Important Treatment Considerations to Implement for Your PALS Patients

Learn about the recommended treatment options when caring for children and little kids in a pediatric environment. Master your PALS career today:

If you’re a doctor, nurse, or healthcare professional who wants to work with children, it’s essential to have Pediatric Advanced Life Support (PALS) training. If you already have similar life support training, such as an Advanced Cardiac Life Support (ACLS) certification, you may think that you can just apply those skills directly to your PALS patients. Unfortunately, this is not always true.

Children and infants have unique needs that, in many cases, can be completely different from an adult in the same circumstance. A child’s small physical size and (often) extreme emotional nature are just two of the key things you must consider when determining the correct treatment to use. As such, it’s essential to train specifically for working with children. Our PALS certification program gives you the vital training you need to properly care for younger patients.

Algorithm Applications

As you have slowly begun to master your PALS requirements, knowing how to implement the correct algorithms into real-world applications is vital for ensuring your patients are receiving the right treatment options.

To do so, knowing all the useful algorithms and when to use them is what will allow you to make the right decisions at the most crucial of times when working with patients like children or infants. There are several different algorithms that may be right for your PALS patients, depending on their unique circumstances. It’s essential to have adequate training in these algorithms so you are ready to utilize them when necessary. Here are some of the most important treatments to consider.

Pediatric Post-Resuscitation Care Algorithm

These are the steps to take with a pediatric patient who has been resuscitated after a life-threatening event:

  • Optimize oxygen and ventilation.
  • Look for signs of shock.
    • Provide treatment for reversible causes, such as hypoxia, hypothermia, toxins, and trauma.
  • Treat hypotensive shock with epinephrine or norepinephrine
  • Treat normotensive shock with epinephrine or milrinone
  • Monitor the patient for seizures, agitation, and hypoglycemia.
    • Provide treatment as necessary.
  • Consider consultation/patient transport

If a child is successfully resuscitated from cardiac arrest, they may experience post-cardiac arrest syndrome, which can have severe symptoms such as brain injury. Pediatric post-resuscitation care is focused on helping the body return to functioning normally.

Pediatric BLS Algorithm

This is the Pediatric Basic Life Support Algorithm for a patient when there are two or more rescuers who are healthcare providers:

  • Check scene safety and shout for help.
    • One rescuer should stay with the child while the other activates EMS and retrieves an AED.
  • If the patient is breathing and has a pulse, monitor them until EMS arrives.
  • If the patient isn’t breathing normally but has a pulse, initiate rescue breathing with one breath every 2 to 3 seconds.
    • If the heart rate drops below 60/min or the pulse stops, start CPR.
  • If the patient is not breathing (or only gasping) and there is no pulse, start CPR.
    • If the patient has a shockable rhythm, use the AED.
    • If there is no shockable rhythm, resume CPR for two minutes and check the rhythm again.

You can continue BLS procedures until the child responds or advanced life support providers take over care.

Pediatric Bradycardia Algorithm

Bradycardia is the term for a too-slow heart rate based on the normal range for the child’s age, activity level, and condition. Here is the Pediatric Bradycardia Algorithm to follow:

  • If the patient is stable, attempt to identify the cause of bradycardia and provide treatment.
    • Maintain patent airway.
    • Apply oxygen as needed.
    • Monitor vital signs, using a cardiac monitor if possible.
  • If the patient is unstable and showing signs of shock, hypotension, or an altered level of consciousness, begin immediate treatment:
    • Maintain airway and administer oxygen as necessary.
    • Monitor vital signs.
    • Initiate CPR if the heart rate drops below 60/min and condition doesn’t improve after oxygenation.
    • If bradycardia continues, consider Atropine or Epinephrine. Also, consider transvenous / transthoracic pacing

Some common causes of bradycardia are hypothermia, medications, and hypoxia. It’s essential to know how to treat a bradycardia patient while you try to identify the cause of the issue.

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Pediatric Tachycardia Algorithm

The opposite of bradycardia, tachycardia is an abnormally fast heart rate. This is the Pediatric Tachycardia Algorithm:

  • Identify and treat the underlying cause.
    • Provide oxygen as needed and attach a cardiac monitor.
    • Monitor vital signs
    • Establish IV/IO access
  • Evaluate the rhythm using the monitor or a 12-lead ECG. A narrow QRS of less than 0.09 seconds should be treated as probable sinus tachycardia (identify and treat the underlying cause) or probable supraventricular tachycardia (consider vagal maneuvers or deliver adenosine). A wide QRS of greater than 0.09 seconds should be treated as possible ventricular tachycardia
    • If there is cardiopulmonary compromise, consider synchronized cardioversion
    • If there is no cardiopulmonary compromise, administer adenosine

Although not uncommon in children, tachycardia can sometimes indicate a serious condition, so it’s essential to know how to respond to this situation.

Pediatric Cardiac Arrest Algorithm

This algorithm is one to use with a child who is unresponsive and possibly under cardiac arrest. Here are the main points of the algorithm:

  • Begin CPR, administer oxygen as needed, and attach defibrillator / monitor.
  • If rhythm is not shockable (asystole/PEA) deliver epinephrine and resume CPR.
  • Once the rhythm is shockable (VF/pVT), deliver shock, resume CPR, and establish IV/IO access.
  • After 2 minutes of CPR, if rhythm is shockable, shock, resume CPR, deliver epinephrine every 3-5 minutes, and consider advanced airway; capnography
  • After another 2 minutes of CPR, if rhythm is shockable, shock, resume CPR, consider amiodarone or lidocaine, and treat reversible causes
  • If rhythm is not shockable and:
    • There are NO signs of ROSC, resume CPR
    • There are signs of ROSC, go to post-cardiac arrest care

Knowing this algorithm could help you save a pediatric patient’s life.

Important Treatment Considerations to...

Emotional and Physical Needs: Children Vs. Adults

Children are in a completely different ballpark than adults when it comes to the emotional and physical differences in emergency situations. As a nurse or doctor in the PALS industry, it is your job to ensure that these specific needs are being met with precision and efficiency.

To do so, understanding how to evaluate a patient’s needs is an important first step. A child’s emotional responses may be very different from an adult’s, so you must take that into consideration. Additionally, you must make sure to choose treatments and equipment that are suitable for a child’s physical size.

Emotional Responses

Children don’t have as much practice as adults at recognizing and controlling their emotions. Stressful, life-threatening situations may cause them to experience severe emotional outbursts. Here are some ways PALS healthcare providers can respond:

  • Focus on building a relationship with the patient, including asking them questions about their hobbies or interests.
  • Provide a simple explanation of what is happening, and comfort the patient when possible.
  • Offer activities to help children express their feelings: walking, drawing, talking, hitting a pillow or punching bag, etc.
  • Create an environment that is as physically comfortable as possible.

It can take a lot of practice to learn how to deal with a pediatric patient’s emotional responses. Patience and compassion are key traits to practice.

Therapy and Treatment Options

Sometimes treatments for infants and children are different than those available to adults with the same medical issues. It’s important to be aware of when you need to utilize a pediatric-specific treatment or therapy. Pediatric treatments may be smaller and more nuanced, and you may need to figure out child-friendly ways to describe what’s happening to help your patient be less afraid.

Physical Body Size

Obviously, most children have smaller bodies than most adults. As such, healthcare providers need to carefully measure medications to make sure they give a pediatric patient the right amount. As an adult, you need to remember that a child may view you as large and frightening, so kneeling or lowering yourself to be more on their level may be helpful.

Additionally, the way to deal with an out-of-control or panicking child is different from reacting to an adult. It’s especially important to remind children that they are not “in trouble” or at fault for what is happening to them. Nurses and doctors need to make sure they keep patients of all ages safe and protect them from accidental self-harm.

Equipment Change

Pediatric patients may need different life support equipment than adults. For example, young children have soft bones, which allows quick intraosseous access. This can be a better, faster way to administer fluids and medications to pediatric patients when IV access is limited.

Bag-mask ventilation is another important treatment option for PALS providers. However, it’s essential to make sure the mask fits properly, which can be challenging with very small children. Likewise, it’s vital to choose an airway device that is not too large for a pediatric patient’s throat.

Essential Knowledge Requirements for a PALS Nurse or Doctor

Doctors and nurses who work with children need a particular set of skills and specific knowledge. Getting your PALS certification is vital. Our online PALS certification covers the six key algorithms that you need to know for the exam: Pediatric BLS (single-rescuer and multiple-rescuer), Pediatric Bradycardia, Pediatric Tachycardia, Pediatric Cardiac Arrest, and Pediatric ROSC.

Along with knowing these algorithms, it’s also essential to understand some of the important differences between pediatric and adult patients. Children and infants have unique emotional and physical needs that must be considered when administering treatment. The best pediatric healthcare providers are individuals who pair education with real-world experience.

Additional PALS Study Material:

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