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Updated peds CPR guidelines

Discussion in 'BLS Discussion' started by vc85, Oct 8, 2018.

  1. vc85

    vc85 Forum Crew Member

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    I was looking over the BLS algorithm and it says that for peds from 0 through puberty you are supposed to add compressions if the pulse rate falls below 60 and they are symptomatic of bradycardia

    Is this fairly new still? The last time I updated in CPR/BLS they were still saying compress for less than sixty in infant CPR only

    This is from Epocrates. If you go to guides-> PALS->BLS for healthcare providers and look to the last heading in each age group.
     
  2. mgr22

    mgr22 Forum Asst. Chief

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    The upper age limit for peds changed from 8 to puberty before the 2015 PALS update -- 2010, I think.
     
  3. Bullets

    Bullets Forum Knucklehead

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    Any idea why it seems like the range for "pediatrics" is expanding? Our protocols were always under 13, but now its been up to "puberty" and my hospitals are taking 18-21 in pedi
     
  4. mgr22

    mgr22 Forum Asst. Chief

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    Raising the upper age limit from 8 to puberty really isn't much of an increase, considering how early kids develop these days. I think the intent was to use an age range that was based more on anatomy and physiology than on an arbitrary age.

    Hospitals treating 18-21-year-olds as peds wouldn't have anything to do with PALS.
     
    Summit likes this.
  5. vc85

    vc85 Forum Crew Member

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    I think peds hospitals taking older ages has more to do with adults who have conditions who would have died in childhood in years past.

    Apparently there are still comparatively few adult doctors who know how to manage things like CF and certain congenital conditions.

    I do know some pads hospitals who would take patients in their 40s and 50s if there condition is as a result of a congenital or "pediatric disease"
     
  6. Peak

    Peak ED/Prehospital Registered Nurse

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    Onset of puberty can be normal as early as 7 years of age or as late as 15 depending on gender and ethnicity, puberty makes a relatively poor marker for transition from PALS to ACLS algorithms and weight based to standardized drug dosing. Even with different onsets of puberty an obese pubescent 9 year old is going to have very different anatomy and physiology than a pre-pubescent 14 year old gymnast, and their care needs to depend on their individual presentation.

    Resuscitation algorithms, regardless of who is publishing them or what they are treating, are typically written for the lowest common denominator which is typically low volume rural EMS/Nursing/Medical providers who run a handful of codes/traumas/OB hemorrhage/et cetera in their entire career. In these cases the algorithms save lives, as these providers would otherwise often make no or poor decisions. Clinicians in more advanced systems often provide care that benefits the patient but also deviates from the algorithms.

    You have to define what symptomatic is, and will compressions improve their disease state. From a BLS perspective there is a lot of limitations as to what can be done to improve presentation from a medication/procedural standpoint but often patients need specific treatments. Especially in children we can see bradycardia from respiratory failure in which advanced airway management has far greater importance (consider in NRP that our CPR ratio is 3:1), or in severe dehydration they need appropriate IV fluid boluses (ideally something with some sugar in it like D5LR to start).

    Some of this does have to do with patients with 'diseases of childhood' who live longer than they would have before, but his also has other influence such as the continued push into sub-specialization within nursing and medicine. What is the difference in treating the disease process of a 17 and 19 year old with ALL (virtually nothing)? Yet we still send them to different sub-specialists and they often have different treatment plans.

    Most large freestanding pediatric hospitals also make quite the Kool-Aid for both their staff and families/patients and are convinced that none of the adult or mixed population medical centers can take care of the their patients. In this theory hospitals like the Mayo Clinic, Detroit Medical Center, New York Presbyterian, Boston Medical Center, John Hopkins, and so on would have no business treating children which we of course know to be a ridiculous notion. Patients and families are often feel special because they go to some regional children's hospital and don't want to change hospitals/medical providers because it would so drastically change how they see themselves.

    I've had multiple patients and families who present to our ED (disclosure- I work for a system that has both an adult and a pediatric quaternary referral hospital adjoined in our medical center) as adults from outside of the region and are livid that we are admitting their 20 year old son with septic shock and ALL to the adult ICU instead of the PICU or that we are calling the adult GI doc to scope their 22 year old with hirschsprung's instead of peds GI. This despite the fact that we often admit teens to our adult floors because the sub-specialist they need simply doesn't exist in the pediatric care environment, and those families love the care their receive.

    The reality is that while these patients may have a 'disease of childhood' they are now adults, and they largely have the anatomy and physiology of an adult. The older they get the more 'adult' disease processes they will develop that pediatricians are not trained in. There is nothing wrong with consulting a pediatric specialist for a specific condition in an adult (we do it all the time), but they should have their care primarily managed by an age appropriate team.

    On a personal note I find it a bit bizarre that teens and adults want to be treated like small children. I had plenty of injuries playing sports as a teen and I never wanted to see pediatric specialists. I went to an adult ortho, had surgeries in the adult OR, and did PT in the adult clinic; I was offered to see peds ortho/pt but I just didn't see the point in it.
     

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