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In this section we will be covering the current PALS pharmacological treatments, and in doing so I believe it's important to remember that no medication will work the way we desire unless a patient's biological status is such that their body at the cellular level will work the way we hope. Now, what do I mean by this? Well, when in cardiac arrest, the patient, at a cellular level, has a short amount of time before clinical death progresses to biological or cellular death. As cellular hypoxia progresses to cellular death, the body's ability to react to treatments becomes more and more difficult. This is why it's important that we provide highly effective basic life support. It is the vital foundation of a successful PALS treatment. Effective BLS buys time by delaying biological death. The PALS medications we will cover are only one part of the successful resuscitation. Advanced life support is the next level in the chain of survival of pediatric patients that includes the administration of medications, ECG monitoring, advanced airways, and other treatments. The goal is to keep the patient in a state of survivability until ultimately we can get the patient to the appropriate definitive treatment, and ideally reverse the life-threatening condition. Compared to adult drug doses, pediatric drug doses vary greatly, depending on a child's size. One very helpful tool with medications for pediatric emergencies is called a color-coded length-based tape, such as a broselow tape. This tool helps a PALS provider quickly determine a child's weight for calculating drug doses. You would simply lay the tape down next to the child and measure from their head to their feet. The tape relates a child's height as measured by the tape to his or her weight, and provides medication dosages, the size of the resuscitation equipment that should be used, and the level of shock to deliver for defibrillation. The Broselow Tape is designed for children up to about 12 years of age who have a maximum weight of about 36 kilograms, other words 80 pounds. Now, as we leave you the PALS medications, we'll break the drugs down into four basic categories. One, the drug and its effect. Two, its indications. Three, precautions and contraindications. And four, the appropriate dosage.
In this section of your ProPALS course, we're going to cover the current PALS pharmacological treatment options. And in this lesson, we'll go over some important things to keep in mind as you progress through this section of your course.
It's important to remember that no medication will the work the way you want it to unless the patient's biological status is such that the patient's body, at the cellular level, is able to respond favorably to that medication.
What does that mean? When a person is in cardiac arrest, that person, at the cellular level, has only a short amount of time before clinical death progresses to biological or cellular death. (These two terms, cellular death and biological death are interchangeable, and we'll often use just one or the other, rather than both.)
As you can see in the video above, clinical death occurs around the six-minute mark, after the patient's breathing and heart rate have stopped. While biological death occurs around the 10-minute mark.
Pro Tip #1: As cellular hypoxia progresses to cellular death, the body's ability to react favorably to treatment becomes more difficult and more unlikely. Which is why it's important to provide high-quality and highly effective basic life support. This is the vital foundation for any successful PALS treatment, as effective basic life support buys you and the patient time by delaying the onset of biological death.
The variety of medications that we'll cover in this section of the course are only one part of any successful resuscitation (and one part of the chain of survival) and will include:
Advanced life support is the next level in the chain of survival for pediatric patients. This chain of survival includes:
Pro Tip #2: The goal of the PALS chain of survival is to keep the patient in a state of survivability, by delaying cellular death, until you can get the patient appropriate and definitive treatment that will reverse their life-threatening conditions.
Compared with adult drug dosages, pediatric dosages vary greatly depending on that child's size. One helpful tool to determine a child's medication dosage for pediatric emergencies is known as a color-coded length-based tape, such as a Broselow tape.
The Broselow Tape, also called the Broselow pediatric emergency tape, will help you quickly determine a pediatric patient's weight so that you can better calculate their drug dosage.
To use a Broselow tape, simply lay it next to the pediatric patient and measure from their head to their toes. The tape will then relate the child's height to his or her weight and provide you with information on:
Pro Tip #3: The Broselow tape is designed for children up to approximately 12 years old, with a maximum weight of around 36 kilograms or 80 pounds.
As we review the PALS medications in the upcoming lessons, we'll be breaking down the drugs into four distinct categories:
Your objectives as a PALS provider for administering medications to pediatric patients during cardiac arrest include:
Medications that can be used while treating pediatric patients in cardiac arrest will be covered in detail in the upcoming lessons. But it's important to keep these objectives in mind as you progress through this section of your course.