Update your knowledge of the latest PALS guidelines
Karen Jean Craig BS, RN, EMT-P
Mary Patricia Day MSN, RN, CRNA

June 2011 
Volume 41  Number 6
Pages 44 - 47
  PDF Version Available!

THE AMERICAN HEART Association (AHA) released updated guidelines in 2010 for basic life support (BLS), advanced cardiovascular life support (ACLS), and pediatric advanced life support (PALS). In the May issue of Nursing2011, "Are you up to date on the latest BLS and ACLS guidelines?" covered the changes to BLS and ACLS for adults. In this article, we'll take a look at the changes to PALS.Care of the pediatric patient in cardiac arrest begins with optimal BLS. As for adults, the 2010 AHA guidelines for infants and children emphasize high-quality CPR. Keep in mind that a child is defined as a patient from age 1 until puberty; an infant is under age 1.1As discussed in the previous article, the sequence of BLS has changed from ABC (airway, breathing, compressions) to CAB (compressions, airway, breathing). Follow these steps when you encounter a pediatric patient in possible respiratory arrest:Recognition. First, determine unresponsiveness and check for gasping respirations or the absence of breathing. As for adults, "Look, listen, and feel" has been removed from the pediatric BLS algorithm. Once you've determined that the patient is unresponsive, send someone to activate the emergency response system (ERS) and get an automated external defibrillator (AED)/defibrillator. If you're alone and a child or infant suddenly collapses, activate the ERS and get an AED/defibrillator.Compressions. Pulse checks have been deemphasized in PALS as in adult BLS. Take no longer than 10 seconds to attempt to confirm the presence of a carotid or femoral pulse in a child and a brachial pulse in an infant.2 If you confirm a definite pulse, give 1 breath every 3 seconds and add compressions if the pulse remains less than 60/minute with poor perfusion despite adequate oxygenation and ventilation. Recheck the pulse every 2 minutes.1If pulse is absent, begin resuscitation of an infant or child with compressions at a rate of at least 100/minute. Depth of compressions for a child is at least 1/3 the

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