

What is the formula for determining uncuffed ETT size in pediatrics?

Cuffed tubes?

PALS

• (Age [in years] divided by 4) + 4 (uncuffed)

• (Age [in years] divided by 4) + 3 (cuffed)