PALS vs APLS vs ACLS

[Andy Kahn]

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1. What do most people use for peds (PALS or APLS) and how are they different?
2. What are the major difference between adult and pediatric codes/drugs (ACLS vs. PALS/APLS)?

I am trying to find a PALS book to borrow from one of the upper levels since we don't do PALS until 2nd yr. Just trying to get more proficient with the protocols for peds pts.

-Andy

 

[DrQuinn]

I've only done PALS, not APLS, so I can't comment...

but in my vast 20 month experience, in kids its nearly always airway. And usually its a single system trauma, ie a really $hitty head injury.

Doses are vastly different but hopefully in a real situation you'll have the Braselow tape (damn why couldn't I invent that, or atleast ERMudPhud).

Q

 

[Homunculus]

1. i've never seen (or heard of until you mentioned it) ALPS. i googled it and it looks like a australian thing. i doubt it is very different from PALS.

2. the major differences are dosages and sizes. the braselow tape is definitely nice 👍 so is your nearest peds intensivist.

Quin is right. most of the time once you get A/B the kid will usually improve. if not, you're in for a bumpy ride. The other thing that isn't covered in PALS is that most kids that come in needing coded are not going to be an average kid that had XXX happen-- they're more than likely going to be a trainwreck, ie former preemie MR/CP with ventricular shunts in RDS or a shortgut syndrome TPN dependent toddler in sepsis.

--your friendly neighborhood train tending caveman

 

[roja]

I concur.


During our month of orientation we got BLS, ACLS, ATLS and PALS. The major difference is dosing and as said, in kids, its airway, airway airway.

 

[Sheerstress]

APLS is basically just a pediatric emergency medicine course. I don't believe there's any test involved, but there is a book that is referenced:

http://www.aplsonline.com/

 

[Doczilla]

PALS is mostly about running pediatric codes, with some toxicology, shock, and respiratory failure thrown in. APLS focuses more on medical emergencies common to pediatric populations (which includes toxicology, shock, and respiratory failure, but others as well).

Key differences between ACLS and PALS:
As pointed out, there is more emphasis on respiratory failure and shock. Children don't tend to suffer primary arrhythmias the way that adults do, but die as a result of one of the above conditions. Toxicology also gets special attention.

Atropine is played down in infant populations for treating bradycardia because of potential of harming the developing parasympathetic system. The general rule in kids is that bradycardia = hypoxia, so ventilation with 100% O2 is treatment of choice. Atropine is, however, encouraged for premedication prior to intubation to prevent bradycardia.

High dose epi still shows up in some pediatric protocols, though is not really recommended (left to local protocol). It is absent from the adult protocols since it was shown to improve ROSC but have worse overall neurologic and cardiovascular outcomes.

Epi drips for bradycardia or shock are used in kids but very infrequently in adults.

CPR is performed on children with bradycardia refractory to ventilation, but not adults.

As others have said, drug dosages and defibrillation energy are weight-based.

Apart from the above differences, protocols are very similar between ACLS and PALS for tachycardia, v-fib, asystole, and PEA.


'zilla

 

[trauma_junky]

I concur.


During our month of orientation we got BLS, ACLS, ATLS and PALS. The major difference is dosing and as said, in kids, its airway, airway airway.

Did she mention airway? By the way, it might be airway or respiratory.