2020 Interim Training Materials: PALS Lesson Plan Changes



2020 PALS CHANGES Purpose These instructions will help you as a Pediatric Advanced Life Support (PALS) Instructor to update the current course materials* with science from the 2020 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) (2020 Guidelines). Use the interim materials to teach all PALS courses from October 21, 2020, until you begin teaching the new 2020 PALS course with the new materials. You must complete the 2020 PALS Instructor Update online course and begin using the 2020 PALS course materials by February 1, 2021. *The 2016 PALS Instructor Manual and the 2016 PALS Provider Manual Instructor Preparation As a PALS Instructor, you should be prepared to answer students’ questions about the 2020 Guidelines. Therefore, you should review these interim training materials, interim written exam information, the 2020 Guidelines, and the Highlights of the 2020 AHA Guidelines Update for CPR and ECC before the course. Instructor Manual Lesson Plan Changes To teach the PALS Course or the PALS Update Course, modify the lesson plans from the 2016 PALS Instructor Manual with the changes listed in this document. Only those lessons affected by the 2020 Guidelines science changes are listed here. Lessons not listed here should be taught as written in the 2016 PALS Instructor Manual. Throughout any course you teach, emphasis should be on the components of high-quality CPR. 1. Pediatric Chains of Survival 2020 Changes A new in-hospital cardiac arrest Chain of Survival for pediatrics was added, and it has a sixth link, for recovery. A sixth link, recovery, was added to the out-of-hospital Chain of Survival. ? The process of recovery from cardiac arrest extends long after the initial hospitalization. Support is needed during recovery to ensure optimal physical, cognitive, and emotional well-being and return to social and role functioning. This process should be initiated during the initial hospitalization and continue for as long as needed. Apply Here Video discussions 2. Infant Compressions 2020 Changes Single rescuer: use 2 fingers, 2 thumbs, or the heel of 1 hand for infants. ? For infants, single rescuers (whether lay rescuers or healthcare providers) should compress the sternum with 2 fingers or 2 thumbs placed just below the nipple line. ? For infants, if the rescuer is unable to achieve guideline-recommended depths (at least one third the diameter of the chest), it may be reasonable to use the heel of 1 hand. Apply Here Part 3: Testing and Remediation ? Section: Understanding the Infant CPR Skills Testing Checklist (Skills Checklist and Video) Part 6 ? PALS Lesson Plans 457518-19684

Lesson 5A: Learning/Testing Station: Infant High-Quality BLS Practice (Video and skills sheets) Lesson PALS-Update 4A: Learning/Testing Station: Infant High-Quality BLS Practice (Video and skills sheets) ? PALS Update Lesson Plans 457518-19684

Lesson 5A: Learning/Testing Station: Infant High-Quality BLS Practice (Video and skills sheets) Lesson PALS-Update 4A: Learning/Testing Station: Infant High-Quality BLS Practice (Video and skills sheets) 3. Pediatric Assisted Ventilation Rates 2020 Change For infants and children with a pulse who are receiving rescue breathing or who are receiving CPR with an advanced airway in place, provide 1 breath every 2 to 3 seconds (20-30 breaths per minute). Apply Here Part 5: Appendixes ? Appendix B: Instructor Case Scenarios and Debriefing Tools Various case scenarios that use advanced airways; videos Part 6 ? PALS Lesson Plans Lesson 3: Science of Resuscitation, Section Summary of High-Quality CPR Components for BLS Providers—Comparison of Key Elements of Child and Infant BLS (Video) 4. Intubation 2020 Changes It is reasonable to choose a cuffed endotracheal tube (ETT) over an uncuffed ETT for intubating infants and children. When a cuffed ETT is used, attention should be paid to ETT size, position, and cuff inflation pressure (usually less than 20-25 cm H2O). Routine use of cricoid pressure is not recommended during endotracheal intubation of pediatric patients. Apply Here Part 5: Appendixes ? Appendix A: Skills Testing Checklists, Skills Station Competency Checklists, and PALS Case Scenario Testing Checklists Airway Management Skills Station Competency Checklist ? Appendix B: Instructor Case Scenarios and Debriefing Tools Various case scenarios that use advanced airways; videos Part 6 ? PALS Lesson Plans Lesson 9B: Respiratory Video Case Discussions (Video) 5. Pediatric Cardiac Arrest Algorithm 2020 Change Early epinephrine: modified to emphasize the role of early epinephrine for nonshockable rhythms after starting CPR; it is reasonable to administer the initial dose of epinephrine within 5 minutes from the start of chest compressions. Apply Here PALS posters ? Pediatric Cardiac Arrest Algorithm Algorithms and flowcharts ? Pediatric Cardiac Arrest Algorithm 6. Septic Shock Treatment 2020 Changes Administer fluid—10 mL/kg to 20 mL/kg aliquots—with frequent reassessment. It is reasonable to use either epinephrine or norepinephrine as an initial vasoactive infusion; if neither is available, dopamine can be considered. ? If the patient is still unresponsive to fluids and requiring vasoactive support, it may be reasonable to consider stress-dose corticosteroids. Apply Here PALS posters ? Pediatric Cardiac Arrest Algorithm Algorithms and flowcharts ? Pediatric Cardiac Arrest Algorithm Part 5 ? Appendix B: Instructor Case Scenarios and Debriefing Tools Various case scenarios, videos 7. Hypoglycemia 2020 Change For children with suspected hypoglycemia who are awake but unwilling to swallow oral glucose, it may be reasonable to apply a slurry of granulated sugar and water under the tongue. Apply Here Part 5: Appendix B: Instructor Case Scenarios and Debriefing Tools ? Various case scenarios, videos Part 6 ? PALS Lesson Plans 457518-19684

Lesson 7A: Overview of Systematic Approach Model (Video) Lesson 9B: Respiratory Video Case Discussions (Video) 8. Additional PALS Updates 2020 Changes The Pediatric Cardiac Arrest Algorithm and the Pediatric Bradycardia With a Pulse Algorithm have been updated to reflect the latest science. The single Pediatric Tachycardia With a Pulse Algorithm now covers both narrow-complex and wide-complex tachycardias in pediatric patients. Apply Here PALS posters Algorithms and flowcharts ................
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