# PALS tips and tricks



## VA Transport EMT (May 29, 2013)

So I'm in my local CC's paramedic program and our PALS class has been two days of instruction and two days of hands on. We test on Tuesday, so I'm asking are there any specific subjects on the test or is it just memorizing the algorithm? I am having a hard time with the drug dosages (it's a little bit harder to switch to the PEDS mindset than I thought it would be).


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## Anjel (May 29, 2013)

There is a lot of scenario based questions. For example, the kid has this symptom, this, this and that. What do you think is wrong.


Maybe 3-4 questions on drug dosages. I can't remember. But it's basically just the dosages for Epi. D50 vs D10.


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## VA Transport EMT (May 29, 2013)

thank you, this will help me a lot


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## jefftherealmccoy (Jun 2, 2013)

Here's some help with your drugs-

MANZ V V.  

Morphine, Adenosine, Narcan, Zofran, Valium, Versed

All these drugs are .1mg/kg in peds.


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## WTEngel (Jun 5, 2013)

Your volume of amiodarone will generally be the same as your volume dosage of epi 1:10,000.

For example, a 13 kg patient needs a code dose of epi. You give 0.13 mg, or 1.3 mL of 1:10,000 epi.

Same patient needs a code dose of amiodarone. 13 kg patient should get 5 mg/kg, or 80 mg. Amiodarone is packaged 50 mg/mL. Normally this is where people get confused in the heat of battle. They start trying to calculate home many mL to give, and come up with all sorts of answers. The volume is going to be 1.3 mL though, if you are using 50 mg/mL standard concentration. This happens to be identical to the epi dosage, which is much easier to calculate.


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## VA Transport EMT (Jun 6, 2013)

thanks to both of you, I passed the test!


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## Handsome Robb (Jun 7, 2013)

Little cheater thing about amio I use is know 0.1 mL is 5 mg. just count by 5s till you get your desired dosage, provided you're using a TB syringe. 

Congrats on passing, PALS can be stressful the first time around.


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## VA Transport EMT (Jun 13, 2013)

if any of you guys were wondering, I got to use this during my clinical rotations for a 16yo with svt. got to push adenosine.


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## Trashtruck (Jun 13, 2013)

You used a pediatric dose of adenosine on a 16yo?

That's an adult in my world(and my protocol's world)


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## Handsome Robb (Jun 13, 2013)

Trashtruck said:


> You used a pediatric dose of adenosine on a 16yo?
> 
> That's an adult in my world(and my protocol's world)



Technically a 16 year old is a pediatric...to get to the adult dose using the 0.1 mg/kg for peds you need a 60kg kid. I've met plenty of 16 year olds that meet that and plenty that don't.

Crappy source (www.ask.com) but the average weight for a 16 year old male is 58-65 kg and female is 52-55kg.

As far as protocols go though I agree. They'd be classified as an adult and treated with adult dosing. Pedis for us is <13 years old.


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## WTEngel (Jun 14, 2013)

Technical definition of adulthood (per AHA anyway) is onset of secondary sexual characteristics.

An adult dose of adenosine in a 45-50 kg patient is not going to be detrimental. I only mention adenosine because we happen to be talking about it at this point. Please don't take this as me making light of using best practice when making dosing decisions for our patients. In this case however, given my experience, the effect is negligible. 

16 year old patients are routinely managed at adult hospitals in non pediatric wards, and in some cases are transferred away from pediatric hospitals depending on what the nature of illness or injury is. It all depends on your system I suppose. 

At any rate, while some protocols may use an age definition for adult v. pedi, and some use onset of secondary sexual characteristics, the practicality of either method is lost in the field if providers aren't allowed to use common sense.


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## VA Transport EMT (Jun 14, 2013)

Robb said:


> Technically a 16 year old is a pediatric...to get to the adult dose using the 0.1 mg/kg for peds you need a 60kg kid. I've met plenty of 16 year olds that meet that and plenty that don't.
> 
> Crappy source (www.ask.com) but the average weight for a 16 year old male is 58-65 kg and female is 52-55kg.
> 
> As far as protocols go though I agree. They'd be classified as an adult and treated with adult dosing. Pedis for us is <13 years old.



6mg dose, worked on first try


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## VA Transport EMT (Jun 14, 2013)

WTEngel said:


> Technical definition of adulthood (per AHA anyway) is onset of secondary sexual characteristics.
> 
> An adult dose of adenosine in a 45-50 kg patient is not going to be detrimental. I only mention adenosine because we happen to be talking about it at this point. Please don't take this as me making light of using best practice when making dosing decisions for our patients. In this case however, given my experience, the effect is negligible.
> 
> ...



he was transported by IFT to CHKD.


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