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108-446: PALS builds upon AHA's Pediatric Basic Life Support (BLS). Providers should follow the AHA's Pediatric BLS Algorithms for single and ≥ 2 person rescuer. The most essential component of BLS and PALS cardiac arrest care is high quality cardiopulmonary resuscitation (CPR). CPR should begin with a check for responsiveness, getting help, and activating the emergency response system. After this,

216-446: A carbohydrate , followed by a 15-minute wait and re-measurement of blood glucose level to assess if blood glucose has returned to normal levels. If an individual recognizes the symptoms of hypoglycemia coming on, blood sugar should promptly be measured, and a sugary food or drink should be consumed. The person must be conscious and able to swallow. The goal is to consume 10–20 grams of a carbohydrate to raise blood glucose levels to

324-406: A psychiatric disorder . Demographics affected by factitious hypoglycemia include women aged 30–40, particularly those with diabetes, relatives with diabetes, healthcare workers, or those with history of a psychiatric disorder. The classic way to identify surreptitious insulin use is through blood work revealing high insulin levels with low C-peptide and proinsulin . The production of glucose

432-488: A bystander, early use of a defibrillator, and early advanced life support once more qualified medical help arrives. Qualified bystanders with training in BLS are encouraged to perform the first three steps of the five-link chain of survival. High Quality CPR High quality cardiopulmonary resuscitation (CPR) and early defibrillation using an automated external defibrillator (AED) are the most important aspects of BLS to ensure

540-1091: A child can have surgery or receive anesthesia ), events (onset of illness and events leading up to illness). Parts of the history that are especially important for children include asking about medications that the child could have gotten into (e.g., if a pill fell on the floor or an unlocked medicine cabinet), history of prematurity , birth history, and immunizations . Providers must be able to identify respiratory problems that are easily treatable (e.g., treated with oxygen, suctioning/ clearing airway, albuterol , etc.) and those that can rapidly progress to life-threatening conditions. Respiratory distress can progress to respiratory failure which can progress to cardiac arrest . Once respiratory complaints have progressed to cardiac arrest , death and neurological damage are more likely to occur. For this reason, providers should aim to identify and treat respiratory conditions before they progress and worsen. Common signs of respiratory distress Respiratory distress can progress and worsen to respiratory failure . Signs of respiratory failure include

648-670: A data review, the Pediatric Endocrine Society concluded that neonates aged less than 48 hours begin to respond to hypoglycemia at serum glucose levels of 55–65 mg/dL (3.0–3.6 mmol/L). This is contrasted by the value in adults, children, and older infants, which is approximately 80–85 mg/dL (4.4–4.7 mmol/L). In children who are aged greater than 48 hours, serum glucose on average ranges from 70 to 100 mg/dL (3.9–5.5 mmol/L), similar to adults. Elderly patients and patients who take diabetes pills such as sulfonylureas are more likely to suffer from

756-537: A fasting state, and thus hypoglycemia. The glycogen storage diseases associated with hypoglycemia include type 0 , type I , type III , and type IV , as well as Fanconi syndrome . Some organic and amino acid acidemias, especially those involving the oxidation of fatty acids , can lead to the symptom of intermittent hypoglycemia, as for example in combined malonic and methylmalonic aciduria (CMAMMA), propionic acidemia or isolated methylmalonic acidemia . A primary B-cell tumor , such as an insulinoma ,

864-511: A few hours. Hypoglycemia is treated by eating a sugary food or drink, for example glucose tablets or gel, apple juice, soft drink, or lollipops. The person must be conscious and able to swallow. The goal is to consume 10–20 grams of a carbohydrate to raise blood glucose levels to a minimum of 70 mg/dL (3.9 mmol/L). If a person is not able to take food by mouth, glucagon by injection or insufflation may help. The treatment of hypoglycemia unrelated to diabetes includes treating

972-410: A few hours. During the 48-hour neonatal period, the neonate adjusts glucagon and epinephrine levels following birth, which may trigger transient hypoglycemia. In children who are aged greater than 48 hours, serum glucose on average ranges from 70 to 100 mg/dL (3.9–5.5 mmol/L), similar to adults, with hypoglycemia being far less common. The most reliable method of identifying hypoglycemia

1080-425: A foreign body obstructs the trachea. Rescuers should only intervene in patients who show signs of severe airway obstruction, such as a silent cough, cyanosis, or inability to speak or breathe. If a patient is coughing forcefully, rescuers should not interfere with this process and encourage the patient to keep coughing. If a patient shows signs of severe airway obstruction, anti-choking maneuvers such as back slaps or in

1188-399: A healthcare setting or through pharmacy errors, also called iatrogenic hypoglycemia. When individuals take insulin without needing it, to purposefully induce hypoglycemia, this is referred to as surreptitious insulin use or factitious hypoglycemia . Some people may use insulin to induce weight loss, whereas for others this may be due to malingering or factitious disorder , which is

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1296-423: A hypoglycemic episode. A single blood sugar reading below 70 mg/dL is also not specific enough to characterize a hypoglycemic episode. Whipple's triad is a set of three conditions that need to be met to accurately characterize a hypoglycemic episode. The three conditions are the following: The biggest difference in blood glucose levels between the adult and pediatric population occurs in newborns during

1404-598: A large caliber needle] and if that isn't possible, intraosseous access (IO) or central venous line ). Providers should also obtain initial lab studies including a rapid blood glucose , basic metabolic panel (BMP) (measures serum electrolytes , blood urea nitrogen , and creatinine ), lactic acid level, complete blood count (CBC), and urine dipstick . The provider should start crystalloid fluids ( normal saline or lactated Ringers ). For compensated shock give 10-20 ml/kg over 5-20 min and for hypotensive shock, give 20 ml/lg over 5-10 min. However, if there are signs that

1512-446: A longer time (e.g., 5-10 ml/kg over 15-30 min). Hypovolemic shock is mainly treated with fluid replacement, as described in the fluids section above. If the hypovolemic shock is caused by a hemorrhage, then the provider should obtain blood type , blood cross match , and coagulation studies ( PT , INR , PTT ). In hemorrhagic shock, patients should receive blood or blood products if they aren't improving with fluids. Distributive shock

1620-620: A meal, resulting in insulin being non-functional. At a later time, the antibodies fall off insulin, causing insulin to be functional again leading late hypoglycemia after a meal, called late postprandial hypoglycemia . Another mechanism causing hypoglycemia is due to antibodies formed against insulin receptors , called insulin receptor antibodies . The antibodies attach to insulin receptors and prevent insulin breakdown, or degradation, leading to inappropriately high insulin levels and low glucose levels. Low blood sugar may occur in healthy neonates aged less than 48 hours who have not eaten for

1728-537: A minimum of 70 mg/dL (3.9 mmol/L). Examples of products to consume are: Improvement in blood sugar levels and symptoms are expected to occur in 15–20 minutes, at which point blood sugar should be measured again. If the repeat blood sugar level is not above 70 mg/dL (3.9 mmol/L), consume another 10–20 grams of a carbohydrate and remeasure blood sugar levels after 15–20 minutes. Repeat until blood glucose levels have returned to normal levels. The greatest improvements in blood glucose will be seen if

1836-608: A patient survives. CPR involves a rescuer or bystander providing chest compressions to a patient in a supine position while also giving rescue breaths. The rescuer or bystander can also choose not to provide breaths and provide compression-only CPR. Depending on the age and circumstances of the patient, there can be variations in the compression to breath ratio given. European Resuscitation Council According to 2015 guidelines published by European resuscitation council , early initiation of resuscitation and coordination of lay people with medical personnel on helping an unconscious person

1944-546: A person is identified, rapid treatment is necessary and can be life-saving. The main goal of treatment is to raise blood glucose back to normal levels, which is done through various ways of administering glucose, depending on the severity of the hypoglycemia, what is on-hand to treat, and who is administering the treatment. A general rule used by the American Diabetes Association is the "15-15 Rule," which suggests consuming or administering 15 grams of

2052-518: A sense of hunger and drives the person to eat, in an attempt to increase glucose. Hypoglycemia is most common in those with diabetes treated by insulin , glinides , and sulfonylureas . Hypoglycemia is rare in those without diabetes, because there are many regulatory mechanisms in place to appropriately balance glucose , insulin , and glucagon . Please refer to Pathophysiology section for more information on glucose , insulin , and glucagon . The most common cause of hypoglycemia in diabetics

2160-420: A severe hypoglycemic episode. Whipple's triad is used to identify hypoglycemia in children who can communicate their symptoms. Other conditions that may present at the same time as hypoglycemia include the following: Hypoglycemic symptoms are divided into two main categories. The first category is symptoms caused by low glucose in the brain, called neuroglycopenic symptoms. The second category of symptoms

2268-466: A shock and thus, should receive a shock. Unshockable rhythms are rhythms that won't improve with a shock and thus, should NOT receive a shock. The monitor/defibrillator will either tell the providers if the rhythm is shockable ( automated external defibrillators (AED)) or the providers will be able to read the ECG and determine for themselves if the rhythm is shockable (manual defibrillators). If shockable, give

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2376-409: A shock then resume CPR. If not shockable, continue CPR, give epinephrine, and consider an advanced airway. After every 2 minutes of giving CPR the provider should reassess the patient's heart rhythm to see if it is shockable or unshockable, and give a shock if it is shockable. This 2 minute cycle of CPR and rhythm assessment should continue until it is determined by the providers that further management

2484-402: A state of increased insulin, specifically increased insulin-like growth factor II , which decreases glucose levels. The Roux-en-Y gastric bypass , is a weight-loss surgery performed on the stomach, and has been associated with hypoglycemia, called post-gastric bypass postprandial hypoglycemia . Although the entire mechanism of hypoglycemia following this surgery is not fully understood, it

2592-464: A state of sepsis those organs may not receive enough oxygen, leading to decreased glucose production due to organ damage. Other causes of serious illness that may cause hypoglycemia include liver failure and kidney failure. The liver is the main site of glucose production in the body, and any liver failure or damage will lead to decreased glucose production. While the kidneys are also sites of glucose production, their failure of glucose production

2700-407: A state of sepsis, the body uses large amounts of glucose for energy. Glucose use is further increased by cytokine production. Cytokines are a protein produced by the body in a state of stress, particularly when fighting an infection. Cytokines may inhibit glucose production, further decreasing the body's energy stores. Finally, the liver and kidneys are sites of glucose production, and in

2808-444: A student must take an online or in-person course. However, an online BLS course must be followed with an in-person skills session in order to obtain a certification issued by The American Heart Association. Chain of survival The American Heart Association highlights the most important steps of BLS in a "five-link chain of survival." The chain of survival includes early recognition of an ongoing emergency, early initiation of CPR by

2916-514: Is medications used to treat diabetes such as insulin , sulfonylureas , and biguanides . Risk is greater in diabetics who have eaten less than usual, recently exercised, or consumed alcohol . Other causes of hypoglycemia include severe illness, sepsis , kidney failure , liver disease , hormone deficiency, tumors such as insulinomas or non-B cell tumors, inborn errors of metabolism , and several medications. Low blood sugar may occur in otherwise healthy newborns who have not eaten for

3024-631: Is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose below 70 mg/dL (3.9 mmol/L), symptoms associated with hypoglycemia, and resolution of symptoms when blood sugar returns to normal. Hypoglycemia may result in headache , tiredness, clumsiness, trouble talking, confusion , fast heart rate , sweating , shakiness, nervousness , hunger, loss of consciousness , seizures , or death . Symptoms typically come on quickly. The most common cause of hypoglycemia

3132-484: Is a level of medical care which is used for patients with life-threatening condition of cardiac arrest until they can be given full medical care by advanced life support providers (paramedics, nurses, physicians or any trained general personnel). It can be provided by trained medical personnel, such as emergency medical technicians , qualified bystanders and anybody who is trained for providing BLS and/or ACLS . The International Liaison Committee on Resuscitation (ILCOR)

3240-620: Is a result of progressive respiratory failure and/or shock. For this reason, it is important to treat respiratory failure and shock early so that they don't progress to cardiac arrest. Sudden cardiac arrest is typically caused by arrhythmias such ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) . These arrhythmias are more common in kids with hypertrophic cardiomyopathy , cardiac channelopathies (e.g., long QT syndrome ), myocarditis , drugs (e.g., cocaine , digoxin ), commotio cordis , and anomalous coronary artery . There are many causes of reversible cardiac arrest and

3348-399: Is associated with chronically low levels of the stress hormone cortisol , which leads to decreased glucose production. Hypopituitarism , leading to decreased growth hormone , is another cause of hypoglycemia in children, particularly with long periods of fasting or increased exercise. Briefly, inborn errors of metabolism are a group of rare genetic disorders that are associated with

Pediatric advanced life support - Misplaced Pages Continue

3456-570: Is associated with hypoglycemia. This is a tumor located in the pancreas . An insulinoma produces insulin , which in turn decreases glucose levels, causing hypoglycemia. Normal regulatory mechanisms are not in place, which prevent insulin levels from falling during states of low blood glucose. During an episode of hypoglycemia, plasma insulin , C-peptide , and proinsulin will be inappropriately high. Hypoglycemia may occur in people with non-B cell tumors such as hepatomas , adrenocorticoid carcinomas, and carcinoid tumors. These tumors lead to

3564-564: Is blocked by alcohol. In those who misuse alcohol, hypoglycemia may be brought on by a several-day alcohol binge associated with little to no food intake. The cause of hypoglycemia is multifactorial, where glycogen becomes depleted in a state of starvation . Glycogen stores are then unable to be repleted due to the lack of food intake, all compounded the inhibition of glucose production by alcohol. Children with primary adrenal failure, also called Addison's disease , may experience hypoglycemia after long periods of fasting . Addison's disease

3672-509: Is called a diagnostic fast , in which a patient undergoes an observed fast to cause a hypoglycemic episode, allowing for appropriate blood work to be drawn. In some, the hypoglycemic episode may be reproduced simply after a mixed meal, whereas in others a fast may last up to 72 hours. In those with a suspected insulinoma , imaging is the most reliable diagnostic technique, including ultrasound , computed tomography (CT) imaging, and magnetic resonance imaging (MRI) . After hypoglycemia in

3780-508: Is caused by abnormally distributed blood throughout the body which causes some parts of the body to receive inadequate blood supply. Common causes of distributive shock include sepsis , anaphylaxis , and head or spinal cord injury ( neurogenic shock ). Cardiogenic shock is caused by abnormal heart function or problems within the heart that impair pumping of blood within the heart. Common causes of cardiogenic shock include congenital heart diseases , arrhythmias , myocarditis (inflammation of

3888-406: Is caused by the body's reaction to low glucose in the brain, called adrenergic symptoms. Everyone experiences different symptoms of hypoglycemia, so someone with hypoglycemia may not have all of the symptoms listed above. Symptoms also tend to have quick onset. It is important to quickly obtain a blood glucose measurement in someone presenting with symptoms of hypoglycemia to properly identify

3996-408: Is dangerous for a number of reasons. The hypoglycemic person not only gains awareness of hypoglycemia at very low blood glucose levels, but they also require high levels of carbohydrates or glucagon to recover their blood glucose to normal levels. These individuals are also at far greater risk of severe hypoglycemia. While the exact cause of hypoglycemic unawareness is still under research, it

4104-402: Is essential during resuscitation. Defibrillation during the first 3 to 5 minutes during resuscitation can produce survival rates as high as 50 to 70%. Placing AEDs in public places where there is one cardiac arrest in five years is cost-effective. Although the adult CPR sequence can be safely used in children, a modified sequence of basic life support that entails less forceful chest compression

4212-620: Is even more suitable in children. United Kingdom Adult BLS guidelines in the United Kingdom were published in 2015 by the Resuscitation Council (UK), based on the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) published in November 2005. The newest guidelines for adult BLS allow a rescuer to diagnose cardiac arrest if

4320-500: Is important to recognize and treat shock as early as possible because the body requires oxygen and nutrients to function and without them, organs can eventually shut down and people can die. Common signs of shock include weak pulses, altered mental status , bradycardia or tachycardia , low urine output, hypotension , and pale, cold skin. Treating shock focuses on increasing blood flow and oxygen delivery to tissues and organs before organs are permanently damaged. This section will discuss

4428-704: Is mainly treated with fluid replacement, as described in the fluids section above, and vasopressors . For those with suspected septic shock, providers should obtain blood culture , urinalysis , urine culture , c-reactive protein (CRP) (marker of inflammation), procalcitonin (marker of inflammation), fibrinogen , D-dimer , bilirubin labs, and more. Those in anaphylactic shock should be treated with intramuscular epinephrine . Cardiogenic shock typically worsens with fluids. Providers should obtain an ECG and echocardiogram for patients suspected to have cardiogenic shock. Treatment can include vasopressors , inotropes , and treatment of any arrhythmias . Obstructive shock

Pediatric advanced life support - Misplaced Pages Continue

4536-449: Is meant to be a very quick assessment performed within the first few seconds of interacting with a child and it utilizes the acronym ABC - appearance, breathing, and color. The provider will assess appearance (level of consciousness and responsiveness, speaking or crying), breathing (breathing or not breathing, increased work of breathing, abnormal breath sounds), and color (pale, mottled, cyanotic , bleeding). The primary assessment uses

4644-477: Is medications used to treat diabetes such as insulin , sulfonylureas , and biguanides . This is often due to excessive doses or poorly timed doses. Sometimes diabetics may take insulin in anticipation of a meal or snack; then forgetting or missing eating that meal or snack can lead to hypoglycemia. This is due to increased insulin without the presence of glucose from the planned meal. Recurrent episodes of hypoglycemia can lead to hypoglycemic unawareness , or

4752-449: Is not significant enough to cause hypoglycemia. Instead, the kidneys are responsible for removing insulin from the body, and when this function is impaired in kidney failure, the insulin stays in circulation longer, leading to hypoglycemia. A number of medications have been identified which may cause hypoglycemia, through a variety of ways. Moderate quality evidence implicates the non-steroidal anti-inflammatory drug indomethacin and

4860-407: Is reasonable to assume the cause of hypoglycemia is due to insulin, glinides, or sulfonylurea use. In those without a history of diabetes with hypoglycemia, further diagnostic testing is necessary to identify the cause. Testing, during an episode of hypoglycemia, should include the following: If necessary, a diagnostic hypoglycemic episode can be produced in an inpatient or outpatient setting. This

4968-433: Is the most common cause of shock in pediatric patients. Common causes of volume loss include diarrhea , vomiting, hemorrhage , not drinking enough, burns, osmotic diuresis (e.g., diabetic ketoacidosis ), and third space losses. Signs of hypovolemic shock are related to the low blood volume and decreased blood flow to extremities (e.g., cold extremities, slow capillary refill , and weak distal pulses). Distributive shock

5076-428: Is the most common indication of BLS in infants and toddlers. The most critical factor in restoring breathing in the patient is to provide high quality rescue breaths. Shock , also known as Inadequate Tissue Perfusion, is a life-threatening condition that occurs as a result of the disruption to 3 major components of the cardiovascular system : Heart Function, Blood Vessel Function, and Blood Volume. Perfusion describes

5184-477: Is the next step in emergency situations as continuing with other forceful methods of BLS could exacerbate the patient's condition and can be seen as assault. AVPU (Alert, Verbal, Pain, Unconscious) is the commonly used acronym for quickly assessing the level of consciousness in a patient. Pain stimulus in particular should be used with caution as many methods if done incorrectly can leave bruises (sternal rub for example) commonly used methods for central stimulus are

5292-572: Is thought that meals cause very high levels of glucagon-like peptide-1 (also called GLP-1), a hormone that increases insulin, causing glucose levels to drop. Antibodies can be formed against insulin, leading to autoimmune hypoglycemia. Antibodies are immune cells produced by the body, that normally attack bacteria and viruses, but sometimes can attack normal human cells, leading to an autoimmune disorder . In autoimmune hypoglycemia, there are two possible mechanisms. In one instance, antibodies bind to insulin following its release associated with

5400-744: Is thought that these individuals progressively begin to develop fewer adrenergic-type symptoms, resulting in the loss of neuroglycopenic-type symptoms. Neuroglycopenic symptoms are caused by low glucose in the brain, and can result in tiredness, confusion, difficulty with speech, seizures, and loss of consciousness. Adrenergic symptoms are caused by the body's reaction to low glucose in the brain, and can result in fast heart rate, sweating, nervousness, and hunger. See section above on Signs and Symptoms for further explanation of neuroglycopenic symptoms and adrenergic symptoms. In terms of epidemiology, hypoglycemic unawareness occurs in 20–40% of type 1 diabetics. Other causes of hypoglycemia in diabetics include

5508-504: Is through identifying Whipple's triad . The components of Whipple's triad are a blood sugar level below 70 mg/dL (3.9 mmol/L), symptoms related to low blood sugar, and improvement of symptoms when blood sugar is restored to normal. Identifying Whipple's triad in a patient helps to avoid unnecessary diagnostic testing and decreases healthcare costs . In those with a history of diabetes treated with insulin , glinides , or sulfonylurea , who demonstrate Whipple's triad, it

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5616-622: Is treated by treating the underlying cause of the shock. Tension pneumothorax is treated with a chest tube and needle thoracostomy which allows the air to get out of the pleural space. Cardiac tamponade is treated with pericardiocentesis which removes the fluid from the pericardium and decompresses the heart. Pulmonary embolism is treated with anticoagulants (prevent body from making more clots) and if bad enough, thrombectomy (surgical removal of clots). Ductal dependent congenital heart defects are treated with prostaglandin E1 / alprostadil which keeps

5724-426: Is typically advised to give CPR for a short time before leaving the patient to call emergency medical services. Since the primary cause of cardiac arrest and death in drowning and choking patients is hypoxemia, it is recommended to start with rescue breaths before proceeding to chest compressions (if pulseless). If the patient presents in a shockable rhythm, early defibrillation is still recommended. Choking occurs when

5832-625: Is unlikely to save the patient. For patients with shockable rhythms who haven't achieved ROSC, providers can give epinephrine after 2 shocks and amiodarone or lidocaine after 3 shocks. Throughout CPR and rhythm assessments, the providers should be treating any suspected reversible causes of cardiac arrest (H's and T's listed above). Defibrillations/shocks Medicines that can be given during treatment of cardiac arrest are listed below. The doses listed below are for IV/IO medicationa. Medications via endotracheal tube (ET) are often given at higher doses. Basic Life Support Basic life support ( BLS )

5940-448: Is very helpful in increasing the chance of survival of the patient. When a person is unconscious and is not breathing normally, emergency services should be alerted and cardiopulmonary resuscitation (CPR) and mouth-to-mouth resuscitation (rescue breaths) should be initiated. High quality CPR is important. An adequate ratio of high quality chest compressions and rescue breaths are crucial. An automated external defibrillator (AED) machine

6048-645: The ductus arteriosus closes after birth) (e.g., hypoplastic left heart syndrome and coarctation of the aorta ). Management of shock should be based on the type of shock. When the type of shock hasn't been identified yet, the provider should start with some initial treatments and labs. All children with suspected shock should receive supplemental oxygen , ventilation if in respiratory distress (via nasal canula , high flow nasal canula , noninvasive ventilation , or mechanical ventilation ), and treatment for life-threatening conditions. Providers should establish vascular access ( intravenous access [2 peripheral IVs with

6156-437: The ductus arteriosus open. Cardiac arrest occurs when the heart stops working and blood stops moving throughout the body. In infants and children, cardiac arrest is typically caused by (1) hypoxic/asphyxial arrest and less commonly by (2) sudden cardiac arrest due to heart problems or arrhythmias. In adults, cardiac arrest is usually caused by heart problems such as acute coronary syndrome . Hypoxic/asphyxial cardiac arrest

6264-408: The glottis such as OPA , NPA , laryngeal mask airway ), infraglottic devices (devices that lie below the glottis and go into the trachea such as endotracheal tube ( intubation )), and surgery (incision below the glottis such as cricothyrotomy and tracheotomy ). Surgical advanced airways are typically performed when intubation and other less invasive methods fail or are contraindicated or when

6372-517: The pancreas . This drop in insulin allows the liver to increase glycogenolysis . Glycogenolysis is the process of glycogen breakdown that results in the production of glucose. Glycogen can be thought of as the inactive, storage form of glucose. Decreased insulin also allows for increased gluconeogenesis in the liver and kidneys . Gluconeogenesis is the process of glucose production from non- carbohydrate sources, supplied from muscles and fat. Once blood glucose levels fall out of

6480-650: The Advanced Cardiac Life Support (ACLS) protocols, in addition to BLS protocols. However, the American Heart Association 's BLS protocol is designed for use by laypeople, as well as students and others certified first responder , and to some extent, higher medical function personnel. BLS for Healthcare Providers Course According to the American Heart Association, in order to be certified in BLS,

6588-465: The American Heart Association's (AHA) Pediatric Cardiac Arrest Algorithm . The goals of treatment are to obtain return of spontaneous circulation (ROSC), meaning that the heart starts working on its own. Once cardiac arrest is recognized, high quality CPR needs to be started immediately. After starting chest compressions, the provider should (1) give ventilations (via bag mask ) and oxygen, (2) attach monitor/ defibrillator pads or ECG electrodes to

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6696-547: The COSTR methodology, ILCOR also started to conduct yearly reviews and published updates on the latest evidence in resuscitation, changing it from the previous 5-yearly review on resuscitation. CPR provided in the field increases the time available for higher medical responders to arrive and provide ALS care. An important advance in providing BLS is the availability of the automated external defibrillator or AED. This improves survival outcomes in cardiac arrest cases. One of

6804-1004: The acronym ABCDE - airway, breathing, circulation, disability, exposure. Airway - assess airway patency (open/patent, unobstructed vs obstructed) and if the patient will need assistance maintaining their airway Breathing - assess respiratory rate, respiratory effort, lung sounds , airway sounds, chest movement, oxygen saturation via pulse oximetry Circulation - assess heart rate, heart rhythm, pulses, skin color, skin temperature, capillary refill time, blood pressure Disability - assess neurological function with AVPU pediatric response scale (alert, voice, painful, unresponsive), pediatric Glasgow Coma Scale (eye opening, motor response, verbal response), pupil response to light (normal, pinpoint , dilated , unilateral dilated), blood glucose test (low blood sugar / hypoglycemia can cause altered mental status ) Exposure - assess temperature/ fever, signs of trauma (cuts, bleeding, bruises, burns, etc.), skin ( petechiae , purpura , etc.) Once

6912-405: The amount of glucose in the body, especially after meals. Glucagon is another hormone involved in regulating blood glucose levels, and can be thought of as the opposite of insulin. Glucagon helps to increase blood glucose levels, especially in states of hunger. When blood sugar levels fall to the low-normal range, the first line of defense against hypoglycemia is decreasing insulin release by

7020-442: The anti-malarial quinine . Low quality evidence implicates lithium , used for bipolar disorder . Finally, very low quality evidence implicates a number of hypertension medications including angiotensin converting enzyme inhibitors (also called ACE-inhibitors), angiotensin receptor blockers (also called ARBs), and β-adrenergic blockers (also called beta blockers). Other medications with very low quality evidence include

7128-467: The antibiotics levofloxacin and trimethoprim-sulfamethoxazole , progesterone blocker mifepristone , anti-arrhythmic disopyramide , anti-coagulant heparin , and chemotherapeutic mercaptopurine . If a person without diabetes accidentally takes medications that are traditionally used to treat diabetes, this may also cause hypoglycemia. These medications include insulin , glinides , and sulfonylureas . This may occur through medical errors in

7236-518: The body diverts blood to organs that cannot tolerate the lack of blood, such as the heart and the brain, resulting in widespread vasoconstriction , or thinning of the blood vessels. Consequently, blood is prevented from reaching organs that can tolerate the lack of perfusion, or hypoperfusion, in organs such as the skin, resulting in the typical presentation of pale and clammy skin conditions during shock . Moreover, disruptions may present specifically to each component or multiple systems may be affected at

7344-515: The carbohydrate is chewed or drunk, and then swallowed. This results in the greatest bioavailability of glucose, meaning the greatest amount of glucose enters the body producing the best possible improvements in blood glucose levels. A 2019 systematic review suggests, based on very limited evidence, that oral administration of glucose leads to a bigger improvement in blood glucose levels when compared to buccal administration . This same review reported that, based on limited evidence, no difference

7452-478: The chance of survival. It is also acknowledged that rescuers may either be unable, or unwilling, to give effective rescue breaths; in this situation, continuing chest compressions alone is advised, although this is only effective for about 5 minutes. For choking, the guidelines in the United Kingdom first call for assessing the severity of the situation. If the patient is able to speak and cough effectively,

7560-506: The child has no pulse and isn't breathing, start CPR . If the child has a pulse but isn't breathing, provide ventilation and give oxygen (when possible). Once it has been established that the child has a pulse, is breathing, and doesn't require immediate life saving treatment, the provider will begin their primary assessment followed by a secondary assessment and further diagnostic workup. Continuous reassessments should be done to reassess for life-threatening conditions. The initial assessment

7668-439: The child is experiencing respiratory distress secondary to asthma , management would include albuterol , inhaled corticosteroids , supplemental oxygen , and more depending upon the severity of the asthma. Shock is defined as inadequate blood flow ( perfusion ) in the body, causing tissues and organs to (1) not get enough oxygen and nutrients and (2) have trouble getting rid of toxic products of metabolism (e.g., lactate ). It

7776-484: The child so that defibrillations (aka shocks) can be given if needed, and (3) establish vascular access (IV, IO). Attaching the defibrillator and establishing vascular access should NOT interrupt chest compressions. Once the monitor/defibrillator is connected, the provider should assess the heart rhythm. Of the 4 cardiac arrest rhythms, VF and pVT are shockable rhythms and asystole and PEA are unshockable rhythms. Shockable rhythms are rhythms that can improve with

7884-405: The child will need long term mechanical ventilation . To perform an intubation, the health care provider should be able to perform the steps of rapid sequence intubation (preparation, preoxygenation, pretreatment, paralysis and sedation, positioning, placement of tube, postintubation management). Further management should be based on the specific medical condition the child has. For example, if

7992-428: The committee has provided materials for regional resuscitation providers such as European Resuscitation Council and American Heart Association to write their own guidelines. Since 2015, ILCOR has used a new methodology called Consensus on Science with Treatment Recommendations (COSTR) to evaluate the quality of latest evidence available and to reach a conclusion on the best treatments available in resuscitation. Using

8100-465: The decreased ability to recognize hypoglycemia. As diabetics experience more episodes of hypoglycemia, the blood glucose level which triggers symptoms of hypoglycemia decreases. In other words, people without hypoglycemic unawareness experience symptoms of hypoglycemia at a blood glucose of about 55 mg/dL (3.0 mmol/L). Those with hypoglycemic unawareness experience the symptoms of hypoglycemia at far lower levels of blood glucose. This

8208-523: The first 48 hours of life. After the first 48 hours of life, the Pediatric Endocrine Society cites that there is little difference in blood glucose level and the use of glucose between adults and children. During the 48-hour neonatal period, the neonate adjusts glucagon and epinephrine levels following birth, which may cause temporary hypoglycemia. As a result, there has been difficulty in developing guidelines on interpretation and treatment of low blood glucose in neonates aged less than 48 hours. Following

8316-453: The first checks done in emergency response is to assess the situation for any danger. If the person does not remove themselves or others from the danger then they are liable to become a patient and require emergency assistance themselves or become unable to render assistance for the other patient. Examples of dangerous situations which should cease before BLS is administered are electrocution, assault, drowning, burning etc. Checking for response

8424-516: The following The initial management for respiratory distress uses the acronym ABC - airway, breathing, circulation. Airway Breathing Circulation Advanced airways may be necessary if the child can't maintain their airway on their own and isn't responding to other methods of ventilation and oxygenation. Advanced airways use medical equipment to allow for open airways and ease of ventilation and medication delivery. Types of advanced airways include supraglottic devices (devices that lie above

8532-418: The following: Serious illness may result in low blood sugar. Severe disease of many organ systems can cause hypoglycemia as a secondary problem. Hypoglycemia is especially common in those in the intensive care unit or those in whom food and drink is withheld as a part of their treatment plan. Sepsis , a common cause of hypoglycemia in serious illness, can lead to hypoglycemia through many ways. In

8640-488: The heart muscle), cardiomyopathy (impairment of the heart's ability to pump), trauma/injury of the heart, drug or poison toxicity. Common signs include tachycardia, distant pulses, and worsening with giving fluids. Obstructive shock is caused by disrupted flow of blood to the heart or flow of blood out of the heart. Common causes include tension pneumothorax , cardiac tamponade , pulmonary embolism , and ductal dependent congenital heart defects (conditions that worsen when

8748-438: The heart rate, increasing systemic vascular resistance, and more) to keep the systolic blood pressure in a normal range. Hypotensive/ decompensated shock is when the body cannot maintain systolic blood pressure in the normal range, and it becomes too low ( hypotensive ). There are 4 main types of shock: hypovolemic, distributive, cardiogenic, and obstructive. Hypovolemic shock is caused by low blood volume (hypovolemia) and

8856-436: The hypoglycemic episode. Glucose is the main source of energy for the brain, and a number of mechanisms are in place to prevent hypoglycemia and protect energy supply to the brain. The body can adjust insulin production and release, adjust glucose production by the liver , and adjust glucose use by the body. The body naturally produces the hormone insulin , in an organ called the pancreas . Insulin helps to regulate

8964-546: The improper breakdown or storage of proteins , carbohydrates , or fatty acids . Inborn errors of metabolism may cause infant hypoglycemia, and much less commonly adult hypoglycemia. Disorders that are related to the breakdown of glycogen, called glycogen storage diseases , may cause hypoglycemia. Normally, breakdown of glycogen leads to increased glucose levels, particularly in a fasting state. In glycogen storage diseases, however, glycogen cannot be properly broken down, leading to inappropriately decreased glucose levels in

9072-770: The management of diabetes and prevention of hypoglycemia. Hypoglycemia , also called low blood sugar or low blood glucose, is a blood-sugar level below 70 mg/dL (3.9 mmol/L). Blood-sugar levels naturally fluctuate throughout the day, the body normally maintaining levels between 70 and 110 mg/dL (3.9–6.1 mmol/L). Although 70 mg/dL (3.9 mmol/L) is the lower limit of normal glucose, symptoms of hypoglycemia usually do not occur until blood sugar has fallen to 55 mg/dL (3.0 mmol/L) or lower. The blood-glucose level at which symptoms of hypoglycemia develop in someone with several prior episodes of hypoglycemia may be even lower. The symptoms of low blood sugar alone are not specific enough to characterize

9180-698: The mnemonic "H's and T's" is used to remember these causes. Signs of cardiac arrest include no pulse (within 10 seconds), no breathing or only gasping, and unresponsiveness. As mentioned above, cardiac arrest in kids is mainly a result of respiratory failure and shock, so providers need to treat those conditions quickly and be on the look out for signs of cardiac arrest. Because cardiac arrest can also be caused by arrhythmias, providers should get ECGs of these patients. The 4 main cardiac arrest rhythms are ventricular fibrillation (VF), pulseless ventricular tachycardia (pVT), asystole , and pulseless electrical activity (PEA). Treatment of pediatric cardiac arrest follows

9288-438: The most severe cases abdominal thrusts should be applied until the obstruction is relieved. If a patient becomes unresponsive he should be lowered to the ground, and the rescuer should call emergency medical services and initiate CPR. When the airway is opened during CPR, the rescuer should look into the mouth for an object causing obstruction, and remove with a finger sweep it if it is evident however many organisations state that

9396-484: The normal range, additional protective mechanisms work to prevent hypoglycemia. The pancreas is signaled to release glucagon , a hormone that increases glucose production by the liver and kidneys, and increases muscle and fat breakdown to supply gluconeogenesis . If increased glucagon does not raise blood sugar levels to normal, the adrenal glands release epinephrine . Epinephrine works to also increase gluconeogenesis and glycogenolysis , while also decreasing

9504-812: The obstruction is mild. If the patient is unable to speak or cough effectively, or is unable to breathe or is breathing with a wheezy sound, the airway obstruction is severe. It is then recommended to perform back blows until the obstruction clears. If the patient becomes unresponsive, CPR is started. The term BLS is also used in some non-English speaking countries (e.g. in Italy ) for the education of first responders . Terms with similar meanings for similar skill sets are also common. When performing BLS, laypeople and medical personnel are encouraged to remember that some groups of people have certain conditions that need to be taken into considerations. To relieve choking, chest thrusts should be used instead of abdominal thrusts when

9612-413: The patient has too much fluid (fluid overload) such as worsening respiratory distress, jugular venous distention , crackles , hepatomegaly , then fluids should not be given. With continued signs of shock and no signs of fluid overload, kids can continue to receive 10-20 ml/kg of fluids with a max of 60 ml/kg in the first hour. However, if cardiogenic shock is suspected, kids should receive less fluids over

9720-541: The patient is in late pregnancy. If a patient of choking is obese and a rescuer cannot perform adequate abdominal thrusts, they are encouraged to instead perform chest thrusts. To relieve choking, abdominal thrusts should not be used in infants under 1 year of age due to risk of causing injury. A sequence of back slaps and chest compressions are used instead. Hypoglycemia Hypoglycemia ( American English ), also spelled hypoglycaemia or hypoglycæmia ( British English ), sometimes called low blood sugar ,

9828-424: The patient is unresponsive and not breathing normally. The guidelines also changed the duration of rescue breaths and the placement of the hand on the chest when performing chest compressions. These changes were introduced to simplify the algorithm , to allow for faster decision making and to maximize the time spent giving chest compressions; this is because interruptions in chest compressions have been shown to reduce

9936-418: The patient's heart back to a normal rhythm. When a defibrillator is not readily available, a rescuer or bystander should keep the blood flowing by performing chest compressions and rescue breaths at an age-appropriate rate until it is. Respiratory arrest is when there is no measurable breathing in a patient. It tends to occur in conjunction with cardiac arrest, but this is not always the case. Respiratory arrest

10044-503: The person is in danger of pulmonary aspiration then they should be placed in the recovery position or more advanced airway management should be used. Once the airway has been opened checking for breathing should begin, if the respiratory rate is below 12-20 breaths per minute then CPR should begin, however if the patient is breathing normally then the rescuer should place them in the recovery position and summon an ambulance. Once an automated external defibrillator (AED) has been acquired

10152-451: The primary assessment is completed, the provider can do a secondary assessment which consists of a complete physical exam and focused medical history . The information asked in the medical history uses the acronym SAMPLE - signs and symptoms , allergies, medications (prescribed, over the counter, vitamins, herbal), past medical history (any medical problems, prior surgeries), last meal (helpful information to know because it can affect when

10260-438: The process of adequate blood flow to the organs, where the waste and reactants that are involved in cellular respiration are removed or transported throughout the 3 parts of the cardiovascular system for metabolism to be processed effectively. However, if one part were to fail, important resources for cellular respiration such as oxygen would not be able to reach the organs that needs it function. In an attempt to compensate,

10368-418: The provider know if the child has a shockable heart rhythm . If shockable, give a shock and then immediately resume CPR. PALS teaches a systematic assessment approach so that the health care provider can quickly identify any life-threatening conditions and treat them. The PALS systematic approach algorithm begins with a quick initial assessment followed by checking for responsiveness, pulse, and breathing. If

10476-472: The provider placing the heel of one hand over the child's lower chest and pressing down while keeping their arms straightened at the elbow. If help hasn't arrived after 2 minutes, the provider should call for help again and get an automated external defibrillator (AED). Once help and the AED arrives, the provider should place the AED pads on the child, making sure to not disrupt chest compressions. The AED will let

10584-620: The provider should assess for breathing and a pulse ( brachial pulse in infant and carotid pulse in child) - all within 10 seconds. If no pulse and no breathing or only gasping, start CPR. CPR consists of chest compressions followed by rescue breaths - for single rescuer do 30 compressions and 2 breaths (30:2), for > 2 rescuers do 15 compressions and 2 breaths (15:2). The rate of chest compressions should be 100-120 compressions/min and depth should be 1.5 inches for infants and 2 inches for children. Chest compressions differ between infants and children. For infants, chest compressions can be done with

10692-454: The recognition and management of shock. The severity of shock is typically based on systolic blood pressure . For this reason, measuring blood pressure is an important way to assess shock; however, blood pressure machines may not be very accurate if pulses are weak and the arms and legs (where the blood pressure is measured) are poorly perfused. Compensated shock is when the body is able to compensate through various mechanisms (e.g., raising

10800-498: The rescuer should not try to remove the foreign object as they might worsen the situation (either pushing it further down the trachea or initiating vomiting). Basic Life Support Emergency Medical Services in the United States are generally identified with Emergency Medical Technicians-Basic (EMT-B). EMT-B is the highest level of healthcare provider that is limited to the BLS protocol; higher medical functions use some or all of

10908-416: The rescuer should then finish the round of CPR, use the AED and then begin another round of CPR. However the AED will usually notify the rescuer of any impediments to continued CPR (such as a sinus rhythm or asystole ) in which case the rescuer may be prompted to cease CPR. Cardiac arrest occurs when the heart stops pumping in a regular rhythm. In this situation, early defibrillation is the key to returning

11016-490: The same time, which generally results in the 3 designated types of shock: Obstructive , Distributive , Hypovolemic . Typically, patients would have a presentation of shock at the Compensated , Decompensated, and Irreversible Stage. In cases of drowning, rescuers should provide CPR as soon as an unresponsive patient is removed from the water. In particular, rescue breathing is important in this situation. A lone rescuer

11124-407: The trapezius squeeze and for peripheral stimulus it is squeezing the side of the finger. Sending for help allows much more assistance to be rendered upon the patient and increases their chances of receiving ALS. Opening of the airway via the jaw-thrust maneuver is the preferred method as the head-tilt maneuver is thought to be more risky for people with suspected spinal injury or inconveniency. If

11232-438: The two-fingers technique (single rescuer) or two-thumbs encircling hands technique (2 rescuer). In the two-fingers technique, the provider uses their index and middle finger to press down on the infant's sternum , below the nipples. In the two-thumb encircling hands technique, the provider's hands should wrap around the chest with both thumbs pressing down on the infant's sternum. For children, chest compressions should be done with

11340-401: The underlying problem. Among people with diabetes, prevention starts with learning the signs and symptoms of hypoglycemia. Diabetes medications, like insulin , sulfonylureas , and biguanides can also be adjusted or stopped to prevent hypoglycemia. Frequent and routine blood glucose testing is recommended. Some may find continuous glucose monitors with insulin pumps to be helpful in

11448-405: The use of glucose by organs, protecting the brain's glucose supply. After hypoglycemia has been prolonged, cortisol and growth hormone are released to continue gluconeogenesis and glycogenolysis , while also preventing the use of glucose by other organs. The effects of cortisol and growth hormone are far less effective than epinephrine. In a state of hypoglycemia, the brain also signals

11556-553: Was formed in 1992 to coordinate the efforts of resuscitation worldwide. The ILCOR representatives come from various countries such as the United States, Canada, Australia, New Zealand, and from the European, Asian, and African continents. In 2000, the committee published the first resuscitation guideline. In 2005, the committee published International Consensus on Cardiopulmonary resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science with Treatment Recommendations. Since 2010,

11664-402: Was found in plasma glucose when administering combined oral and buccal glucose (via dextrose gel) compared to only oral administration. The second best way to consume a carbohydrate it to allow it to dissolve under the tongue, also referred to as sublingual administration . For example, a hard candy can be dissolved under the tongue, however the best improvements in blood glucose will occur if

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