Watch More! Unlock the full videos with a FREE trial
Included In This Lesson
Access More! View the full outline and transcript with a FREE trial
Transcript
I’m going to take the next couple of slides to cover some basic information about PALS-obviously this doesn’t cover everything and with real advanced life support, there is a lot of simulation and hands on practice. The first thing you need to keep in mind is that pediatric arrests are different than adults. The primary way they are different is in the cause. The most common causes of arrest in childhood are respiratory problems, sepsis, and shock.
When a child actually arrests it’s usually the end point of a really long process- so what i mean by this is that they have been sick for a while, they have been hypoxic and dehydrated for a long time so they are very unstable. Because of this- if cardiac arrest actually occurs and the child’s heart stops the outcomes are pretty poor. So to prevent this from happening a lot of PALS focuses on actually preventing that decline by recognizing hypoxia, dehydration, infection, and shock as early as possible and intervening.
The structure used when assessing an acutely unwell patient is ABCDE. This is true for adults as well. A stands for airway, B for breathing, C for circulation, D for disability and E for exposure. I think AB and C are pretty straight forward. For A you are checking to see if the patient has a patent airway so listening and looking at the airway. For breathing, you are looking for increased work of breathing and listening for added lung sounds like wheezing and crackles. For circulation, you want to assess for signs of dehydration and shock. Disability is when you assess their level of consciousness, so Glasgow coma scale, pupils, posturing and checking blood sugar. For exposure you want to look at the entire body, looking for rashes, bruising, signs of injury or bleeding. Sometimes we call this- everything else.
For children there are some common problems to be on the lookout for. These are upper airway obstruction, lower airway obstruction, shock and seizures.
Upper airway obstruction usually presents as stridor. Stridor is a high pitched sound that indicates decreased airflow in the upper airway. You won’t need a stethoscope to hear stridor, it’s audible without one. Most of the time, in kids this is caused by croup, epiglottitis, anaphylaxis or inhaled foreign body. Other things that may indicate a compromised airway are drooling and cyanosis.
Lower airway obstruction will make the child work hard to breathe. This will often cause retractions, nasal flaring and and an increased RR. Things to listen for are a wheeze, or possibly a silent chest. The silent chest is a really bad sign because it means no air is moving through the lungs. Common diagnoses that cause these problems are asthma and bronchiolitis.
Signs of shock are cool peripheries, mottled skin, increased HR and RR and probably the most important thing to assess is capillary refill. In kids you want capillary refill to be less than two seconds. Always keep in mind that blood pressure is the last thing to change in kids so don’t wait in the blood pressure to drop to give fluids and treat the cause of shock. Common diagnoses that may cause shock and dehydration are sepsis, severe dehydration from n/v and DKA.
Seizures are most often caused by fevers and low blood sugar. So for your D assessment remember- DEFG- don’t ever forget glucose.
There is a lot to know about how these are managed, but i’m just going to highlight some of the basics. The first thing we do is make sure the airway is in the best position. Then we apply oxygen- usually in an acute setting, this means high flow oxygen given via mask. Fluids are very important as well to correct dehydration and shock. Check out the peds lesson on dehydration for details on how we calculate fluids for kids.
Common medications used in these critical scenarios are albuterol (used to treat a wheeze), epinephrine (used to treat croup and airway obstruction), steroids (to reduce inflammation in airways) and antibiotics (to treat infection).
Okay- key points to remember for this lesson are, first that the causes of pediatric arrests are different than those that cause adult arrest. They are respiratory problems, sepsis or shock.
Efforts should focus on preventing arrest and identifying early on when a child is unwell. This early intervention provides the opportunity for the best outcomes.
The structure to use when assessing a critically unwell patient are ABCDE. That stands for airway, breathing, circulation, disability, and exposure.
Key interventions that are part of treating these sick kids are oxygen, fluids and meds are albuterol, steroids, epinephrine, and antibiotics. Your priority nursing concepts when providing Pediatric Advanced Life Support are clinical judgment, oxygenation and perfusion. We love you guys! Go out and be your best self today! And as always, Happy Nursing!
View the FULL Transcript
When you start a FREE trial you gain access to the full outline as well as:
- SIMCLEX (NCLEX Simulator)
- 6,500+ Practice NCLEX Questions
- 2,000+ HD Videos
- 300+ Nursing Cheatsheets
“Would suggest to all nursing students . . . Guaranteed to ease the stress!”
