Regional Nursing Grand Rounds

AHA PALS
2015 Updates
 Outreach Education Warmly Welcomes

Presenters:
Eileen Reichert, MN, ARNP
Reid Farris, MD, MS
Silvia Hartmann, MD
Joan Roberts, MD
Jennifer Reid, MD

PALS Team:
Haiyen Tang, BSN, RN, CCRN
Elizabeth Masse, FL Ldr, CPM, Critical Care
Hector Valdivia, MN, RN, CCRN
Jen Peterson, MSN/Ed, RN, CCRN
Heather Johnston, RN
Elaine Beardsley, Unit Based Clinical Nurse

Guest Student:
Evan Dembowski
Program Objectives

• The learner will be able to:

1. Explain recommendations of AHA guidelines 2015 for PALS.
2. Discuss applications of new PALS guidelines to the care of
children when indicated.
3. Utilize team approach communication skills in implementing
PALS Guidelines 2015 recommendations for improved patient
outcomes
Disclosure Statement

• We do not have any conflict of interest nor will we be

discussing any off-label product use.

• This class has no commercial support or

sponsorship, nor is it co-sponsored.
Outline

• Overview of Changes • Neurologic Deterioration

• BLS & High quality CPR Scenario
• Atropine for intubation • Septic Shock Scenario
• CPR Feedback
• Overview of Changes
• VF Cardiac Arrest • Judicious fluid resuscitation
Scenario
• Overview of Changes
• Antiarrhythmic medications
• Targeted temperature
management
Pediatric BLS Updates

• 5 components of High Quality CPR

• 100 - 120 compressions/min (same as adult)
• ‘Feedback device’ use suggested – if available
• Reasonable depth of compression: ⅓ the AP diameter of chest
• 1½” in infants, 2” in children, 2 - 2.5” in adolescents
• ‘Conventional’ CPR (compressions & respiration) should be
provided for pediatric cardiac arrest unless rescuers are
unable or unwilling to provide rescue breaths

• Routine use of Atropine pre-intubation discouraged

CPR ‘Feedback’
VF Cardiac Arrest Scenario
Antiarrythmic Medications

• 2000 & 2005 guidelines recommneded amiodarone vs.

lidocaine for VF or Pulseless VT
• Some data suggests that lidocaine is as good if not better
than amiodarone

• For VF or pVT refractory to defibrillation; lidocaine or

amiodarone is recommended
Neurologic Deterioration Scenario

Enter two line

department name here
Targeted Temperature Management post Cardiac Arrest

• Therapeutic Hypothermia led to no change in outcomes

in pediatric out of hospital cardiac arrest compared to
normothermia
• 48 hours of 32 – 34oC followed by 72hrs of normothermia
or 5 days of normothermia may be considered for
children who remain comatose after cardiac arrest
• Fever should be aggressively treated

• In hospital arm of THAPCA trial pending

 Code Blue and Rapid Response Events

Several recent code blue and rapid response events show that
there is confusion on when to activate code blue for
neurologic indications.

So what to activate code blue for:

•New onset seizure activity
•Persistent seizure activity > 20 minutes or if cardiopulmonary
compromise if present
•New onset anisocoric pupils and/or altered mental status,
bradycardia, hypertension
•Loss of consciousness
•Sudden change in motor function or speech
Strong Communication Methods to Look for:

• Read backs and repeats

• Call and response checklist
• Team leader summary statements
• SBAR
• ARCC
• STAR
 ACTIONS PRIOR TO CODE TEAM ARRIVAL
(perform as feasible)

Initiate PEARS/BLS (Pediatric Emergency Assessment,

Recognition and Stabilization)
Confirm to call to Stat line x7-9999 of code blue location
Turn on ALL lights
Stop feeds
Move bed to middle of room to allow code team access
Remove all non-essential items:
a. Comfort items in bed
b. Furniture
c. Equipment
d. Visitors
e. Patient and family in other bed if double room
Bring code cart to room and defibrillator to bedside
Apply defib pads to patient if concerned for cardiac arrest
Code Blue Committee 11-16
Code Blue/Green Transport Checklist
Septic Shock Scenario
 Assessment & Management of Septic Shock

• In settings with limited access to critical care resources,

judicious use of fluid resuscitation is recommended in
patients with severe febrile illness
• Crystalloid or colloid can both be effective as initial
choice for fluid resuscitation

• Patient evaluation before & after fluid resuscitation

cannot be under-emphasized
PALS 2015 Update Summary

• High Quality CPR

• Routine use of Atropine pre-intubation, not needed
• Amiodarone or Lidocaine for shock refractory VF/pVT
• Targeted temperature therapy for out of hospital arrest
• Fever should be aggressively treated post-arrest
• Aggressiveness of initial fluid resuscitation in severe
febrile illness should take clinical setting & resources into
account