Faculty Disclosure 5/14/2012. Educational Need/Practice Gap. No financial disclosures No off label medications/therapies to discuss

Transcription

1 Erich C. Maul, DO, FAAP, FHM Pediatric Hospitalist Kentucky Children s Hospital Faculty Disclosure No financial disclosures No off label medications/therapies to discuss Will mention Trade Names, but I make no specific endorsement and have no disclosures Educational Need/Practice Gap The science, technology and landscape of Pediatric Advanced Life Support (PALS) is ever changing In my 24 years of healthcare Can be a challenge to stay current 1

2 Objectives Upon completion of this educational activity, you will be able to: Discuss the importance of Basic Life Support (BLS) in the framework of PALS Describe the changes of the 2010 PALS guidelines Teach your staff how to recognize a sick child and make initial interventions Expected Outcome Realize that BLS is the most important thing in emergency care Feel more confident when approaching emergent pediatric care 2

3 Start with the Basics Without adequate basic life support, all the advanced life support skills in the world are useless! E. C. Maul, DO Basic Life Support A B C New Sequence Check for responsiveness and breathing Call for help, get AED Check pulse <10 seconds Give 30 compressions 15 for two rescuer BLS Rate of >100/minute (<18 sec) Open airway and give 2 breaths Attach and use AED when it arrives 3

4 AHA AHA PALS curriculum, PALS curriculum, Why Monkey with the Dogma? Most kids arrest secondary to RESPIRATORY issues So, why deviate to CAB from ABC? Standardization across all of BLS ABC delays compressions Why breathe for the patient if they can t circulate what you just breathed in for them? AED Use For children 1-8 y/o Use a dose attenuation system For kids <1 y/o Manual defibrillator preferred AED with attenuation system if manual not available Effective energy doses are not known 4

5 Defibrillation Initial dose of 2 J/kg 4 J/kg for second shock Increase from there Maximum of 10 J/kg or adult equivalents ECG definitions Wide complex tachycardia is now defined as >0.09 sec Not >0.08 sec Really yglad that got cleared up I was losing sleep at night! Pharmacology No longer recommend routine calcium administration Only used for Documented hypocalcemia CCB overdose Hypermagnesemia Hyperkalemia Removed atropine from PEA algorithm No routine place for lidocaine Role of vasopressin not clear 5

6 Pediatric Cardiac Arrest AHA PALS curriculum, 2011 AHA PALS curriculum,

7 AHA PALS curriculum, 2011 AHA PALS curriculum, 2011 Post Arrest Care Now a big issue again.. I say again because 3 versions ago of PALS 7

8 AHA PALS curriculum, 2011 Simple things for when the poo hits the fan Even better, what to do BEFORE the poo starts flying Who should be able to recognize a sick child? 8

9 So how can I teach all my office staff? Pediatric Assessment Triangle Completely HANDS OFF Has been removed from PALS Dieckmann, R. A., D. Brownstein, et al. (2010). "The pediatric assessment triangle: a novel approach for the rapid evaluation of children." Pediatr Emerg Care 26(4): APLS Borrow slides from our APLS course we teach This solves the problem of teaching what toxic looks like Story from internship Pediatric Assessment Triangle Appearance Breathing (work) Circulation to skin Tone Interactiveness Consolability Look/gaze Speech/cry Appearance 9

10 Work of Breathing Abnormal airway sounds Abnormal positioning Retractions Nasal flaring Head bobbing Pallor Mottling Cyanosis Circulation to Skin How to put it together? Ask our Physician Liaison Service to set up a Lunch and Learn Happy to come to you and teach your staff Takes about an hour; didactic and case based Did I mention lunch? 10

11 Do I need emergency equipment in my office? That depends How close is the hospital? How close is EMS? How skilled? What level of skill does your staff have? What type of triage system does the office have? Essential Emergency Equipment Length based resuscitation tape ECC handbook AED Adult and Peds pads Medications EpiPens Diastat AcuDial Albuterol (MDI or neb) 0.9% saline for infusion G IV catheters Oxygen NC, Simple and NR masks BVM s Infant, child and adult Suction Oral airways Office Emergency Plan Office Emergency Plan Create a plan Everyone has predesignated roles Liberal use of 911 & the Emergency Dept Practice your plan Inspect your equipment Practice your plan 11

12 We talkin bout practice, man! Anyone know what this is? Thunderbird 6 crashing at MHAFB, ID, 2003 Never thought this would happen, but all our practice paid off Ready to receive casualties 45 seconds after notification Had 2-level 1 traumas in trauma center within 30 minutes of injuries No fatalities Did we practice? In Closing PALS has not changed significantly Without adequate basic life support, all the advanced life support skills in the world are useless! Train your ENTIRE office staff to recognize emergencies Prepare and practice your plan References American Academy of Pediatrics Childhood Emergencies in the Office, Hospital, and Community. Elk Grove Village, IL. American Academy of Pediatrics and American College of Emergency Physicians The Advanced Pediatric Life Support Course Toolkit. American Heart Association Pediatric Advanced Life Support Course Manual. Cumbermack, K Kentucky Children s Heart Center Emergency Policy. Dieckmann, R. A., D. Brownstein, et al. (2010). "The pediatric assessment triangle: a novel approach for the rapid evaluation of children." Pediatr Emerg Care 26(4):