Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: PALS Revised: 11/2013

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1 NUMBERS Emergency Medical Training Services Emergency Medical Technician Paramedic Program Outlines Outline Topic: PALS Revised: 11/2013 Weight in kg = 8 + (age in yrs X 2) Neonate (less than 1 month) = 3 5kg Infant (up to 1 year) = 6 9kg Over 1 year = use above formula Blood volume = 80mL/kg Blood pressure (ages > 10) = 90 + (age in yrs X 2) (ages < 10) = 70 + (age in yrs X 2) Use the numbers below for lower limits of normal systolic Decompensated shock Neonate (less than 1 month) = SBP < 60 Infant (up to 1 year) = SBP < 70 Child (1 Adolescent) = SBP < 70 + (age in yrs X 2) Heart rate (the younger, the faster) Neonate (< 1 month) = 140 (+/-) 20 Infant (up to 1 year) = 120 (+/-) 20 Young child (1 5 yrs) = 100 (+/-) 20 Older child (5-9 yrs) = 90 (+/-) 10 Adolescent to adult = 80 (+/) 20

2 Normal Cap. Refill = < 2 seconds Urine output = 1 2 ml/kg/hr Respiratory Rate Neonate (< 1 month) = Child (1 8 yrs) = Adolescent to adult = Normal tidal volume = 4 6 ml/kg ET tube size = age (yrs)/4 + 4 or (16 + age in years)/4 Depth of insertion = age (yrs)/ or 3 X tube diameter Cardioversion: Defibrillation: J/kg then 2.0 J/kg 2.0 J/kg then 4.0 J/kg Drugs: Epinephrine 1: Epinephrine 1:10, mg/kg ET 0.01 mg/kg IV Atropine mg/kg but not less than 0.1 mg and not more than 0.5 mg for a single dose IV Adenosine - Calcium Chloride - Amiodarone - Lidocaine - Procainamide mg/kg IV fast push repeat X 2 at 0.2 mg/kg 20 mg/kg IV slow push 5.0 mg/kg IV push (if successful, 1.0 mg/kg over 5 minutes) 1.0 mg/kg 15 mg/kg IV over minutes

3 Magnesium Sulfate mg/kg IV over 10 minutes Sodium Bicarbonate - Child: 1.0 meq/kg of 4.2% IV push Adolescent: 1.0 meq/kg of 8.4% IV push Dopamine - Dobutamine - Morphine Sulfate - Glucose - Narcan - Valium mcg/kg/min IV infusion 2 20 mcg/kg/min IV infusion 0.1 mg/kg g/kg of 25% (or 12.5% for newborn) 0.1 mg/kg titrated up to 2.0 mg 0.1 mg/kg Physical differences between children and adults Head is a greater percentage of body surface area in children than in adults Lose and gain heat more quickly Heavier so children tend to land head-first from falls Tongue is proportionately larger in children and take up more space in the mouth The occipital area of the skull is much larger than in an adult Bones are soft Placing a child on a flat surface will flex the head and can occlude airway Tend to bend rather than break Forces are easily transmitted to internal structures Greater internal injury can occur without external signs Abdominal organs are larger and mostly unprotected by the rib cag

4 Emotional and psychological differences between children and adults Stranger anxiety Children up to the age of about six do not like strangers and fear separation from parents Body image and fear of mutilation Preschoolers fear blood Guilt Adolescents fear permanent scarring and disfigurement School-aged children through adolescents feel responsible for their injuries You may not get the full story when interviewing them Respiratory Distress vs Respiratory Failure 1) Respiratory Distress Increased work of breathing Tachypnea Shock DKA Cardiac defects

5 Salicylate poisoning Diarrhea Metabolic acidosis Sternal retractions Nasal flairing Grunting Tachycardia Normal blood gases Adequate oxygen saturation Slight acrocyanosis Respiratory Failure May be preceded by respiratory distress but may occur without signs Shallow, ineffective respirations (slow respirations are very bad) Low oxygen saturation Mottling and cyanosis Lethargy Hypotonia (limp)

6 Weak cry Bradycardia Shock Causes: Hypovolemia (vomiting, diarrhea, blood loss) Septic (infection) Anaphylactic (acute allergic reaction) Cardiogenic (ineffective heart action) Respiratory failure Signs and symptoms of shock: Tachycardia proceeding to bradycardia Lethargy Hypotonia Oligouria Weak femoral pulse Absent peripheral pulse Cool, mottled, or cyanotic extremities Delayed capillary refill (with extremity warm)

7 Treatment for Shock and Respiratory Failure Correct respiratory situation Insure patent airway Provide oxygenation Provide ventilation Provide CPR if bradycardic for age group Replace fluids 10 ml/kg IV bolus if < 1 month old 20 mlkg IV bolus if > 1 month Pediatric Medical Emergencies Croup Epiglottitis Asthma (Reactive Airways Disease) Bronchiolitis Epilepsy Meningitis Dehydration

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