PALS

Brachial artery/pulse

Carotid or femoral artery/pulse

- check responsiveness, shout for help, activate emergency response system
- assess breathing & pulse <10 sec
--> abnormal breathing, good pulse --> breathe q2-3 sec (20-30 breaths/min), assess pulse q2min; if HR <60 c S/S poor perfusion, begin CPR
--> no pulse --> CPR (1 person: 30 compressions + 2 breaths; 2 people: 15 compressions +2 breaths), use AED as soon as possible

If pediatric (<8 y/o) collapse was sudden and witnessed, first activate emergency response system and retrieve AED/defibrillator, then begin CPR; if able, do not delay CPR, but assign role to someone else who is available
- If collapse not witnessed, complete 5 rounds/2 min CPR, the activate emergency response system and get AED

If HR <60 with signs of poor perfusion in the pediatric pt, begin CPR

- Temp: cool extremities
- Alterned mentation: continued decline in LOC
- Pulses: weak
- Skin: pallor, mottling, and later, cyanosis

Compression rate: 100-120 compressions/min
C-to-V ratio: 30:2 for a single rescuer, 15:2 if 2 rescuers; give breaths over 1 sec
--> general rescue breaths in infants/children <8: 1 breath q2-3 sec or 20-30 breath/min

- use 2 fingers OR 2 thumb-encircling hands technique for compressions in infants
- 2 thumb is preferred bc produced better blood supple to the heart, ensures consistent depth and force of compressions, and may generate higher BPs

- Adults and adolescents: at least 2"
- Children: at least 1/3 the AP (anteroposterior) diameter of the chest or approx 2"
- Infants: at least 1/3 the AP diameter of the chest or approx 1.5"

>80%

- Precharge the defib 15 sec before q2min rhythm analysis
- Hover over the chest during shock, rhythm analysis, & other necessary pauses
- Have next compressor ready
- Intubate and deliver meds without pausing compressions
- Consider CPR protocols that deliver fewer pauses (e.g. continuous comrpessions with asynchronous ventilation with BVM)

- Appearance, work of breathing, and circulation (color)
- Appearance: degree of interactivity, muscle tone, verbal response/cry
-->TICLS (tone, interactiveness, consolability, lookaze, speech/cry)
- Work of breathing: triping or sniffing position, retractions, audible breath sounds
- Circulation: pale, mottled, cyanotic

- infants (0-1 y/o): 30-53

toddlers (1-3): 22-37

preschoolers (3-5): 20-28

School-age child (6-12): 18-25

12-20

- mild to moderate breathing difficulty: subcostal, substernal, or intercostal
- severe: supraclavicular, suprasternal, sternal

When the chest retracts and the abd expands during inspiration and then the chest expands and the abd moves inward during expiratino
--> may be observed in neuromuscular disease, severe lower airway obstruction, lung tissue disease, and states of disordered control of breathing

minute ventilation = respiratory rate x tidal volume
--> potential causes of low minute ventilation: slow or extremely rapid RR or small TV (shallow breathing, high airway resistance, stiff lungs)

- anemia
- methemoglobinemia
- carboxyhemoglobin (carbon monoxide poisoning)

- very rapid or inadequate RR; possible apnea
- significant, inadequate, or absent resp effort
- absent distal air movement
- extreme tachycardia; bradycardia often indicates life-threatening deterioration
- low SpO2 despite high-flow supplemental O2
- decreased LOC
- cyanosis
- seesaw breathing
- head bobbing

- HR and rhythm
- pulses (peripheral and central)
- cap refill
- skin color and temp
- BP
- urine output
- LOC

up to 1 mo old
- awake: 100-205
- sleeping: 90-106

1-12 mo old
- awake: 100-180
- sleeping: 90-160

1-3 y/o
- awake: 98-140
- sleeping: 80-120

3-5 y/o
- awake: 80-120
- sleeping: 65-100

5-11 y/o
- awake: 75-118
- sleeping: 58-90

12-17 y/o
- awake: 60-100
- sleeping: 50-90

anxiety, crying, fever, or serious illness or injury
--> HR >180/min in infants or toddlers or >160/min in a child >2 y/o warrants further assessment and may be a serious condition

- central pulses: femoral, brachial (in infants), carotid (in older children), and axillary
- peripheral includes radial, dorsalis pedis, and posterior tibial
--> an exaggerated difference in quality between central and peripheral pulses occurs when peripheral vasoconstriction is associated with shock
--> a cold environment can cause vasoconstriction and discrepancy between peripheral and central pulses; however, if CO remains adequate, central pulses should remain strong

- at least 50-75% of the length of the upper arm
- cuff bladder that covers about 40% of the mid-upper arm circumference

- neonates: SBP <60
- infants (1-12 mo): SBP <70
- children 1-10 y/o: SBP <70 + (age in years x2)
- children >10 y/oL SBP <90

- AVPU, GCS, pupil response to light, BG
--> neuro signs of sudden and severe cerebral hypoxia: decreased LOC, loss of muscular tone, generalized seizures, pupil dilation
--> signs of gradual cerebral hypoxia: decreased LOC c or s confusion, irritability, lethargy, agitation alternating with energy

- hypoglycemia in newly born: <45 mg/dL
- hypoglycemia in children: <60 mg/dL