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Pediatric Basic and Advanced Life Support



Pediatric BLS Algorithm


Full text article: Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW, Berg RA, Sutton RM, Hazinski MF. Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010 Nov 2;122(18 Suppl 3):S862-75.


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Vital Signs in Children


Heart Rate (rate/min)
AgeAwake RateSleeping Rate
Newborn to 3 months 85 to 205 80 to 160
3 months to 2 years 100 to 190 75 to 160
2 to 10 years 60 to 140 60 to 90
>10 years 60 to 100 50 to 90


Respiratory Rate (breaths/min)
Age Rate
Infant 30 to 60
Toddler 24 to 40
Preschooler 22 to 34
School-age child 18 to 30
Adolescent 12 to 16


Definition of Hypotension by Systolic Blood Pressure and Age
Age Systolic Blood Pressure
Term neonates (0 to 28 days) <60 mm Hg
Infants (1 to 12 months) <70 mm Hg
Children 1 to 10 years (5th BP percentile) <70 mm Hg + (age in years x 2) mm Hg
Children >10 years <90 mm Hg

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Modified Glasgow Coma Scale for Infants and Children


  Child Infant Score
Eye opening Spontaneous
 To speech
 To pain only
 No response
Spontaneous
 To speech
 To pain only
 No response
4
 3
 2
 1
Best verbal response Oriented, appropriate
 Confused
 Inappropriate words
 Incomprehensible sounds
 No response
Coos and babbles
 Irritable cries
 Cries to pain
 Moans to pain
 No response
5
 4
 3
 2
 1
Best motor  response* Obeys commands
 Localizes painful stimulus
 Withdraws in response to  pain
 Flexion in response to pain
 Extension in response to  pain
 No response
Moves spontaneously and  purposefully
 Withdraws to touch
 Withdraws to response in pain
 Abnormal flexion posture to pain
 Abnormal extension posture to pain
 No response
6
 5
 4
 3
 2
 1

*If patient is intubated, unconscious, or preverbal, the most important part of this scale is motor response. Motor response should be carefully evaluated.

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Pediatric Trauma Score


Assessment  Component SCORE
+2+1-1
Weight Weight >20 kg (>44  lb) 10-20 kg (22-44 lb) <10kg (<22 lb)
Airway Normal Oral or nasal airway,  oxygen Intubated,  cricothyroidotomy, or  tracheostomy
Systolic Blood  Pressure >90 mm Hg, good  peripheral pulses and  perfusion 50-90 mm Hg,  carotid/femoral pulses  palpable <50 mm Hg, weak or  no pulses
Level of  Consciousness Awake Obtunded or any loss  of consciousness Coma, unresponsive
Fracture None seen or  suspected Single, closed Open or multiple
Cutaneous None visible Contusion, abrasion,  laceration <7 cm not  through fascia Tissue loss, any  gunshot wound or stab  wound through fascia
Totals    
Adapted with permission from Tepas JJ, Molitt DL, Talbert JL, et al: The pediatric trauma score  as a predictor of injury severity in the injured child. Journal of Pediatric Surgery. 1987;22(1)15.

*PTS > 8 should have 0 % mortality.
All injured children with PTS < 8 should be triaged to an appropriate pediatric trauma center.



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Pediatric Advanced Life Support (PALS) Algorithms


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