TREKK Virtual Education Session - 6 - PALS

PALS Algorithms

Science of Pediatric Resuscitation (2020 Updates)

• Respiratory rates: higher ventilation rates have shown improved rates of ROSC and survival in cardiac arrest
  • Infants <1 yr = at least 30 breaths per minute
  • Infants >1 yr & children = at least 25 breaths per minute
• With advanced airway in place, target respiratory rate range of 1 breath every 2 to 3 seconds (20-30 per minute)
• Intubation with cuffed ETT is preferred
  • Improves capnography and ventilation in patients with poor pulmonary compliance
  • Decreases the need for ETT changes
  • Improves rate of successful ventilation
  • Decreases risk of aspiration
• Cricoid pressure may decrease the success of the first intubation attempt
  • Impedes visualization
  • Impairs chest rise with bag mask ventilation
  • Thus not recommended
• Routine use of epinephrine during CPR aims to improve coronary perfusion pressure and maintain cerebral perfusion pressure
  • Earlier administration may increase survival to discharge rates
  • Should be started 5 mins after chest compression
• Diastolic blood pressure can be used to assess CPR quality
  • Marker of adequate blood flow during CPR if arterial line is in place
• Seizures post cardiac arrest are common, and usually non-convulsive
  • Can be detected by EEG
  • Recommended when available, and to treat seizures if present