Online PALS Course

Our online PALS certification course includes pediatric assessment and practice of medical emergency scenarios. It also includes identifying shock and cardiac arrest in pediatric patients. OSHA-certified trainers have designed this course curriculum. It is for all medical/healthcare professionals. Earn CE credit hours. Print your wallet card instantly after passing.

Home
»
PALS Course
»
Postresusciation Management

Chapter 7: Postresusciation Management

Postresusciation management occurs once the child’s health is under proper control and return of spontaneous circulation is achieved. The postresusciation method assesses the following organ system optimizes ventilation and circulation to ensure proper treatment techniques are applied for adequate management and recovery of the child.
The organ systems in the postresusciation methods are as follows:

Cardiovascular
Gastrointestinal
Hematologic
Neurologic
Renal
Respiratory
Shock

PALS Certification By American HealthCare Academy Videos:

Cardiovascular

Monitor

Heart rate and rhythm
Blood pressure
Spo2
Urine output

Physical Examination

Quality of central and peripheral pulses, HR, temperature and color
Monitor end-organ function

Lab Test

Arterial blood gas
Hemoglobin and hematocrit
Serum glucose, electrolytes, BUN/creatinine, Calcium
Lactate and central venous oxygen saturation

Non Lab Tests

Chest x-ray to check ET tube insertion, heart size, pulmonary edema, etc
12-lead ECG
Echocardiogram

Intravascular Volume

Get vascular access
Give fluid boluses of 10 to 20 mL/kg of isotonic crystalloid over 5 to 20 minutes
Blood administration
Maintain fluid

Blood Pressure

Treat hypotension with vasoactive drugs
Treat arrhythmia if hypotension is due to that
Give vasopressor for vasodilation induced hypotension

Tissue Oxygenation

Give supplementary oxygen
Support perfusion
Maintain hemoglobin concentration
Targeted temperature management to achieve ROSC normal paCO2 35-45 mmHg

Metabolic Demand

Pain control with morphine or fentanyl
Agitation control with sedation
Fever maintenance with antipyretics
ET tube and ventilation to control breathing

Arrhythmias

Tachyarrhythmias and bradyarrhythmias with medicine and cardioversion
Expert consultation

Postarrest Myocardial Dysfunction

Postarrest myocardial dysfunction for 4 to 24 hours after ROSC
Vasoactive agents to fix hemodynamic functions
Maintain blood pressure and perfusion

Gastrointestinal

Monitor

Monitor type and quality of nasogastic tube drainage

Physical Exam

Abdominal examination and check for bowel sounds, girth and tightness

Lab Tests

Liver function by ALT/AST, albumin, PT/PTT, bilirubin, glucose, ammonia, etc tests
Pancreatic function by amylase/lipase tests

Non Lab Tests

Ultrasound to check liver, gall bladder, pancreas and bladder
Abdominal CT scan to check for trauma

Gastric Distention

Put in orogastric or NG gupe to aspirate stomach air and contents
Inseart NG feeding tube

Ileus

Put in OG or NG to aspirate gastric fluids and contents
Maintain electrolyte and fluid balance

Hepatic Failure

Administer glucose
Correct clotting factor and use fresh frozen plasma for bleeding

Hematologic

Physical Examination

Find cause of external or internal hemorrhage
Check skin for pallor, petechiae or bruising

Lab Tests

Hemoglobin and hematocrit
Platelet count
Prothrombin time,PTT, INR, fibrinogen, and D-dimer

Neurologic

Monitor

Check and control temperature

Physical Examination

Conduct neurologic assessment by checking pupil response, gag reflex, corneal reflex, etc
Check for cerebral herniation
Identify seizures
Check normal and abnormal movements and neurologic findings

Lab Tests

Check glucose levels
Check serum electrolyes and calcium concentration
Check for overdosage and poisons
Conduct cerebral spinal fluid studies

Non Lab Tests

CT scan
EEG for convusions or epileptic seizures

Brain Perfusion

Support cardiac output and oxygen
Avoid hyperventilllation

Blood Glucose

Treat hypoglycemia
Check glucose concentration
Treat hyperglycemia

Temperature Control

Control hypothermia and hyperthermia. Emphasis on targeted temperature management to achieve ROSC (Return of Spontaneous Circulation).

Increased ICP

Head in midline
Ventilate
Give steroids for inflammation or CNS tumor
Use mannitol or saline for herniation

Seizures

Treat seizures with benzodiazepine, fosphenytoin/phenytoin or barbiturate
Correct metabolic causes
Check for toxins or other diseases

Renal

Monitor

Check for decreased urine output (<1 mL/kg per hour in infants and children)
Check for increased urine output due to glucosuria or DI

Physical Examination

Check abdomen for distended bladder or tight abdomen
Check for hypovolemia
Check urinary catheter placement

Lab Tests

Check renal function by BUN/creatining and serum electrolytes
Get urinalysis
Assess metabolic state by ABG, glucose, anion gap and lactate concentration

Renal Function

Resore intravsasuclar volume and systemic perfusion with vasoactive drugs
Administer loop diuretics to those with volume overload and CHF
Put KCL to IV fluids if renal function is poor or no urine output

Acid-base Balance

Fix lactic acidosis with vasoactive agents and improving tissue perfusion
Fix non-anion gap with sodium bicarbonate

Respiratory

Monitor

Spo2 and heart rate by pulse oximetry
Heart rate and rhythm
Exhaled CO2 by colorimetric device
Check intubation

Physical Examination

Check chest rise and auscultation of abdomen and breath sounds
Check for tachypnea, agitiation, difficulty in breathing, cyanosis, and poor gas exchange

Lab Tests

Get arterial blood gas (ABG)

Non Lab Tests

Get chest x-ray for check for any pulmonary problems and placement of ET tube

Oxygenation

Give oxygen and check for Spo2 ≥ 94-99%
If less than 94% give additional ventilation support

Respiratory Failure

ET intubation
Gastric tube insertion to eliminate gastric contents

Analgesia and Sedation

Control pain with fentanyl or morphine
Sedation with lorazepam or midazolam

Neuromuscular Blockade

For intubated children give becuronium and pancuronium or other neuromuscular blocking agents

Shock

The following algorithm displays PALS postresusciative methods for shock:

Online PALS Course

Select Course

Chapter 7: Postresusciation Management

PALS Certification By American HealthCare Academy Videos:

Cardiovascular

Gastrointestinal

Hematologic

Neurologic

Renal

Respiratory

Shock

Follow Us On

Information

Resources

Courses