12/05/2016
NAEMT Prehospital Trauma Life Support Refresher Course December 12, 2016 (INCLUDES 8th Edition Provider Manual E-Book) from 9 Am to 5 PM at Saving… - Amanda Roszko - Google+
AHA ACLS Advanced Cardiac Life Support
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American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) is an advanced, instructor-led classroom course that highlights the importance of tea LOL!
We have American Heart Association Classes for:
Advanced Cardiac Life Support (ACLS) Initial Certification Class (This course is for Healthcare Providers who have never taken the course, or who's certification has been expired for more than 30 days). Advanced Cardiac Life Support (ACLS) Renewal classes (This course is for Healthcare Providers who are currently certified and not expired, or who have expired within the last 30 days). Advanced Cardiac Life Support (ACLS) Heartcode Parts 2 and 3 Hands On skills sessions (This is for people who have taken the course online, but still need to take the hands on testing to be certified). Advanced Cardiac Life Support (ACLS) Challenge Course (This course is for healthcare providers that are currently certified and not expired who wish to simply test out to receive certification. They make an appointment, take the written and hands on test without watching the video. This typically takes about 2 hours). Advanced Cardiac Life Support (ACLS EP) Initial Certification and Recertification Courses
Basic Life Support for Healthcare Providers (BLS) Initial Certification Class (This course is for Healthcare Providers who have never taken the course, or who's certification has been expired for more than 30 days). Basic Life Support for Healthcare Providers (BLS) Renewal classes (This course is for Healthcare Providers who are currently certified and not expired, or who have expired within the last 30 days). Basic Life Support for Healthcare Providers (BLS) Heartcode Parts 2 and 3 Hands On skills sessions (This is for people who have taken the course online, but still need to take the hands on testing to be certified). Basic Life Support for Healthcare Providers (BLS) Challenge Course (This course is for healthcare providers that are currently certified and not expired who wish to simply test out to receive certification. This typically takes about 1 hour). Pediatric Advanced Life Support (PALS) Initial Certification Class (This course is for Healthcare Providers who have never taken the course, or who's certification has been expired for more than 30 days). Pediatric Advanced Life Support (PALS) Renewal classes (This course is for Healthcare Providers who are currently certified and not expired, or who have expired within the last 30 days). Pediatric Advanced Life Support (PALS) Heartcode Parts 2 and 3 Hands On skills sessions (This is for people who have taken the course online, but still need to take the hands on testing to be certified). Pediatric Advanced Life Support (PALS) Challenge Course (This course is for healthcare providers that are currently certified and not expired who wish to simply test out to receive certification. CABS Child and Babysitting Safety Program Certification
NRP Neonatal Resuscitation Program Initial and Recertification Courses
ECG & Pharmacology Certification - Always FREE Courses twice a month
PEARS Pediatric Emergency Assessment, Recognition and Stabilization
Here are the Preliminary Release Dates for 2015 AHA Guidelines Changes
2015 October 15, 2015
• ILCOR Consensus on Science
• 2015 AHA Guidelines for CPR and ECC
• AHA/Red Cross Guidelines for First Aid
November/December
• 2015 Guidelines Highlights (PDF and eBook)
• 2015 Guidelines Highlights Translations (17 languages)
• Handbook for ECC for Healthcare Providers (PDF and eBook)
• Science In-Service
• Instructor Update Conference at ReSS/SS (November 6, 2015)
2016 January/February
• Basic Life Support (BLS) Blended Learning
• BLS Resuscitation Quality Improvement (RQI™) (Module 2) March/April
• BLS Classroom
• Heartsaver® First Aid CPR AED Blended Learning
• Heartsaver® First Aid CPR AED Classroom
• Heartsaver® Pediatric First Aid CPR AED Blended Learning
• Heartsaver® Automated Training Solution (ATS)
• Advanced Cardiovascular Life Support (ACLS) Classroom
• HeartCode® ACLS
• CPR Anytime® Adult/Child
• Infant CPR Anytime®
• CPR in Schools Training Kit™
2016 May/June
• Resuscitation Quality Improvement (RQI™)
• Heartsaver® Pediatric First Aid CPR AED
• Heartsaver® Bloodborne Pathogens
• Family & Friends® CPR
2016 July/August
• Pediatric Advanced Life Support (PALS) Classroom
• HeartCode® PALS
• Pediatric Emergency Assessment, Recognition and Stabilization (PEARS®)
Welcome to our American Heart Association Life Support Training Classes! Our class minimum is ONE! We will provide one on one classes just for you, at no extra charge. We have multiple ways for you to learn that are specifically tailored just for YOUR NEEDS. We use videos, color association, pictures, and lots of hands on practice so that you are confident and comfortable. We provide tons of candy, coffee, snacks, popcorn, hot chocolate and bottled water. We want you to feel at home! You can take your written test with crayons too! Come have FUN with us! Our classes in a fun exciting atmosphere! IF you are terrified of coming to class, then why don't you audit the class? You can come in for FREE, sit through the class and if you feel like testing, then you can. If you pass, then you can pay for the course. If you don't want to take the written and hands on tests, then you are free to come back on another day and study a little more on your own before taking the tests, and if you really feel like you want to sit through the class again before testing, you can sit through it as many times as you want. There is no charge at all to audit our classes. You just need to let us know the date and which class and that you would like to audit it. We'll still send you our free study guides, just tell us which ones you want, or if you want them all. Email us at admin@savingamericanhearts and we'll send them to you asap. Class doesn't have to be hard and miserable. You don't have to dread coming to class, and you don't have to feel stupid asking a question, or be humiliated! You really can have an amazing time, and you'll be surprised at how much more you will learn and how much fun you had! Our classes are taught in a FUN STRESS FREE ENVIRONMENT! DID YOU KNOW? If your certification is current, and not expired by a single day, then you have the option to "challenge" a course. This must be done 1:1 with the instructor so you'll have to make a special appointment for a 2 hour time slot for ACLS and PALS, and at least 1 hour for BLS. To "challenge" a course, you'll come in, take the written test and score at least 84% on your first attempt. Then perform well on the hands on skills testing and you're done! We have awesome study guides for every class! You can email me and request them and I will send them to you asap. The study guides are free and are intended to be supplements to the provider manual, not a substitute for the provider manuals. To request a study guide, just let me know which one, or if you want them all, and email admin@savingamericanhearts.com. We are located near the intersection of Lehman and Academy in North East Colorado Springs at 6165 Lehman Drive Suite 209 Colorado Springs, Colorado 80918. Our phone number is (719) 551-1222 and our email is admin@savingamericanhearts.com
Do you need a personalized 1:1 class where you can ask any question you want in privacy? We can help! We do one on one classes no extra charge! Our class minimum is one! We provide private classes, last minute ACLS certification, PALS or BLS, and NRP Certification, on weekends, holidays, in an emergency or at night. Whatever your class needs are, we are here for you! Stop stressing over the ACLS or PALS Megacode! ACLS 2013 Megacode Scenarios are posted to the left, right out of the 2010 Guidelines Instructor Manual! Come learn with us and have fun! You'll master all the skills you need to successfully run an ACLS or PALS megacode in a friendly, relaxed, stress free FUN classroom environment! We have slumber party classes too! You are required to attend certain classes in your pajamas and bring a pillow and sleeping bag. We'll be laying on the floor with the lights out eating popcorn and drinking starbucks and hot chocolate while we watch the AHA movies on the ceiling! We always bring candy to class and if you can eat ALL OF IT, before the end of class, YOUR CLASS IS FREE! I've tried, gotten a tummy ache, and just can't do it! All of our classes are taught in a manner that makes learning FUN! I also let you take your written test with crayons! Yes, crayons! Don't worry ! You will Master all the skills to successfully run a code as a team leader, and be 100% confident! Don't hesitate to call me, text or email any questions you have. Don't be afraid to ask a question. All of my courses will leave you feeling like "This was a piece of cake! I wish I had done this sooner! I learned more than I ever have in any other class and I actually had fun! I can't believe I actually enjoyed it!"
We take great pride in our Stress Free approach to training. We teach in a manner that is conducive to learning in a non-threatening atmosphere, which promotes better understanding of the material.
03/20/2016
Welcome to the Advanced Cardiac Life Support Instructor Course ACLS Instructor Course - Please read all of this information before purchasing your course. The cost of this course is $350. You can pay
01/11/2016
AHA ACLS Advanced Cardiac Life Support Renewal March 9, 2016 9 AM to 3 PM at the Trump International Hotel & Tower Chicago 401 N. Wabash Ave, Chicago, IL 60611. Advanced Cardiac Life Support ACLS is an
01/11/2016
AHA ACLS EP Advanced Cardiac Life Support for Experienced Providers March 10, 2016 at the Detroit Marriott Renaissance Center 400 Renaissance Drive West Detroit, MI 48243 Catherine Brinkley (719)
01/11/2016
AHA ACLS EP Advanced Cardiac Life Support for Experienced Providers March 24, 2016 Brooklyn, NY http://www.savingamericanhearts.com/may2320ahaac.html
01/11/2016
AHA ACLS EP Advanced Cardiac Life Support for Experienced Providers March 8, 2016 Chicago, IL http://www.savingamericanhearts.com/ahaacepadcal14.html
01/11/2016
AHA Advanced Cardiac Life Support ACLS Update also known as Advanced Cardiac Life Support ACLS Recert or Advanced Cardiac Life Support ACLS Renewal Course. The cost of this course is $200. Please
12/06/2015
AHA 1 Day ACLS Advanced Cardiac Life Support Initial Certification Course December 10, 2015 from 9 AM to 9 PM at Saving American Hearts 6165 Lehman Drive Suite 209 Colorado Springs, Colorado 80918.
Catherine Brinkley
(719) 551-1222
admin@savingamericanhearts.com
http://www.savingamericanhearts.com
Advanced Cardiac Life Support (ACLS) Initial Certification class of the American Heart Association is an advanced, instructor-led classroom course that highlights the importance of team dynamics and communication, systems of care and immediate post-cardiac-arrest care.
We will teach you all the information you need to successfully manage a cardiac arrest, respiratory arrest, heart attack and stroke.
This course is designed for healthcare providers who conducts or participates in resuscitation of patients in hospital, medical offices, or in settings where conscious sedation is administered and has not previously taken this course or one who has not taken it for over two years. It covers identification and treatment of patients with medical conditions who are at risk for cardiac arrest, primary and secondary assessment survey and actions needed, algorithms for treatment of emergency situations and effective resuscitation team dynamics.
You must purchase the current provider manual and bring it with you to class. The current provider manual is the 2010 Guidelines. The book can be purchased from a number of places online such as E-bay, Valore books and Amazon. You are free to purchase the book from whomever you choose.
Although arrhythmia recognition will be reviewed, it is expected that the participant will have a working knowledge of EKG rhythms. Practice with defibrillators and external pacemaker is included. Assessment and care for the patient experiencing an Acute Coronary Syndrome or Stroke will be included in this course.
We structure this class to meet all of the AHA guidelines and requirements. All scenarios are designed for the work place of the individual participant. Our goal is that each participant will feel comfortable in handling life threatening emergencies in their own setting.
You'll learn the ACLS Algorithms, drug dosages and usage, how to successfully perform cardioversion, defibrillate and perform external pacing as well as basic CPR, using a bag mask device and an AED.
The course includes watching the Advanced Cardiac Life Support (ACLS) full course video, learning stations for Basic Life Support (BLS), CPR and the use of an AED.
You will actively participate in the learning stations for the Advanced Cardiac Life Support (ACLS) algorithms, review of medications used in Advanced Cardiac Life Support, how to manage respiratory emergencies and insert and manage advanced airway devices.
You will practice hands on techniques before taking the written exam and the hands on skills testing portion of the class.
At the end of the class you will take a written test of 50 questions and successfully perform as a team leader in a case scenario.
Upon completion of the course, learners will receive an American Heart Association ACLS Provider course completion card via mail from our American Heart Association training center within 5-7 days.
Skills to be practiced during the course include:
• BLS and ACLS Surveys
• Airway Management
• Rhythm Recognition
• Defibrillation
• IV Access (information only)
• Use of Medications
• Cardioversion
• Transcutaneous Pacing
• 1-rescuer CPR and AED
• Team Resuscitation Concept (Team Leader and Team Member)
• Immediate Post-Cardiac Arrest Care
• 1-Rescuer CPR and AED use
• Science Overview (Update Course)
• Team Dynamics
• Respiratory Arrest
• Peri-arrest Rhythms (Tachycardia, Bradycardia)
• Arrest Rhythms (VF, PVT, PEA, Asystole)
• Acute Coronary Syndromes (ACS)
• Stroke
• Megacode treatment
• Basic life support skills, including effective chest compressions, use of a bag-mask device and use of an AED
• Effective communication as a member and leader of a resuscitation team
• Effective Resuscitation Team Dynamics
• Management of acute coronary syndromes (ACS) and stroke
• Recognition and early management of peri-arrest conditions such as symptomatic bradycardia
• Recognition and early management of respiratory and cardiac arrest
• Related pharmacology
The American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) Course is designed to teach you the lifesaving skills required to be both a team member and a team leader in either an in-hospital or an out-of-hospital setting.
Because the Advanced Cardiac Life Support (ACLS) Course covers extensive material in a short time, you will need to prepare for the course beforehand.
Pre-course Requirements
You should prepare for the course by doing the following:
1. You must purchase the ACLS provider manual for this course and bring it with you to class.
2. Complete the pre-course preparation checklist that came with your American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) Provider Manual. Bring the checklist with you to the course.
3. Review and understand the information in your American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) Provider Manual. Pay particular attention to the 10 cases in Part 5.
4. The resuscitation scenarios require that your BLS skills and knowledge are current. You will be tested on 1-rescuer adult CPR and AED skills at the beginning of the American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) Provider Course.
5. Review, understand, and complete the ECG and Pharmacology Pre-course Self-Assessment on the Student Website (www.heart.org/eccstudent).
6. Print your scores for the Pre-course Self-Assessment and bring them with you to class.
What to Bring and What to Wear
Bring your American Heart Association (AHA) Advanced Cardiac Life Support (ACLS) Provider Manual to each class. You will need it during each lesson in the course. Please wear loose, comfortable clothing to class. You will be practicing skills that require you to work on your hands and knees, and the course requires bending, standing, and lifting.
If you have any physical condition that might prevent you from engaging in these activities, please tell an instructor. The instructor may be able to adjust the equipment if you have back, knee, or hip problems.
The course is taught in a STRESS FREE, FUN environment. I want you to leave class feeling like you're glad you came, you learned a lot and you ACTUALLY HAD FUN !!!
You will MASTER all the skills you need to run a code and learn all the rhythms and drugs to treat them. IT'S A PIECE OF CAKE !!! STRESS FREE ! FUN !!
If you have any questions about the course, please call Catherine Brinkley RN at (719) 551-1222. http://www.savingamericanhearts.com/ahaadcalisua9.html
Nursing Education
Emergency Services
Acls Instruction
11/07/2015
Pediatric Advanced Life Support PALS Skills Session Heartcode PALS Parts (2 & 3) Dec 6, 2015 4 PM to 6 PM at Saving American Hearts 6165 Lehman Drive Suite 209 Colorado Springs, Colorado 80918 Catherine Brinkley (719) 551-1222 admin@savingamericanhearts.com
You must bring your Heartcode PALS Part 1 completion certificate with you to class. Heartcode PALS Part 1 is the online course. Parts 2 and 3 is the skills session portion of the course.
The cost of this course is $100. Please register and pay for your class at: http://www.savingamericanhearts.com/peadlisupsks.html
This is a hands on skill practice and testing course.
You will first practice, and then be tested on:
1 and 2 rescuer infant and child CRP using a bag mask device and an AED
Intraosseous access (I/ O access)
Fluid bolus administration using a syringe and stop-cock device
You will then practice and be tested on the following Core Case Scenarios
You must successfully complete all skills competencies above and 1 cardiac or rhythm disturbance case and 1 respiratory or shock case.
Upon successful completion of all 3 parts of the course you will receive your American Heart Association PALS Provider card via regular mail issued by your instructor's training center.
If you will send me an email to admin@savingamericanhearts. com and request the core case scenarios I will email them to you. These are the cases from your provider manual or your online course.
____________________________________________________________
Learning Station Competency Checklists For Pediatric Advanced Life Support AHA 2010 Guidelines
____________________________________________________________
Respiratory Learning Station Competency Checklists
Core Case 1 Upper Airway Obstruction
Use this checklist during the PALS core case simulations and tests to check off the performance of the team leader.
CRITICAL PERFORMANCE STEPS DETAILS
TEAM LEADER
Assigns team member roles
Uses effective communication throughout
Closed-loop communication
Clear messages
Clear roles and responsibilities
Knowing limitations Knowledge sharing Constructive intervention Reevaluation and summarizing
Mutual respect
PATIENT MANAGEMENT
Directs assessment of airway, breathing, circulation Team leader directs or performs assessment to determine disability, and exposure, including vital signs responsiveness, breathing and pulse
Team leader directs manual airway maneuver and administration of 100% oxygen
Team leader directs that pads/ leads be properly placed and that monitor be turned onto an appropriate lead; requests use of pulse oximetry
Team leader verbalizes features of history and exam that indicate upper airway obstruction
Team leader verbalizes whether patient is in respiratory distress or failure
Team leader verbalizes that for patient with ineffective ventilations or poor oxygenation, assisted ventilations are required
Directs IV or IO access
Team leader directs team member to place IV (or IO) access, if appropriate; placement simulated properly
Directs reassessment of patient in response to treatment Team leader directs team member to reassess airway, breathing and circulation
CASE CONCLUSION
Team leader summarizes specific treatments for upper airway obstruction (IM epinephrine, racemic epinephrine, CPAP)
If scope of practice applies: Verbalizes indications for endotracheal intubation (child unable to maintain adequate when intubation is anticipated airway, oxygenation, or ventilation despite initial intervention).
Notes need to anticipate use of an ET tube smaller than predicted for age, especially is subglottic narrowing is suspected.
____________________________________________________________
Core Case 2 Lower Airway Obstruction
Use this checklist during the PALS core case simulations and tests to check off the performance of the team leader.
CRITICAL PERFORMANCE STEPS DETAILS
TEAM LEADER
Assigns team member roles
Uses effective communication throughout
Closed-loop communication
Clear messages
Clear roles and responsibilities
Knowing limitations Knowledge sharing Constructive intervention Reevaluation and summarizing
Mutual respect
PATIENT MANAGEMENT
Directs assessment of airway, breathing, circulation Team leader directs or performs assessment to determine disability, and exposure, including vital signs airway patency, adequacy of breathing and circulation, level of responsiveness, temperature and vital signs
Team leader directs manual airway maneuver and administration of 100% oxygen
Team leader directs that pads/ leads be properly placed and that monitor be turned onto an appropriate lead; requests use of pulse oximetry
Recognizes signs and symptoms of lower airway obstruction
Team leader verbalizes features of history and exam that indicate lower airway obstruction
Categorizes as respiratory distress or failure
Team leader verbalizes whether patient is in respiratory distress or failure
Verbalizes indications for assisted ventilations Team leader verbalizes that for patient with ineffective ventilations or poor oxygenation, assisted ventilations are required
Directs IV or IO access Team leader directs team member to place IV (or IO) access, if appropriate; placement simulated properly
Directs reassessment of patient in response to treatment Team leader directs team member to reassess airway, breathing and circulation
CASE CONCLUSION
Summarizes specific treatment for lower airway obstruction Team leader summarizes specific treatments for lower airway obstruction (nebulized albuterol)
If scope of practice applies: Verbalizes indications for endotracheal intubation and special considerations (child unable to maintain adequate when intubation is anticipated airway, oxygenation, or ventilation despite initial intervention).
_____________________________________________________________
Core Case 3 Lung Tissue Disease
Use this checklist during the PALS core case simulations and tests to check off the performance of the team leader.
CRITICAL PERFORMANCE STEPS DETAILS
TEAM LEADER
Assigns team member roles
Uses effective communication throughout
Closed-loop communication
Clear messages
Clear roles and responsibilities
Knowing limitations Knowledge sharing Constructive intervention Reevaluation and summarizing
Mutual respect
PATIENT MANAGEMENT
Directs assessment of airway, breathing, circulation
Team leader directs or performs assessment to determine disability, and exposure, including vital signs airway patency, adequacy of breathing and circulation, level of responsiveness, temperature and vital signs
Team leader directs assisted ventilation with administration of 100% oxygen
Ensures that bag-mask ventilations are effective
Team leader observes or directs team member to observe for chest rise and breath sounds
Directs placement of pads/ leads and pulse oximetry
Team leader directs that pads/ leads be properly placed and that monitor be turned onto an appropriate lead; requests use of pulse oximetry
Recognizes signs and symptoms of lung tissue disease
Team leader verbalizes features of history and exam that indicate lung tissue disease
Categorizes as respiratory distress or failure
Team leader verbalizes whether patient is in respiratory distress or failure
Verbalizes indications for assisted ventilations Team leader verbalizes that for patient with ineffective ventilations or poor oxygenation, assisted ventilations are required
Directs IV or IO access
Team leader directs team member to place IV (or IO) access, if appropriate; placement simulated properly
Directs reassessment of patient in response to treatment Team leader directs team member to reassess airway, breathing and circulation
CASE CONCLUSION
Summarizes specific treatment for lung tissue disease
Team leader summarizes specific treatments for lung tissue disease (antibiotics for suspected pneumonia)
If scope of practice applies: Verbalizes indications
endotracheal intubation and special considerations
Team leader verbalizes need for endotracheal intubation (child unable to maintain adequate oxygenation, or ventilation despite initial intervention).
_____________________________________________________________
Core Case 4 Disordered Control of Breathing
Use this checklist during the PALS core case simulations and tests to check off the performance of the team leader.
CRITICAL PERFORMANCE STEPS DETAILS
TEAM LEADER
Assigns team member roles
Uses effective communication throughout
Closed-loop communication
Clear messages
Clear roles and responsibilities
Knowing limitations Knowledge sharing Constructive intervention Reevaluation and summarizing
Mutual respect
PATIENT MANAGEMENT
Directs assessment of airway, breathing, circulation
Team leader directs or performs assessment to determine disability, and exposure, including vital signs airway patency, adequacy of breathing and circulation, level of responsiveness, temperature and vital signs
Directs assisted ventilations with administration of 100% oxygen
Team leader directs assisted ventilation with administration of 100% oxygen
Ensures that bag-mask ventilations are effective
Team leader observes or directs team member to observe for chest rise with assisted ventilations
Directs placement of pads/ leads and pulse oximetry
Team leader directs that pads/ leads be properly placed and that monitor be turned onto an appropriate lead; requests use of pulse oximetry
Recognizes signs and symptoms of disordered control of breathing
Team leader verbalizes features of history and exam that indicate disordered control of breathing
Categorizes as respiratory distress or failure
Team leader verbalizes whether patient is in respiratory distress failure (note that respiratory failure can occur without distress in this setting)
Directs IV or IO access
Team leader directs team member to place IV (or IO) access, if appropriate; placement simulated properly
Directs reassessment of patient in response to treatment
Team leader directs team member to reassess airway, breathing and circulation
CASE CONCLUSION
Summarizes specific treatment for disordered control of breathing
Team leader summarizes specific treatments for disordered control of breathing (sedation reversal agents)
If scope of practice applies: Verbalizes indications for endotracheal intubation and special considerations (child unable to maintain adequate airway, oxygenation, or ventilation despite initial intervention).
____________________________________________________________
Core Case 5 Hypovolemic Shock
Use this checklist during the PALS core case simulations and tests to check off the performance of the team leader.
CRITICAL PERFORMANCE STEPS DETAILS
TEAM LEADER
Assigns team member roles
Uses effective communication throughout
Closed-loop communication
Clear messages
Clear roles and responsibilities
Knowing limitations Knowledge sharing Constructive intervention Reevaluation and summarizing
Mutual respect
PATIENT MANAGEMENT
Directs assessment of airway, breathing, circulation
Team leader directs or performs assessment to determine disability, and exposure, including vital signs airway patency, adequacy of breathing and circulation, level of responsiveness, temperature and vital signs
Directs administration of 100% oxygen
Team leader directs administration of 100% oxygen
Directs placement of pads/ leads and pulse oximetry
Team leader directs that pads/ leads be properly placed and that monitor be turned onto an appropriate lead; requests use of pulse oximetry
Recognizes signs and symptoms of hypovolemic shock
Team leader verbalizes features of history and exam that indicate hypovolemic shock
Categorizes as compensated or hypotensive shock
Team leader verbalizes whether patient is compensated or hypotensive
Directs IV or IO access
Team leader directs team member to place IV (or IO) access, if appropriate; placement simulated properly
Directs rapid administration of a fluid bolus of isotonic cyrstalloid
Team leader directs administration of isotonic crystalloid 20mL/ kg rapidly (over 5 to 20 minutes) IV or IO
Directs reassessment of patient in response to treatment Team leader directs team member to reassess airway, breathing and circulation
CASE CONCLUSION
Verbalizes therapeutic end points during shock
Team leader identifies parameters that indicate response to management therapy (heart rate, blood pressure, distal pulses and capillary refill, urine output, mental status)
_____________________________________________________________
Core Case 6 Obstructive Shock
Use this checklist during the PALS core case simulations and tests to check off the performance of the team leader.
CRITICAL PERFORMANCE STEPS DETAILS
TEAM LEADER
Assigns team member roles
Uses effective communication throughout
Closed-loop communication
Clear messages
Clear roles and responsibilities
Knowing limitations Knowledge sharing Constructive intervention Reevaluation and summarizing
Mutual respect
PATIENT MANAGEMENT
Directs assessment of airway, breathing, circulation
Team leader directs or performs assessment to determine disability, and exposure, including vital signs airway patency, adequacy of breathing and circulation, level of responsiveness, temperature and vital signs
Directs placement of pads/ leads and pulse oximetry
Team leader directs that pads/ leads be properly placed and that monitor be turned onto an appropriate lead; requests use of pulse oximetry
Verbalizes DOPE mnemonic for intubated patient
Team leader reviews elements of DOPE mnemonic who deteriorates (displacement, obstruction, pneumothorax, equipment failure)
Recognizes signs and symptoms of obstructive
Team leader verbalizes features of history and exam that indicate shock obstructive shock
States at least 2 causes of obstructive shock
Team leader states at least 2 common causes of obstructive shock (tension pneumothorax, cardiac tamponade, pulmonary embolus)
Categorizes as compensated or hypotensive shock
Team leader verbalizes whether patient is compensated or hypotensive
Directs IV or IO access
Team leader directs team member to place IV (or IO) access, if appropriate; placement simulated properly
Directs rapid administration of a fluid bolus of isotonic cyrstalloid
Team leader directs administration of isotonic crystalloid 10-20mL/ kg rapidly (over 5 to 20 minutes) IV or IO
Directs reassessment of patient in response to treatment Team leader directs team member to reassess airway, breathing and circulation
CASE CONCLUSION
Summarizes the treatment for a tension pneumothorax
Team leader describes use of emergency pleural decom- pression (second intercostal space, midclavicular line)
Verbalizes therapeutic end points during shock
Team leader identifies parameters that indicate response to management therapy (heart rate, blood pressure, distal pulses and capillary refill, urine output, mental status)
___________________________________________________________
Core Case 7 Distributive Shock
Use this checklist during the PALS core case simulations and tests to check off the performance of the team leader.
CRITICAL PERFORMANCE STEPS DETAILS
TEAM LEADER
Assigns team member roles
Uses effective communication throughout
Closed-loop communication
Clear messages
Clear roles and responsibilities
Knowing limitations Knowledge sharing Constructive intervention Reevaluation and summarizing
Mutual respect
PATIENT MANAGEMENT
Directs assessment of airway, breathing, circulation
Team leader directs or performs assessment to determine disability, and exposure, including vital signs airway patency, adequacy of breathing and circulation, level of responsiveness, temperature and vital signs
Directs administration of 100% oxygen
Team leader directs administration of 100% oxygen
Directs placement of pads/ leads and pulse oximetry
Team leader directs that pads/ leads be properly placed and that monitor be turned onto an appropriate lead; requests use of pulse oximetry
Recognizes signs and symptoms of distributive (septic) shock
Team leader verbalizes features of history and exam that indicate distributive (septic) shock
Categorizes as compensated or hypotensive shock
Team leader verbalizes whether patient is compensated or hypotensive
Directs IV or IO access
Team leader directs team member to place IV (or IO) access, if appropriate; placement simulated properly
Directs rapid administration of a fluid bolus of isotonic cyrstalloid
Team leader directs administration of isotonic crystalloid 20mL/ kg rapidly (over 5 to 20 minutes) IV or IO
Directs reassessment of patient in response to treatment Team leader directs team member to reassess airway, breathing and circulation
CASE CONCLUSION
Summarizes indications for vasoactive drug support
Team leader verbalizes that vasoactive medications are indicated for fluid-refractory septic shock
Verbalizes therapeutic end points during shock therapy
Team leader identifies parameters that indicate response to management (heart rate, blood pressure, distal pulses and capillary refill, urine output, mental status)
____________________________________________________________
Core Case 8 Cardiogenic Shock
Use this checklist during the PALS core case simulations and tests to check off the performance of the team leader.
CRITICAL PERFORMANCE STEPS DETAILS
TEAM LEADER
Assigns team member roles
Uses effective communication throughout
Closed-loop communication
Clear messages
Clear roles and responsibilities
Knowing limitations Knowledge sharing Constructive intervention Reevaluation and summarizing
Mutual respect
PATIENT MANAGEMENT
Directs assessment of airway, breathing, circulation
Team leader directs or performs assessment to determine disability, and exposure, including vital signs responsiveness, breathing and pulse
Directs administration of 100% oxygen
Team leader directs administration of 100% oxygen by high flow device
Directs placement of pads/ leads and pulse oximetry
Team leader directs that pads/ leads be properly placed and that monitor be turned onto an appropriate lead; requests use of pulse oximetry
Recognizes signs and symptoms of cardiogenic shock Team leader verbalizes features of history and exam that indicate cardiogenic shock
Categorizes as compensated or hypotensive shock
Team leader verbalizes whether patient is compensated or hypotensive
Directs IV or IO access
Team leader directs team member to place IV (or IO) access, if appropriate; placement simulated properly
Directs slow administration of 5 to 10 mL/ kg isotonic crystalloid
Team leader directs administration of fluid bolus of isotonic cyrstalloid 5-10mL/ kg IV or IO (over 10 to 20 minutes) while carefully monitoring patient for signs of pulmonary edema or worsening heart failure
Directs reassessment of patient in response to treatment
Team leader directs team member to reassess airway, breathing and circulation
Recalls indications for use of vasoactive drugs
Team leader verbalizes indications for initiation of vasoactive drugs during cardiogenic shock (persistent signs of shock despite fluid therapy)
CASE CONCLUSION
Summarizes indications for vasoactive drug support
Team leader verbalizes that vasoactive medications are indicated for fluid-refractory septic shock
Verbalizes therapeutic end points during shock management
Team leader identifies parameters that indicate response to therapy (heart rate, blood pressure, perfusion,, urine output, mental status). In cardiogenic shock, team leader recognizes importance of reducing metabolic demand by reducing work of breathing and temperature.
____________________________________________________________
Core Case 9 Supraventricular Tachycardia
Use this checklist during the PALS core case simulations and tests to check off the performance of the team leader.
CRITICAL PERFORMANCE STEPS DETAILS
TEAM LEADER
Assigns team member roles
Uses effective communication throughout
Closed-loop communication
Clear messages
Clear roles and responsibilities
Knowing limitations Knowledge sharing Constructive intervention Reevaluation and summarizing
Mutual respect
PATIENT MANAGEMENT
Directs assessment of airway, breathing, circulation
Team leader directs or performs assessment to determine disability, and exposure, including vital signs airway patency, adequacy of breathing and circulation, level of responsiveness, temperature and vital signs
Directs administration of supplementary oxygen
Team leader directs administration of supplementary oxygen by high flow device
Directs placement of pads/ leads and pulse oximetry
Team leader directs that pads/ leads be properly placed and that monitor be turned onto an appropriate lead; requests use of pulse oximetry
Recognizes narrow-complex tachycardia and
Team leader recognizes narrow-complex tachycardia and verbalizes how to distinguish between ST and SVT
verbalizes reasons for identification as SVT versus ST
Categorizes as compensated or hypotensive shock
Team leader verbalizes whether patient is compensated or hypotensive
Directs performance of appropriate vagal maneuvers
Team leader directs team member to perform appropriate vagal maneuvers (Valsalva, blowing through straw, ice to face)
Directs IV or IO access
Team leader directs team member to place IV (or IO) access, if appropriate; placement simulated properly
Directs preparation and administration of appropriate
Team leader directs team member to prepare correct dose of dose of adenosine adenosine (first dose: 0. 1 mg/ kg, maximum: 6 mg second dose: 0. 2 mg/ kg, maximum 12 mg) uses drug dose resource if needed: states need for rapid administration with use of saline flush
Directs reassessment of patient in response to treatment Team leader directs team member to reassess airway, breathing and circulation
CASE CONCLUSION
Verbalizes indications and appropriate energy doses for synchronized cardioversion
Team leader verbalizes indications and correct energy dose for synchronized cardioversion (0. 5 to 1 J/ kg for initial dose)
______________________________________________________________
Core Case 10 Bradycardia
Use this checklist during the PALS core case simulations and tests to check off the performance of the team leader.
CRITICAL PERFORMANCE STEPS DETAILS
TEAM LEADER
Assigns team member roles
Uses effective communication throughout
Closed-loop communication
Clear messages
Clear roles and responsibilities
Knowing limitations Knowledge sharing Constructive intervention Reevaluation and summarizing
Mutual respect
PATIENT MANAGEMENT
Directs assessment of airway, breathing, circulation
Team leader directs or performs assessment to determine disability, and exposure, including vital signs airway patency, adequacy of breathing and circulation, level of responsiveness, temperature and vital signs
Directs initiation of assisted ventilations with 100% oxygen
Team leader instructs team member to provide assisted ventilations with 100% oxygen
Directs placement of pads/ leads and pulse oximetry
Team leader directs that pads/ leads be properly placed and that monitor be turned onto an appropriate lead; requests use of pulse oximetry
Categorizes bradycardia with cardiorespiratory
Team leader recognizes rhythm and verbalizes presence of compromise bradycardia to team members
Characterizes as compensated or hypotensive
Team leader communicates that patient has cardiorespiratory compromise and is hypotensive
Recalls indications for chest compressions in a bradycardic patient (may or may not perform)
Team leader vervalizes indications for chest compressions
Directs IV or IO access
Team leader directs team member to place IV (or IO) access, if appropriate; placement simulated properly
Directs preparation and administration of appropriate dose of epinephrine
Team leader directs team member to prepare initial dose of epinephrine (0. 01 mg/ kg or 0. 1 mL/ kg of 1: 10, 000 dilution IV/ IO, uses drug dose resource if needed: directs team member to administer epinephrine dose and saline flush
Directs reassessment of patient in response to treatment Team leader directs team member to reassess airway, breathing and circulation
CASE CONCLUSION
Verbalizes consideration of a least 3 underlying causes of bradycardia
Team leader verbalizes potentially reversible causes of bradycardia (toxins, hypothermia, increased ICP)
___________________________________________________________
Core Case 11 Asystole/ PEA
Use this checklist during the PALS core case simulations and tests to check off the performance of the team leader.
CRITICAL PERFORMANCE STEPS DETAILS
TEAM LEADER
Assigns team member roles
Uses effective communication throughout
Closed-loop communication
Clear messages
Clear roles and responsibilities
Knowing limitations Knowledge sharing Constructive intervention Reevaluation and summarizing
Mutual respect
PATIENT MANAGEMENT
Recognizes cardiopulmonary arrest
Team leader directs or performs assessment to determine absence of responsiveness, breathing and pulse
Directs initiation of CPR by using the C-A-B sequence
Team leader monitors quality of CPR at all times (adequate rate, and ensures performance of high-quality CPR adequate depth, chest recoil) and provides feedback to team member providing compressions; directs resuscitation so as to minimize interruptions in CPR; directs team members to rotate role of chest compressor approximately every 2 minutes
Directs placement of pads/ leads and pulse oximetry
Team leader directs that pads/ leads be properly placed and that monitor be turned onto an appropriate lead; requests use of pulse oximetry
Recognizes asystole or PEA
Team leader recognizes rhythm and verbalizes presence of asystole or PEA to team members
Directs IV or IO access
Team leader directs team member to place IV (or IO) access, if appropriate; placement simulated properly
Directs preparation and administration of appropriate dose of epinephrine
Team leader directs team member to prepare initial dose of epinephrine (0. 01 mg/ kg or 0. 1 mL/ kg of 1: 10, 000 dilution IV/ IO, uses drug dose resource if needed: directs team member to administer epinephrine dose and saline flush
Directs administration of epinephrine at appropriate intervals
Team leader directs team member to administer epinephrine dose with saline flush and prepare to administer again every 3 to 5 minutes
Directs checking rhythm on monitor approximately every 2 minutes
Team leader directs team members to stop compressions and checks rhythm on monitor approximately every 2 minutes
CASE CONCLUSION
Verbalizes consideration of a least 3 underlying causes of PEA or asystole
Team leader verbalizes potentially reversible causes of PEA or asystole (hypovolemia, tamponade)
____________________________________________________________
Core Case 12 VF/ Pulseless VT
Use this checklist during the PALS core case simulations and tests to check off the performance of the team leader.
CRITICAL PERFORMANCE STEPS DETAILS
TEAM LEADER
Assigns team member roles
Uses effective communication throughout
Closed-loop communication
Clear messages
Clear roles and responsibilities
Knowing limitations Knowledge sharing Constructive intervention Reevaluation and summarizing
Mutual respect
PATIENT MANAGEMENT
Recognizes cardiopulmonary arrest
Team leader directs or performs assessment to determine absence of responsiveness, breathing and pulse
Directs initiation of CPR by using the C-A-B sequence
Team leader monitors quality of CPR (adequate rate, and ensures performance of high-quality CPR at all times adequate depth, chest recoil) and provides feedback to team member providing compressions; directs resuscitation so as to minimize interruptions in CPR; directs team members to rotate role of chest compressor approximately every 2 minutes
Directs placement of pads/ leads and pulse oximetry
Team leader directs that pads/ leads be properly placed and that monitor be turned onto an appropriate lead; requests use of pulse oximetry
Recognizes VF or pulseless VT
Team leader recognizes rhythm and verbalizes presence of VF/ VT to team members
Directs attempted defibrillation at 2 to 4 J/ kg safely Team leader direct team member to set proper energy and attempt defibrillation; observes for safe performance
Directs immediate resumption of CPR by using the C-A-B sequence
Team leader directs team member to resume CPR immediately after shock (no pulse or rhythm check)
Directs IV or IO access
Team leader directs team member to place IV (or IO) access, if appropriate; placement simulated properly
Directs preparation and administration of appropriate dose of epinephrine
Team leader directs team member to prepare initial dose of epinephrine (0. 01 mg/ kg or 0. 1 mL/ kg of 1: 10, 000 dilution IV/ IO, uses drug dose resource if needed: directs team member to administer epinephrine dose and saline flush
Directs attempted defibrillation at 4 J/ kg or higher
Team leader direct team member to set proper energy and (not to exceed 10 J/ kg or standard adult dose safely attempt defibrillation; observes for safe performance
Directs immediate resumption of CPR by using the Team leader directs team member to resume CPR immediately C-A-B sequence after shock (no pulse or rhythm check)
Directs administration of epinephrine at appropriate intervals
Team leader directs team member to administer epinephrine dose with saline flush and prepare to administer again every 3 to 5 minutes
CASE CONCLUSION
Verbalizes consideration of antiarrhythmic (amiodarone or lidocaine)
Team leader indicates consideration of appropriate antiarrhythmic using appropriate dose in proper dose
SAVING AMERICAN HEARTS PALS STUDY GUIDE Based on the 2010 Guidelines of the American Heart Association
This study guide is a supplement to your provider manual. It is not a substitute for purchasing the provider manual. You must purchase the correct provider manual and bring it with you to class. The latest guidelines by the American Heart Association are the 2010 Guidelines.
WHEN YOU FIND AN UNCONSCIOUS CHILD ( Age 1 to Puberty)
You are a lone rescuer:
STEP 1:
Assess scene safety. Always assess scene safety first. If the scene is not safe, it is reasonable to withhold resuscitation efforts.
STEP 2:
Tap and shout "Hey are you ok?"
STEP 3:
Assess breathing. If there is no breathing, or only gasping: Activate the Emergency Response System and get an AED. If others are around, send someone to get help.
STEP 4:
Check a carotid pulse. Check for at least 5 seconds but no more than 10. If there is no pulse or you are not sure if you feel a pulse, begin chest compressions.
Compress at a depth of at least 2 inches or 5 cm (or 1/ 3 the anterior posterior diameter of the chest).
Compress at a rate of at least 100 compressions per minute. Push hard and fast.
Make sure you allow the chest to completely recoil between compressions.
After 30 compressions, give 2 breaths.
If there is no suspected head or neck injury: Perform a "head tilt chin lift" and give 2 breaths.
If you suspect a neck injury: Perform a "jaw thrust" to open the airway and deliver 2 breaths.
Give each breath over 1 second watching for chest rise. Do not give large breaths. You want to see the chest just begin to rise. If you give breaths that are too large, all that extra air will go into the stomach. After several large breaths, the pressure will begin to increase in stomach which will then crush the lungs, heart and the diaphragm making it more difficult to save your patient.
Give cycles of 30 compressions and 2 breaths. 5 cycles = two minutes
STEP 5:
If you are alone, and there is no one to get help, leave the child, activate the emergency response system, then return to the child. Reassess the pulse. If there is no pulse, resume chest compressions and breaths for 2 more minutes. Every two minutes check a pulse.
Continue to steps of 30 compressions and 2 breaths until more advanced help arrives.
ONCE THE AED ARRIVES
When an AED arrives, use it.
Step 1:
Turn on the AED. It may take up to 5-15 seconds to warm up.
Step 2:
Follow the instructions given by the AED. Continue chest compressions and breaths while listening to the AED.
STEP 3:
Place the pads on the patient following the pictures on the pads for correct placement. If you are not alone, continue chest compressions and have someone else place the pads.
STEP 4:
When the AED says "ANALYZING RHYTHM, DO NOT TOUCH THE PATIENT" make sure no one is touching the patient, not even the person giving breaths. If the AED says "SHOCK ADVISED, CHARGING" continue chest compressions while the AED is charging.
STEP 5:
When the AED is charged, clear the patient and deliver the shock. Immediately resume chest compressions. Begin with 30 compressions and 2 breaths. Complete 5 cycles of 30 compressions and 2 breaths. When 2 minutes have passed, the AED will automatically reanalyze the rhythm.
If the AED says: "NO SHOCK ADVISED" you do not check a pulse, you immediately resume CPR for 2 more minutes. Continue these steps until more advanced help arrives.
Always assess scene safety first. If the scene is not safe, it is reasonable to withhold resuscitation efforts. If you find someone unconscious in the middle of the street and run out to save them and get hit by a car, the situation just got worse and now there are two people needing to be saved.
The American Heart Association now recommends C. A. B. Instead of A. B. C. When a cardiac arrest happens, there is usually enough oxygen in the blood stream to sustain life, but it must circulate throughout the body. So the most important step to begin with is chest compressions, not rescue breaths. Beginning with chest compressions is the easiest step for bystanders to perform. It will only delay rescue breaths by about 18 seconds.
An AED only detects 2 particular heart rhythms. They are Ventricular Fibrillation or V-Fib and Pulseless Ventricular Tachycardia or Pulseless V-Tach. If the AED detects either of these rhythms it will deliver a shock.
The biggest misconception people have is that when you shock someone, you jump start the heart just like you would jump start a car. This is not true. When the heart is in Ventricular Fibrillation or Pulseless Ventricular Tachycardia the heart is quivering. The heart is getting told to contract too fast, from too many different cells that it can't possibly keep up and just begins to vibrate.
Almost like seeing someone on TV getting stunned with a taser. The heart just vibrates. The only way to correct all the over stimulation is to stop all of the electricity in the heart.
For example: My computer gets a virus. The first thing I want to do is pull the cord from the wall and stop the virus. I don't want to start opening other programs and get them running too.
The same goes for V-Fib and Pulseless V-Tach. The shock stops the heart completely, giving it a chance to start over and hopefully produce a normal organized rhythm. So if defibrillating actually stops the heart, do you see why shocking someone in asystole doesn't make any sense? Why shock someone to stop the heart, when their heart is already stopped.
Always allow the chest to completely recoil when doing compressions. Say there was a small fire, and you had a water bottle full of water. Would it make sense to squeeze tiny amounts out really really fast? Or, would it make more sense to give the bottle a good squeeze and force out as much water as you can at one time, and repeat? When you compress the chest, it squeezes a small amount of blood out. By letting the chest completely recoil with each compression, more blood is squeezed out with every compression.
CHILD SPECIFIC
A CHILD is considered to be 1 year to puberty. (Puberty is not an age but rather physical signs)
For boys: If there is any chest hair, or underarm hair present, they are considered an adult.
For girls: Look for signs of breast development. If any breast development is present they are considered an adult. So, if you had a 10 year old girl who happens to be pregnant, she has hit puberty and is treated as an adult. For lone rescuers, to provide child CPR, use one hand instead of two and compress 2 inches = 5 cm (The same as an adult) or compress 1/ 3 the depth of the chest. Deliver 30 compressions and 2 breaths.
An INFANT is 0 to 1 year old. For lone rescuers, to provide infant CPR, use two fingers on the lower half of the breastbone and compress 1 1/ 2 inches = 4 cm or 1/ 3 the depth of the chest. Deliver 30 compressions and 2 breaths.
MAJOR DIFFERENCES IN CHILD AND INFANT CPR:
Over puberty is treated as an adult. Puberty is not defined by age, but instead by physical appearance.
When there are TWO RESCUERS, and the child us UNDER PUBERTY the compression to ventilation ratio changes to 15: 2 (Now, 10 cycles is 2 minutes - Check the pulse every two minutes ) SAVING AMERICAN HEARTS PALS STUDY GUIDE (PAGE 4) Based on the 2010 Guidelines of the American Heart Association
For infant compressions with two rescuers, encircle your hands around the infant's chest and provide the compressions using your thumbs over the lower half of the breastbone. Compress at least 1 1/ 2 inches = 4 cm or 1/ 3 the depth of the chest.
DIFFERENCES WITH AN AED USED ON CHILDREN AND INFANTS
Some AEDs have Adult and Pediatric pads. Pediatric pads should be used on anyone 8 yrs and under. If pediatric pads are not available you should use the adult pads on an infant or child. For a child, place the pads the same way you would on an adult. Make sure the pads do not touch, or overlap. For an infant, place one pad in the center of the chest, and one pad on the back in the center. If you can remember, "baby sandwich". Pads used on infants under 1 year old are always placed front and back whether you are using pediatric or adult pads.
Adult pads can be used on an infant under 1 year old. A burned baby is better than a dead baby, and if a shock is needed it must be delivered.
Never cut the adult pads in half. This will leave a bare metal edge which will allow the shock to arc and shock someone else.
RESCUE BREATHING
For a child/ infant, give 1 breath every 3-5 seconds this is 12-20 breaths/ min. If you can remember 1 breath every 3-5 seconds (then multiply each x 4) 3 x 4 = 12 and 5 x 4 = 20. This is 12-20 breaths per minute. Children run faster than adults, so they must breathe faster too.
If an advanced airway (ETT) is in place regardless of age deliver one breath every 6-8 seconds. If someone has an advanced airway in place, they will not be conscious. If the person is "sleeping" they will not need to breathe as fast as an adult or child and is the slowest rate of all. Only 1 breath every 6-8 seconds. This is only 8-10 breaths per minute. When an advanced airway is used, compressions must be stopped until the tube in placed in the airway. Once it is in place, provide continuous chest compressions without pauses for the breaths. (The tubes are very stiff and firm, slightly flexible. But they are firm enough and long enough to allow oxygen to pass through them effectively while someone is pushing down and compressing the chest.
WHEN TO CALL FOR HELP AND WHEN TO START COMPRESSIONS
If a child, check responsiveness, tap and shout "hey, are you ok ?"
Check for breathing: if no breathing activate emergency response system and get an AED
Check for a pulse: if no pulse begin chest compressions at a rate of 30: 2
If the victim is UNDER PUBERTY, and there are 2 rescuers, begin 15: 2
IF they are UNDER PUBERTY and the arrest is witnessed, GET HELP FIRST then return to the child and begin with compressions. Provide 2 minutes of CPR and check a pulse.
When you see a child collapse, (WITNESSED) you know their last breath and last heartbeat was just now. Their blood oxygen level should be pretty high. So get help first. If there are others around, send someone to get help and get and AED.
If you find a child who has collapsed and it was not witnessed, you have no idea if their blood oxygen level is adequate, so provide 2 minutes of CPR and get their blood oxygen level back up, then leave the child and go get help. If there are others around, send someone to get help and get and AED.
IF the arrest is NOT WITNESSED, Begin 2 minutes of CPR, go get help and an AED and return to the child. Begin cycles of 30 compressions and 2 breaths if you are alone. Check a pulse every 2 minutes.
If there are two rescuers and the child is under puberty, begin cycles of 15 compressions and 2 breaths. Check a pulse every 10 cycles or 2 minutes.
ONE MORE VERY IMPORTANT THING ABOUT KIDS
If the child is UNDER PUBERTY AND HAS A PULSE OF 60 or less BEGIN CHEST COMPRESSIONS.
Only perform chest compressions if they show signs of poor perfusion.
Are they cold, are their fingers or lips blue, does their color just not look right ? Are there any signs the child is not getting enough blood supply and oxygen? If you see these signs, BEGIN CHEST COMPRESSIONS. DO NOT DELAY.
CHOKING
For an adult or child, wrap your hands around the victim's waist and begin abdominal thrusts until the victim becomes unconscious or the foreign object is removed. For an infant, lay them over your forearm supporting the infant's head and neck and begin 5 back slaps (Be sure to cradle the infant face down with head lower than the rest of the body).
Turn the infant over and begin 5 chest thrusts (just as you would chest compressions). Continue with 5 back slaps and 5 chest compressions until the object is removed or the infant becomes unconscious.
Once an adult, child or infant becomes unconscious, do not continue to treat them as a chocking victim. Lay them on a hard flat surface and begin Basic Life Support. Start by tapping and shouting "Hey, Are you Ok ?" Assess breathing, if no breathing or only gasping, activate emergency response and get an AED. Begin chest compressions.
Before giving breaths, look in the mouth for the obstructing object. If you can see the object, try to remove it. Do not perform a blind finger sweep.
Attempt to give 2 rescue breaths. If the chest does not rise, reposition the airway and attempt again. If the chest does not rise, begin chest compressions. Between chest compressions and rescue breath attempts, it is hoped that the back and forth motions will move the object one way or the other.
Continue as long as you can and just know, that you cannot continue CPR forever. There may be a time when it is just not humanly possible to continue for hours and hours, nor would you want to continue CPR on someone for that length of time. The chances of successfully reviving someone without significant brain damage after an extended amount of time is very slim.
FOUR TYPES OF RESPIRATORY DISORDERS
UPPER AIRWAY OBSTRUCTION
These children will present with stridor. The most important INITIAL medication is IM Epi, or an EPI pen. Give steroids if the child has a history of asthma. Provide oxygenation. If the oxygen sat continues to drop despite oxygen administration then preparations need to be made for BVM or intubation.
LOWER AIRWAY OBSTRUCTION
This is bronchiolitis or asthma. You’ll hear wheezes and a prolonged expiratory phase. Provide nebulizer treatments, steroids and support the oxygen needs.
LUNG TISSUE DISEASE
This is pneumonia, or aspiration pneumonia. Expect to hear crackles. The child will have a low oxygen saturation and resp effort will be increased. Provide oxygenation, antibiotics and antipyretics. Obtain cultures if the fever is over 101.
DISORDERED CONTROL OF BREATHING
This is an example of a post dictal child, a brain injury or neuro child, or even a child that has been sedated and doesn’t have control over their breathing. As long as their V/ S are stable, simply monitor. The resp rate may only be 6, but if their sat is 99% on room air, just monitor.
FOUR TYPES OF SHOCK
CARDIOGENIC
Defined as cold and dusky hands and feet, murmur on auscultation, palpable liver and crackles to lung bases as the heart struggles to preserve the core and circulate the blood volume. Treatment includes antibiotics and fluids of ONLY 5-10ml/ kg given very slowly. This will thin the blood and allow the sick heart to pump more efficiently clearing up the crackles in the lungs.
DISTRIBUTIVE/ SEPTIC SHOCK
With septic shock, the child will have a very low BP, good cap refill, most likely a very high fever near or above 103. A child with a high fever who is on chemotherapy would be in septic shock with a very low BP. Treatment consists of supporting the airway, obtaining cultures, administering antibiotics and antipyretics and a fluid bolus of 20ml/ kg given very quickly followed with vasopressors if the BP does not respond to the fluid bolus.
OBSTRUCTIVE SHOCK
This could be due to a tension pneumothorax. This will cause an obstruction of the oxygen which can lead to shock. Treatment consists of immediate correction of the pneumothorax with needle decompression and preparation of a chest tube. If the child is on a ventilator, and the oxygen saturation is 68%, Remember the D. O. P. E. mnemonic.
D. O. P. E.
D = Displacement
(Check to see that the tube has not moved and is still at the previous cm marking at the lip
O = Obstruction
Listen for breath sounds. If any breath sounds are heard, the tube is not obstructed or you would hear no breath sounds at all.
P = Pneumothorax
Check to see if breath sounds are equal. Is the trachea deviated (Very late sign in children) and check to see if there is equal rise and fall of the chest.
E = Equipment
This step should be preformed FIRST. Disconnect the ventilator, attach BVM and bag the child. If the O2 sat does NOT rise, it is not an equipment problem.
HYPOVOLEMIC SHOCK
This can be due to volume depletion caused by blood loss or by dehydration. Administer rapid fluid bolus of 20ml/ kg over 5 minutes up to 3 times. If the BP does not respond then blood should be administered. A low blood pressure is a very late sign of shock in children. Children can maintain a normal blood pressure until they have lost 25% of their total blood volume.
Always keep children’s O2 Sat between 94-99% to prevent hyperoxia. If the child is on oxygen and the sat is 100%, then turn the oxygen down to achieve a sat of 94-99%.
From the age of puberty and under. If the child has a pulse of 60 or less, begin chest compressions and treat them as though they have no pulse. Administer EPI. Do not give Atropine to a child for bradycardia until they are beyond puberty. The only exception is a 3rd Degree Block. In case of a 3rd degree block there must be a child appropriate dose.
If a child’s heart slows down or stops, it is because they can’t breathe. If a child has been in respiratory distress for a few days, and the heart rate begins to drop, and resp rate begins to drop it’s because they are getting tired and are going to stop breathing. Begin ventilations with a BVM device. The same goes for a child in respiratory distress for a few days. If they have been struggling to breathe and you suction away what little bit of air they were able to get in, their heart rate will drop. Simply bag them and replace the oxygen you took away.
When you place a pulse ox on a child, make sure that the heart rate on the pulse ox correlates with the heart rate on the monitor. If the monitor shows a heart rate of 200, and your pulse ox says the heart rate is 99, the pulse ox is not reliable. So if it says the O2 sat is 98%, it is not reliable and the child must be given oxygen.
The best way to establish vascular access in a child is IO Intraosseous.
The preferred vagal maneuver in children is ice to the face.
When performing cardioversion for an unstable tachycardia, begin with ½ to 1J/ kg.
When defibrillating, begin with 2J/ kg, then 4J/ kg, 6J/ kg, 8J/ kg and finally 10J/ kg which is the maximum. Repeat 10J/ kg as needed.
In children 1 year and under, check a brachial pulse.
When using an AED, if pediatric pads are not available, you may use adult pads. For a child, place them in the same place you would an adult. If it is an infant, always place one pad in the center of the chest, and one on the back directly behind the one on the chest.
As soon as an AED arrives, use it. Be sure to turn it on FIRST.
When performing CPR alone, everyone is 30 compressions and 2 breaths regardless of age. If the child is under puberty, and there are 2 rescuers, the ratio changes to 15: 2
Just remember that children are not small adults. If an adult wants to increase their cardiac output, their cardiac muscle fibers stretch to hold move blood volume, thus they can pump more blood with each heartbeat. Kids can't do that. Their muscle fibers are very short and don't stretch enough to change cardiac output. All they can do is increase their heart rate. Kids can compensate too !
Did you know, that if a 4 year old child's body can hold 4 liters of blood, that they can lose an ENTIRE LITER (or 25% of their total circulating volume) and still maintain a normal blood pressure !!! Scary isn't it !!!! Kids can compensate for a while, but not forever. So if you notice a low blood pressure on a child, you have only a minute or two notice that the child is about to CODE ! If their blood pressure is low, that means their compensatory mechanisms are failing and in just a minute, they will completely stop ! Replace fluids quickly !!! Not over 20 min. They could be dead in 20 minutes. And make sure to check a blood sugar in every child. This is as high a priority, if not higher than a type and cross match. You see, if a child's blood sugar drops, they have no glycogen stores to fall back on. They must burn their own tissue as a source of energy. If they are busy burning their own tissue to survive, they are going to be a little too busy to metabolize any of the drugs you give them.
I hope this study guide has been helpful. If you have any questions or comments please let us know.
The American Heart Association (AHA) strongly promotes knowledge and proficiency in BLS, ACLS, and PALS and has developed instructional materials for this purpose. Use of these materials in an educational course does not represent course sponsorship by the AHA. Any fees charged for such a course, except for a portion of fees needed for AHA course materials, do not represent income to the AHA.
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