Palsnotes

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Palsnotes

  1. 1. PEDI ADVANCE LI SUPPORT ATRIC FE Head Tilt-Chin Lift (Jaw-Thrust)/Oral Airway/ A IRWAY AIR Oral Size(angle of mouth to angle of mandible)/ Insert propertly Naso-Pharyngeal (Shortened E.T.Tube) Use E.T. tube/Size (Tip of nares to tragus of ear) in Conscious or semiconscious P WAY Nasal Unmaintainable & Requiring Interventions Assemble Equipment/Select proper size blade & tube/Insert/Fix/Check EI A Intubation / Removal of F.B / Cricothyrotomy Blade size (Angle of mouth to adam's apple) /Fit properly/Check bulb & cells NN Tube Size (age/4+4, little finger's size)/Assemble 3 tubes+ 0.5/ B POTENTIAL RESPIRATORYinFAILURE (Alert child experiencing L D Length (sizeX3 or age/2+12) Uncuffed (<8yr)/Fix properly DT respiratory distress) : Supplement oxygen non-threatening manner(blow by stream Check B/L Chest movements/B/L/ Breath sound Chest, abdomen/ S held by parent’s towards the child mouth & nose) /position of comfort (in parent’s arm) R OU Direct Visualisation/Clinical improvement. Compli- D.O.P.E. Displaced Obstructed Pneumothorax Equipment failure TB DEFINITE RESPIRATORY FAILURE (When potential failure E patient fails to improve after therapy or further deteriorates) : Maintain patent Airway/ cation Sequence of checking the problem: Asymetrical movement & R B/S (withdraw tube slightly) /Movement & B/S/ absent, B/S/ present AA Give maximum Supplemental oxygen providing 100% O by total Non-Rebreathing Mask, 2 on stomach (Direct visualisation - Displaced tube -- Relntubate)/ A Anaesthesia mask or Bag & Mask / Alongwith treat shock if present. C CT Check Equipment (Oxygen source, leakage in Bag & mask. De- SLOW OR IRREGULAR RESPIRATION : (Causes are fatigue, HI press pop off value, give more pressure, check airleak) /Do suction o T carefully timed to augment the child inspiratory effort/Consider intubation. Quickest (for Obstruction)/Needle thoracostomy(for Pneumothorax) Hypothermia and C.N.S. Depression) : Give assisted ventilation with Bag & Mask E AO Way u Extubate --- Bag & mask --- Relntubate ---- Needle Thoracostomy H RESPIRATORY ARREST : Treat with Bag & Mask & Intubate Drugs L.A.N.E. Lidocaine --- Atropine -- Naloxone --- Epinephrine LN r Used Via Dose: Epi (10 times i.v.) Rest all (2-3 times) Dilute in 3-5 ml N.S. I BAG AND MASK VENTILATION : Check leakage/Select proper s BREATHING Nasal Cannula & Prong (1-5L --- 20-30%) Mask & Venturi Mask size mask/Make airtight seal/proper positioning of head & neck/ (5-10L --- 35-60% )High conc (Partial Rebreathing) Mask (10-12 DEVICE e Sellick’s Maneouver (minimises gastric inflation & passive regurgitation) N INEFFECTIVE VENTILATION : Reposition head/Reapply mask/suction/Give L-- 50-60%) Non Rebreathing Mask (10-12 L---95%) Oxygen Hood (10-15 L --- 80-90%) Anaesthesia Bag (15 L---- 100%) 100% O2 Devices- (1) Anaesthesia bag (2) Non-Rebreathing Mask (3) Bag & Mask G more pressure/Bypass pop off valve/Check leakage & O Source/Put nasogastric tube 2 CIRCULATION DRUGS - Ready Reference HYPOTENSION : 60 (0-1 mo) 70 (1mo-!yr) 70+ {ageX2} (>1yr) (For 1 in 10,000)-Dilute 1ml. in 10 ml. D.W. Then calculate dose. Epinephrine P TACHYCARDIA : >180 (5yr) >160 (>5yr) BRADYCARDIA : <80 (<5yr) <60 (>5yr) FIRST DOSE: 0.1 ml/kg of diluted drug (1 in 10,000) Available only as A NEXT DOSE: 0.1ml/kg of undiluted drug (1 in 1000) 1 in 1000 E.T. Route: 0.1ml/kg of undiluted drug (Dilute in 3-5ml of N.S. & ARRYTHMIAS Recognise UNSTABLE RHYTHM & treat only UNSTABLE PATIENT. L 1ml=1mg give through tube & give several positive pressure ventilation) Narrow Complex (SVT) Adenosine(i.v.) UNSTABLE (Rule out sinus tachy) S TACHY DOSE: 0.035ml/kg or app. 1.5 units/k (of 40 units insulin syr) CARDIOVERSION ATROPINE Patient in (For quick calculation: 1.5 times the weight in units) Wide Complex (V.T.) Lidocaine(i.v.) shock/arrest Minimum Single Dose: 0.2ml (0.1mg)- for upto 5kg of weight C 1ml = 0.6mg BRADY Any type (<60/min) { PATIENT Treat Hypoxia Maximum Single Dose: 1ml (0.5mg-Child) 1.8ml (1mg-Adol) Dose 0.02mg/k o Epi / Atropine Repeat Dose: Can be repeated only once after 5 min. { Asystole ABSENT u Epineph(1 in 10000) Pulseless Electrical Activity (Hypoxia, Shock, Acidosis, LIDOCAINE Dose in ml: 0.05ml/kg or app 2 units/kg (of 40 units syr) Epineph(1 in 1000) P U LS E Hypothermia, Cardiac Temponade, Pneumothorax, Elec lmbalance) r (For quick calculation: Twice the weight in units) 1mg/k (1ml=21.3mg) (Treat cause of PEA) Repeat every 3-5min { VT s Defibrillation (3times) VF 2,4,4 Joules/K e Rate & amount of fluid can be altered if needed e.g. Dilute same amount in 500 ml INFUSIONS: fluid or use 1/5th amount of drug in 100ml and increase the drip rate to 5 times. Epineph(1 in 10000) { SHOCK Tachycardia/Capillary Refill time/peripheral pluse/skin temp, Color Defibrillation (4 J/kg) (Compensated) mottling/CNS perfusion (decrease consciousness, Pupil,Muscle tone) Epinephrine 1mk/ml Add 0.6Xwt. in ml (mg) or pre calculated dose in 100ml of fluid Uncompensated- All the above along with HYPOTENSION Lidocaine (1mg/kg) (0.1-1ug/kg/min.) D F L U I D R A T E : 1 ml - 1 0 m l / h r w i l l g i v e 0 . 1 - 1 u g / k g / m i n TREATMENT- I.V. bolus of 20 ml/kg of Normal Saline or Ringer Lactate. Dopamine 1ml=40mg Add 6Xwt. in ml or 0.15Xwt in ml or pre calculated dose in 100ml Defibrillation (4 J/kg) R 5-20ug/kg/min. F L U I D R A T E : 5 m l- 2 0 m l / h r w i l l g i v e 5 - 2 0 u g / k g / m i n o f d r u g . Dobutamine TRAUMA RESUSCITATION : Neutral Head position/Jaw thrust/suction/100% 1ml=25mg Add 6Xwt in mg or 0.25Xwt in ml or pre calculated dose in 100 ml U Epineph(1in1000) 5-10ug/kg/min. FLUID RATE : 5ml - 10ml/hr will will give 5-10ug.kg/min of drug. Qxygen/Hyperventilation/E.T. Intubation (Thoraco-Abdominal examination) Control Bleeding, G Continue Defibrillation Lidocaine 1ml=21.3 add 6Xwt in mg or 0.28Xwt in ml or pre calculated dose in 100 ml Needle Thoracostomy (if sings of shock) Give bolus 20ml/kg - reasses & repeat-reasses & after either Epi or Lido 20-50ug/kg/min. FLUID RATE : 20ml-50ml/hr will give 20-50ug/kg/min of drug. S give o-ve blood - reasses & Laprotomy/ Cervical Immobilisation/N.G. tube decompression. (Bretylium can also be used) (Alternative 6 ml in 100ml will give 1ml/k/hr=20ug/k/min) Cardioversion Defibrillation WEIGHT Ca.gluconate Naloxone Epineph POSTARREST STABILISATION Atropine Lidocaine A Length INFUSIONS 1ml=0.4mg E.T. 1ml=9mg Height G ML of druge in 100 ml. TUBE (ICMR) EVALUATION VENTILATION : Clinical/Pulse oximetry/transcutaneous O2/arte- E app. EPI Size Length 1ml=1mg DOPA DOBUT =21.3mg LIDO rial blood gases.CVS : Continious ECG for H.R. & Rhythm/B.P. (every 5 min until =40mg =25mg Yr. Kg. Cm. mL mL mL mm cm mL mL mL mL Joule Joule mL mL stable then every 15 min.). Peripheral Circulation : Skin Temp./Cap refill/distal Pulse/ level of consciousness/urine out put CNS : Responsiveness/Pupil size/respone to light/ NB 3 45-50 0.3 0.2 0.15 3 9 1.8 0.5 0.75 0.8 1.5 6 0.75 2 Spon movement/movement in response to pain/ability to follow commands. 3mo 5 55-60 0.5 0.2 0.25 4 10 3 0.75 1.25 1.4 2.5 10 1.5 4 LAB EVALUATION : Electrolytes/Calcium/Glucose/Hematocrit/Arterial blood gases (every 10-15 min. of changed setting)/urea/creatinine/X-Ray chest for heart size. 6mo 7 63-67 0.7 0.25 0.35 4 10 4.2 1 1.75 2 3.5 14 2 5 GENERAL MEASURES 2 large bore functional vascular catheters Humidified oxygen of highest conc Preserve core temp. (overhead heating units, 1-2y 10 75-80 1 0.35 0.5 4.5 12 6 1.5 2.5 2.8 5 20 2.5 7 lamps, Incubators, covering head, blankets, etc.) Calculatate proper fluid require- 3yr 12 85-90 1.2 0.4 0.6 5 14 7.2 1.8 3 3.5 6 24 3 9 ment (use N/4 Saline) Put naso or orogastric tube to prevent gastric distention. Search for ppt causes of disease & give treatment (e.g. antibiotics). If significant 5yr 15 95-100 1.5 0.5 0.75 5.5 15 9 2.3 3.75 4.2 7.5 30 4 11 CNS depression: Intubate & Hyperventilate with PaCO2 maintained at 22-29mm Hg until intracranial pressure can be evaluated. Sedation if needed. (to minimise 7yr 20 115-120 2 0.7 1 5.5 15 12 3 5 5.5 10 40 5 14 the risk of ET displacement) Diazepam 0.1-0.2 mg./K iv, Morphine 0.1 mg/K iv. Initial Ventilator Setting 100% oxygen/Tidal vol. 10-15 ml/K/Inspiratory time 0.5-1 9yr 25 125-130 2.5 0.9 1.25 6 16 15 3.8 6.25 7 12.5 50 5 18 Sec/Peak inspiratory Pressure 20-30 cm/RR - 20-30 (in) 16-20 (ch)/PEEP 2-4 cm 11yr 30 135-140 3 1ml 1.5 6.5 17 18 4.5 7.5 8.5 15 60 5 22 Compiled by : DR. SUKHMEET SINGH (LUDHIANA) for P.A.L.S Group Adol 45 155-160 4.5 1.8 2 7,8 20 27 7 11 12.5 25 90 5 30 Visit online : www.geocities.com/sssukhmeet/pals_nals.html

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