Welcome to the overview on Resuscitation Tools. In this video, we will briefly discuss the resuscitation tools and its importance in PALS.
Understanding that resuscitation tools are available is an essential component of PALS. These adjuncts are broken down into two subcategories, which are medical devices and pharmacological tools.
A medical device is an instrument used to diagnose, treat, or facilitate care. Pharmacological tools are the medications used to treat the common challenges experienced during a pediatric emergency.
It is important that you thoroughly understand all resuscitation tools to optimally care for a child or an infant who needs assistant.
This concludes our lesson on the Resuscitation Tools Overview. Next, we will review Medical Devices: Intraosseous Access.
Welcome to the lesson on Medical Devices. In this video, we will discuss the Intraosseous Access.
The relative softness of bones in young children makes intraosseous access a quick, useful means to administer fluids and medications in emergency situations when intravenous access cannot be performed quickly or efficiently. Fortunately, any medication that can be given through a vein can be administered into the bone marrow without dose adjustment. Contraindications include bone fracture, history of bony malformation, and insertion site infection.
Intraosseous access should not be attempted without training.
In the first step of proper intraosseous access, place the child or the infant in the supine position, and support their knee with a towel roll.
Use universal precautions such as preparing the skin with betadine or chlorhexidine.
Use specific intraosseous needle or a large-bore needle that is at least 18 gauge.
Find tibial tuberosity below the knee joint and stabilize the leg with slight external rotation.
Insert the needle firmly but gently. Resistance will suddenly drop when in the marrow.
Do not aspirate. Rapidly infuse 5 mL of fluid.
Keep IV bag under pressure. Stabilize and secure the needle.
This concludes our lesson on Intraosseous Access. Next, we will review Bag-Mask Ventilation.
Welcome to the lesson on Bag-Mask Ventilation. In this video, we will discuss how to perform bag-mask ventilation.
When performed appropriately, bag-mask ventilation is an important intervention in PALS. Proper use of this device requires proper fit, that is, the child or the infant’s mouth and nose should be covered tightly, but not the eyes.
When possible, use a clear mask since it allows you to see the color of the person’s lips and the presence of condensation in the mask indicating exhalation.
The two most common types of masks are self-inflating and flow-inflating. While a self-inflating bag-mask should be the first choice in resuscitations, you should not use it in children or infants who are breathing spontaneously. Flow-inflating bag masks, however, require more training and experience to operate properly as you must simultaneously manage gas flow, suitable mask seal, individual’s neck position, and proper tidal volume.
The minimum size bag should be 450 mL for infants and young and/or small children. Older children require a 1000 mL volume bag. Proper ventilation is of utmost importance as insufficient ventilation leads to respiratory acidosis.
The first step of bag-mask ventilation is proper positioning. In the absence of neck injury, tilt the forehead back and lift the chin.
Next, ensure a tight seal. Use the “E-C clamp” which is the letters E and C formed by the fingers and thumb over the mask.
Then, ventilate by squeezing the bag for over one second until the chest rises. Do not over ventilate.
This concludes our lesson on Bag-Mask Ventilation. Next, we will review Endotracheal Intubation.
Welcome to the lesson on Endotracheal Intubation. In this video, we will briefly discuss when to use Endotracheal, or ET, Intubation.
You should use ET intubation when the airway cannot be maintained, when bag-mask ventilation is inadequate or ineffective, or when a definitive airway is necessary.
ET intubation requires specialized training; a complete description of ET intubation is beyond the scope of this video.
This concludes our lesson on Endotracheal Intubation. Next, we will review Basic Airway Adjuncts.
Welcome to the lesson on Basic Airway Adjuncts. In this video, we will discuss when to use the three basic airway adjuncts: oropharyngeal airway, nasopharyngeal airway, and suctioning.
The oropharyngeal airway, or OPA, is a J-shaped device that fits over the tongue to hold the soft hypopharyngeal structures and the tongue away from the posterior wall of pharynx. OPA is used in individuals who are at risk for developing airway obstruction from the tongue or from relaxed upper airway muscle.
If efforts to open the airway fail to provide and maintain a clear, unobstructed airway, then use the OPA in unconscious individuals. You should not use an OPA in conscious or semiconscious individuals because it can stimulate gagging and vomiting. The key assessment is to check whether the individual has an intact cough and gag reflex. If so, then do not use an OPA.
The nasopharyngeal airway, or NPA, is a soft rubber or plastic un-cuffed tube that provides a conduit for airflow between the nares and the pharynx. The NPA is used as an alternative to an OPA in individuals who need a basic airway adjunct. Unlike the oral airway, NPAs may be used in conscious or semiconscious individuals (with intact cough and gag reflex).
Use NPA when insertion of an OPA is technically difficult or dangerous. Use caution or avoid placing NPAs in individuals with obvious facial fractures.
Suctioning is an essential component of maintaining a patent airway. Providers should suction the airway immediately if there are copious secretions, blood, or vomit. Attempts at suctioning should not exceed 10 seconds. To avoid hypoxemia, follow suctioning attempts with a short period of 100 percent oxygen administration.
Monitor the individual’s heart rate, pulse oxygen saturation, and clinical appearance during suctioning. If you see a change in monitoring parameters, then interrupt suctioning and administer oxygen until the heart rate returns to normal and until clinical condition improves. Assist ventilation as warranted.
This concludes our lesson on Basic Airway Adjuncts. Next, we will review Basic Airway Techniques.
Welcome to the lesson on Basic Airway Technique. In this video, we will discuss how to use the three basic airways: oropharyngeal airway, nasopharyngeal airway, and suctioning.
When selecting an airway device, keep in mind that too large of an airway device can damage the throat and too small of an airway device can press the tongue into the airway.
To insert an oropharyngeal airway, or OPA, first clear the mouth of blood and secretions with suction if possible.
Place the device at the side of the individual’s face. (Make sure to choose a device that extends from corner of the mouth to the earlobe.)
Insert the device into the mouth so the point is toward the roof of the mouth or parallel to the teeth. Do not press the tongue back into the throat.
Once the device is almost fully inserted, turn it until the tongue is cupped by the interior curve of the device.
To insert a nasopharyngeal airway, or NPA, place the device at the side of the individual’s face. (Make sure to choose a device that extends from the tip of the nose to the earlobe. Use the largest diameter device that will fit.)
Lubricate the airway with a water-soluble lubricant or anesthetic jelly.
Insert the device slowly into a nostril, moving straight into the face (not toward the brain).
It should feel snug; do not force the device into the nostril. If it feels stuck, then remove it and try the other nostril.
Here are some tips on suctioning:
When suctioning the oropharynx, do not insert the catheter too deeply. Extend the catheter to the maximum safe depth and suction as you withdraw.
When suctioning an ET tube, remember the tube is within the trachea and you may be suctioning near the bronchi or lung. Therefore, sterile technique should be used.
Each suction attempt should be for no longer than 10 seconds. Remember the individual will not get oxygen during suctioning.
Monitor vital signs during suctioning and stop suctioning immediately if the individual experiences hypoxemia (that is, oxygen sats less than 94 percent), has a new arrhythmia, or becomes cyanotic.
This concludes our lesson on Basic Airway Techniques. Next, we will review Automated External Defibrillator.
Welcome to the lesson on Automated External Defibrillator or AED. In this video, we will discuss the AED steps for children and infants.
An AED is both sophisticated and easy to use, providing life-saving power in a user-friendly device. This makes the device useful for people who have no experience operating an AED and allows successful use in stressful scenarios. However, proper use of an AED is very important. The purpose of defibrillation is to reset the electrical systems of the heart, allowing a normal rhythm a chance to return.
Remember the criteria for AED use is no response after shaking the individual’s shoulders and shouting at them; no breathing or ineffective breathing; and no carotid artery pulse detected.
To use an AED in children or infants, first retrieve the AED. Open the case and turn on the AED.
Expose the infant or the child’s cheat. If the chest is wet, dry it. Remove medication patches.
Open the pediatric AED pads. If pediatric pads are not available, then use adult pads. Ensure that the pads do not touch. Peel off the backing. Check for pacemaker or defibrillator; if either are present, do not apply patches over the device.
Apply the pads on upper right chest above the breast and lower left chest below the armpit.
Ensure that the wires are attached to the AED box.
Move away from the individual. Stop CPR and instruct others not to touch the individual.
The AED analyzes the rhythm and prompts you. If the message reads to “Check Electrodes,” then ensure the electrodes make good contact. If the message reads “Shock,” then shock the individual.
Resume CPR for two minutes. And then repeat the cycle.
Remember that if the AED is not working properly, continue performing CPR. Do not waste excessive time troubleshooting the AED. CPR always comes first, and AEDs are supplemental. Also, do not use AED in water.
This concludes our lesson on AED. Next, we will review Pharmacological Tools.
Welcome to the lesson on Pharmacological Tools. In this video, we will briefly discuss pharmacological tools.
Table 9 in the corresponding PALS manual details medications. The use of any of these medications should be done within your scope of practice and after thorough study of the actions and side effects.
Table 9 provides only a brief reminder for those who are already knowledgeable in the use of these medications. Further, Table 9 contains only pediatric doses, indications, and routes of administration (intravenous or intraosseous) for the most common PALS drugs.
Although cited for reference, routine administration of drugs via an ET tube is discouraged. Rapid access and drug delivery through an intraosseous is preferred over ET administration as drug absorption from ET tube route is unpredictable.
This concludes our lesson on AED Pharmacological Tools Next, we will review Recognizing Respiratory Distress or Failure.
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