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    Top Messages: Paediatric Life Support 2021

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    Mihai Ion Ghioalda
    This document provides guidance on paediatric life support for children ages 0-18. It emphasizes 5 key messages: 1) Use ABCDE as a common language and work as a team; 2) Titrate oxygen therapy to 94-98% saturation or use high flow oxygen for respiratory/circulatory failure; 3) For shock, give fluid boluses of 10ml/kg and start vasoactive drugs early; 4) For basic life support, use the PBLS algorithm of ABC-15:2 if trained; 5) For advanced life support, use the PALS algorithm, treat reversible causes, use 2-person BMV, and ventilate at 10-25 breaths per minute if intubated.

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    Top Messages: Paediatric Life Support 2021

    Uploaded by

    Mihai Ion Ghioalda
    40 views6 pages
    This document provides guidance on paediatric life support for children ages 0-18. It emphasizes 5 key messages: 1) Use ABCDE as a common language and work as a team; 2) Titrate oxygen therapy to 94-98% saturation or use high flow oxygen for respiratory/circulatory failure; 3) For shock, give fluid boluses of 10ml/kg and start vasoactive drugs early; 4) For basic life support, use the PBLS algorithm of ABC-15:2 if trained; 5) For advanced life support, use the PALS algorithm, treat reversible causes, use 2-person BMV, and ventilate at 10-25 breaths per minute if intubated.

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    This document provides guidance on paediatric life support for children ages 0-18. It emphasizes 5 key messages: 1) Use ABCDE as a common language and work as a team; 2) Titrate oxygen therapy to 94-98% saturation or use high flow oxygen for respiratory/circulatory failure; 3) For shock, give fluid boluses of 10ml/kg and start vasoactive drugs early; 4) For basic life support, use the PBLS algorithm of ABC-15:2 if trained; 5) For advanced life support, use the PALS algorithm, treat reversible causes, use 2-person BMV, and ventilate at 10-25 breaths per minute if intubated.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    40 views6 pages

    Top Messages: Paediatric Life Support 2021

    Uploaded by

    Mihai Ion Ghioalda
    This document provides guidance on paediatric life support for children ages 0-18. It emphasizes 5 key messages: 1) Use ABCDE as a common language and work as a team; 2) Titrate oxygen therapy to 94-98% saturation or use high flow oxygen for respiratory/circulatory failure; 3) For shock, give fluid boluses of 10ml/kg and start vasoactive drugs early; 4) For basic life support, use the PBLS algorithm of ABC-15:2 if trained; 5) For advanced life support, use the PALS algorithm, treat reversible causes, use 2-person BMV, and ventilate at 10-25 breaths per minute if intubated.

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    of 6

    PAEDIATRIC*LIFE SUPPORT 2021

    5 TOP MESSAGES
    *0-18y, except newborns ‘at birth’

    1. Use ABCDE as common language


    – Work as a team – Be competent.

    2. Titrate oxygen therapy to Sp02 94-98%


    - only if impossible to measure, start high flow O2
    based on signs of circulatory/respiratory failure.

    3. In ‘shock’, give 1 or more fluid bolus(es) of


    10ml/kg of (preferably balanced) crystalloids
    (or blood products). Reassess after each bolus.
    Start vasoactive drugs early.

    4. For basic life support, use the specific PBLS


    algorithm (ABC - 15:2) if you are trained to do so.
    Both improving the quality of CPR and limiting the
    hands-off time are considered crucial.
    Consider provider safety.

    5. For advanced life support, use the specific PALS


    algorithm. Actively search for and treat reversible
    causes. Use 2-person BMV as the first line ventilatory
    support. Only if intubated, provide asynchronous
    ventilation at an age-dependent rate (10-25/’).
    PAEDIATRIC*LIFE SUPPORT 2021

    COMMON GROUNDS

    KEY EVIDENCE

    With the exception of Only perform or lead procedures


    newborns at birth, all children for which you are sufficiently
    0-18y are best treated by competent (self-reflection – based
    paediatric guidelines. Adult on knowledge, skills, attitudes,
    guidelines can be used for expertise and ongoing training).
    patients that appear adult.

    All children at risk of serious A team-based approach


    illness or injury are best improves performance and
    approached in a stepwise outcome. A structured strategy
    pathophysiology based for implementation and
    ABCDE manner. ongoing evaluation is needed.

    KEY RECOMMENDATIONS

    A B C D E
    For PLS of all children (0-18y): use ABCDE as common
    language – work as a team – be competent.
    PAEDIATRIC*LIFE SUPPORT 2021

    AB

    KEY EVIDENCE

    Too liberal supplemental


    oxygen has undefined
    risks & resource needs
    but there is also a risk of Titrate to
    inadvertent hypoxaemia normoxaemia if
    if conservative. possible. Adjustments
    might be needed for
    chronic conditions or
    severe ARDS. ‘Blind’
    high flow oxygen for
    No evidence to children who present
    support pre-emptive with respiratory or
    oxygen in children circulatory failure.
    without signs or
    immediate risk for
    hypoxaemia or shock.

    KEY RECOMMENDATIONS

    Titrate Oxygen R/ to Sp02 94-98% - only if impossible


    to measure, start high flow oxygen based on signs of
    circulatory/respiratory failure.
    PAEDIATRIC*LIFE SUPPORT 2021

    KEY EVIDENCE

    Circulatory failure is not For a sustained


    one disease – treatment effect on perfusion,
    needs to be tailored to in most patient with
    the individual (etiology, shock – even those
    pathophysiology, age, with underlying
    context, comorbidity, hypovolaemia - early
    resources…). vasoactive drugs are
    mandatory.

    Fluid is key in many patients


    with shock but fluid overload
    will negatively impact outcome.
    Timely reassessment is crucial.

    KEY RECOMMENDATIONS

    In ‘shock’, give 1 or more fluid bolus(es) of 10ml/kg of


    (preferably balanced) crystalloids (or blood products).
    Reassess after each bolus. Start vasoactive drugs early.
    PAEDIATRIC*LIFE SUPPORT 2021

    PBLS

    KEY EVIDENCE

    The specific algorithm for pbls continues to emphasize the


    importance of oxygenation and ventilation as part of CPR.
    We no longer speak of ‘duty to respond’, just of ‘trained in
    PBLS’. Those trained should use the pbls algorithm. Specific
    targetgroups should use 2-person bmv for ventilations.

    112
    To limit hands-off time and be more uniform, immediately
    after the 5 rescue breaths, proceed with chest compressions
    – unless there are clear signs of circulation. Single rescuers
    should first call for help then before proceeding.

    Good quality compressions have a good rate, depth and


    recoil. A trained single rescuer preferably also uses a two-
    thumb encircling technique for infant chest compressions,
    taking care to avoid incomplete recoil.

    KEY RECOMMENDATIONS

    For basic life support, use the specific PBLS algorithm


    (ABC - 15:2) if you are trained to do so. Both improving the quality
    of CPR and limiting the hands-off time are considered crucial.
    Consider provider safety.
    PAEDIATRIC*LIFE SUPPORT 2021

    PALS

    KEY EVIDENCE
    The specific algorithm for PALS continues to highlight
    the importance of early defibrillation for shockable
    rhytms (self-adhesive pads, 4J/kg). If in doubt, consider
    the rhythms to be shockable. Consider stepwise dose
    escalation for refractory VF/pVT (≥ 6 shocks). A stacked
    shock approach is only advised for witnessed onset of
    shockable arrest with defib immediately available (or in
    cases where rescuers are still donning PPE).

    Currently, no single factor exists that can be used as an


    isolated target nor as prognostic argument. However,
    prognosis can be clearly influenced by recognising and
    (aggresively) treating reversible causes.

    2-person BMV is the preferred way to manage the


    airway during advanced CPR. Only in cases where
    a tracheal tube is in place, provide continuous
    compressions and ventilate at the lower limit of
    normal for age (10 (>12y) – 15 (8-12y) – 20 (1-8y) –
    25 (<1y)).

    KEY RECOMMENDATIONS

    For advanced life support, use the specific


    PALS algorithm. Actively search for and
    treat reversible causes. Use 2-person BMV
    as the first line ventilatory support. Only if
    intubated, consider asynchronous ventilation
    at an age-dependent rate (10-25/’).

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