1. PEDI ADVANCE LI SUPPORT ATRIC FE
Head Tilt-Chin Lift (Jaw-Thrust)/Oral Airway/
A IRWAY AIR Oral Size(angle of mouth to angle of mandible)/ Insert propertly
Naso-Pharyngeal (Shortened E.T.Tube) Use E.T. tube/Size (Tip of nares to tragus of ear) in Conscious or semiconscious
P WAY Nasal
Unmaintainable & Requiring Interventions Assemble Equipment/Select proper size blade & tube/Insert/Fix/Check
EI
A
Intubation / Removal of F.B / Cricothyrotomy Blade size (Angle of mouth to adam's apple) /Fit properly/Check bulb & cells
NN Tube Size (age/4+4, little finger's size)/Assemble 3 tubes+ 0.5/
B POTENTIAL RESPIRATORYinFAILURE (Alert child experiencing L D Length (sizeX3 or age/2+12) Uncuffed (<8yr)/Fix properly
DT
respiratory distress) : Supplement oxygen non-threatening manner(blow by stream Check B/L Chest movements/B/L/ Breath sound Chest, abdomen/
S
held by parent’s towards the child mouth & nose) /position of comfort (in parent’s arm)
R OU Direct Visualisation/Clinical improvement.
Compli- D.O.P.E. Displaced Obstructed Pneumothorax Equipment failure
TB
DEFINITE RESPIRATORY FAILURE (When potential failure
E patient fails to improve after therapy or further deteriorates) : Maintain patent Airway/ cation Sequence of checking the problem: Asymetrical movement &
R
B/S (withdraw tube slightly) /Movement & B/S/ absent, B/S/ present
AA
Give maximum Supplemental oxygen providing 100% O by total Non-Rebreathing Mask,
2
on stomach (Direct visualisation - Displaced tube -- Relntubate)/
A Anaesthesia mask or Bag & Mask / Alongwith treat shock if present. C CT Check Equipment (Oxygen source, leakage in Bag & mask. De-
SLOW OR IRREGULAR RESPIRATION : (Causes are fatigue, HI press pop off value, give more pressure, check airleak) /Do suction
o
T carefully timed to augment the child inspiratory effort/Consider intubation. Quickest (for Obstruction)/Needle thoracostomy(for Pneumothorax)
Hypothermia and C.N.S. Depression) : Give assisted ventilation with Bag & Mask E
AO Way
u Extubate --- Bag & mask --- Relntubate ---- Needle Thoracostomy
H RESPIRATORY ARREST : Treat with Bag & Mask & Intubate Drugs L.A.N.E. Lidocaine --- Atropine -- Naloxone --- Epinephrine
LN
r Used Via Dose: Epi (10 times i.v.) Rest all (2-3 times) Dilute in 3-5 ml N.S.
I BAG AND MASK VENTILATION : Check leakage/Select proper s BREATHING Nasal Cannula & Prong (1-5L --- 20-30%) Mask & Venturi Mask
size mask/Make airtight seal/proper positioning of head & neck/ (5-10L --- 35-60% )High conc (Partial Rebreathing) Mask (10-12
DEVICE
e
Sellick’s Maneouver (minimises gastric inflation & passive regurgitation)
N INEFFECTIVE VENTILATION : Reposition head/Reapply mask/suction/Give L-- 50-60%) Non Rebreathing Mask (10-12 L---95%) Oxygen
Hood (10-15 L --- 80-90%) Anaesthesia Bag (15 L---- 100%)
100% O2 Devices- (1) Anaesthesia bag (2) Non-Rebreathing Mask (3) Bag & Mask
G more pressure/Bypass pop off valve/Check leakage & O Source/Put nasogastric tube
2
CIRCULATION DRUGS - Ready Reference
HYPOTENSION : 60 (0-1 mo) 70 (1mo-!yr) 70+ {ageX2} (>1yr) (For 1 in 10,000)-Dilute 1ml. in 10 ml. D.W. Then calculate dose.
Epinephrine
P
TACHYCARDIA : >180 (5yr) >160 (>5yr) BRADYCARDIA : <80 (<5yr) <60 (>5yr) FIRST DOSE: 0.1 ml/kg of diluted drug (1 in 10,000)
Available only as
A NEXT DOSE: 0.1ml/kg of undiluted drug (1 in 1000)
1 in 1000 E.T. Route: 0.1ml/kg of undiluted drug (Dilute in 3-5ml of N.S. &
ARRYTHMIAS Recognise UNSTABLE RHYTHM & treat only UNSTABLE PATIENT.
L 1ml=1mg give through tube & give several positive pressure ventilation)
Narrow Complex (SVT) Adenosine(i.v.)
UNSTABLE
(Rule out sinus tachy) S
TACHY DOSE: 0.035ml/kg or app. 1.5 units/k (of 40 units insulin syr)
CARDIOVERSION
ATROPINE
Patient in
(For quick calculation: 1.5 times the weight in units)
Wide Complex (V.T.) Lidocaine(i.v.)
shock/arrest
Minimum Single Dose: 0.2ml (0.1mg)- for upto 5kg of weight
C 1ml = 0.6mg
BRADY Any type (<60/min)
{
PATIENT Treat Hypoxia Maximum Single Dose: 1ml (0.5mg-Child) 1.8ml (1mg-Adol)
Dose 0.02mg/k
o
Epi / Atropine Repeat Dose: Can be repeated only once after 5 min.
{
Asystole
ABSENT u
Epineph(1 in 10000)
Pulseless Electrical Activity (Hypoxia, Shock, Acidosis,
LIDOCAINE Dose in ml: 0.05ml/kg or app 2 units/kg (of 40 units syr)
Epineph(1 in 1000)
P U LS E Hypothermia, Cardiac Temponade, Pneumothorax, Elec lmbalance)
r (For quick calculation: Twice the weight in units)
1mg/k (1ml=21.3mg)
(Treat cause of PEA) Repeat every 3-5min
{
VT s
Defibrillation (3times)
VF 2,4,4 Joules/K
e Rate & amount of fluid can be altered if needed e.g. Dilute same amount in 500 ml
INFUSIONS: fluid or use 1/5th amount of drug in 100ml and increase the drip rate to 5 times.
Epineph(1 in 10000)
{
SHOCK Tachycardia/Capillary Refill time/peripheral pluse/skin temp, Color
Defibrillation (4 J/kg)
(Compensated) mottling/CNS perfusion (decrease consciousness, Pupil,Muscle tone)
Epinephrine 1mk/ml Add 0.6Xwt. in ml (mg) or pre calculated dose in 100ml of fluid
Uncompensated- All the above along with HYPOTENSION Lidocaine (1mg/kg) (0.1-1ug/kg/min.)
D F L U I D R A T E : 1 ml - 1 0 m l / h r w i l l g i v e 0 . 1 - 1 u g / k g / m i n
TREATMENT- I.V. bolus of 20 ml/kg of Normal Saline or Ringer Lactate. Dopamine 1ml=40mg Add 6Xwt. in ml or 0.15Xwt in ml or pre calculated dose in 100ml
Defibrillation (4 J/kg)
R 5-20ug/kg/min. F L U I D R A T E : 5 m l- 2 0 m l / h r w i l l g i v e 5 - 2 0 u g / k g / m i n o f d r u g .
Dobutamine
TRAUMA RESUSCITATION : Neutral Head position/Jaw thrust/suction/100% 1ml=25mg Add 6Xwt in mg or 0.25Xwt in ml or pre calculated dose in 100 ml
U
Epineph(1in1000) 5-10ug/kg/min. FLUID RATE : 5ml - 10ml/hr will will give 5-10ug.kg/min of drug.
Qxygen/Hyperventilation/E.T. Intubation (Thoraco-Abdominal examination) Control Bleeding,
G
Continue Defibrillation Lidocaine 1ml=21.3 add 6Xwt in mg or 0.28Xwt in ml or pre calculated dose in 100 ml
Needle Thoracostomy (if sings of shock) Give bolus 20ml/kg - reasses & repeat-reasses & after either Epi or Lido 20-50ug/kg/min. FLUID RATE : 20ml-50ml/hr will give 20-50ug/kg/min of drug.
S
give o-ve blood - reasses & Laprotomy/ Cervical Immobilisation/N.G. tube decompression. (Bretylium can also be used) (Alternative 6 ml in 100ml will give 1ml/k/hr=20ug/k/min)
Cardioversion
Defibrillation
WEIGHT
Ca.gluconate
Naloxone
Epineph
POSTARREST STABILISATION
Atropine
Lidocaine
A Length INFUSIONS
1ml=0.4mg
E.T.
1ml=9mg
Height
G ML of druge in 100 ml.
TUBE
(ICMR)
EVALUATION VENTILATION : Clinical/Pulse oximetry/transcutaneous O2/arte- E app. EPI
Size Length 1ml=1mg DOPA DOBUT =21.3mg
LIDO
rial blood gases.CVS : Continious ECG for H.R. & Rhythm/B.P. (every 5 min until =40mg =25mg
Yr. Kg. Cm. mL mL mL mm cm mL mL mL mL Joule Joule mL mL
stable then every 15 min.). Peripheral Circulation : Skin Temp./Cap refill/distal Pulse/
level of consciousness/urine out put CNS : Responsiveness/Pupil size/respone to light/ NB 3 45-50 0.3 0.2 0.15 3 9 1.8 0.5 0.75 0.8 1.5 6 0.75 2
Spon movement/movement in response to pain/ability to follow commands.
3mo 5 55-60 0.5 0.2 0.25 4 10 3 0.75 1.25 1.4 2.5 10 1.5 4
LAB EVALUATION : Electrolytes/Calcium/Glucose/Hematocrit/Arterial blood gases
(every 10-15 min. of changed setting)/urea/creatinine/X-Ray chest for heart size.
6mo 7 63-67 0.7 0.25 0.35 4 10 4.2 1 1.75 2 3.5 14 2 5
GENERAL MEASURES 2 large bore functional vascular catheters Humidified
oxygen of highest conc Preserve core temp. (overhead heating units, 1-2y 10 75-80 1 0.35 0.5 4.5 12 6 1.5 2.5 2.8 5 20 2.5 7
lamps, Incubators, covering head, blankets, etc.) Calculatate proper fluid require-
3yr 12 85-90 1.2 0.4 0.6 5 14 7.2 1.8 3 3.5 6 24 3 9
ment (use N/4 Saline) Put naso or orogastric tube to prevent gastric distention.
Search for ppt causes of disease & give treatment (e.g. antibiotics). If significant
5yr 15 95-100 1.5 0.5 0.75 5.5 15 9 2.3 3.75 4.2 7.5 30 4 11
CNS depression: Intubate & Hyperventilate with PaCO2 maintained at 22-29mm
Hg until intracranial pressure can be evaluated. Sedation if needed. (to minimise
7yr 20 115-120 2 0.7 1 5.5 15 12 3 5 5.5 10 40 5 14
the risk of ET displacement) Diazepam 0.1-0.2 mg./K iv, Morphine 0.1 mg/K iv.
Initial Ventilator Setting 100% oxygen/Tidal vol. 10-15 ml/K/Inspiratory time 0.5-1 9yr 25 125-130 2.5 0.9 1.25 6 16 15 3.8 6.25 7 12.5 50 5 18
Sec/Peak inspiratory Pressure 20-30 cm/RR - 20-30 (in) 16-20 (ch)/PEEP 2-4 cm
11yr 30 135-140 3 1ml 1.5 6.5 17 18 4.5 7.5 8.5 15 60 5 22
Compiled by : DR. SUKHMEET SINGH (LUDHIANA) for P.A.L.S Group
Adol 45 155-160 4.5 1.8 2 7,8 20 27 7 11 12.5 25 90 5 30
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