Tackling the beast that is PALS...

[calivianya, BSN, RN]

I am an adult critical care nurse taking PALS because I will one day need it for school, and I am going ahead and seizing an opportunity for an employer-sponsored class while there's a spot open and my plate is relatively empty. I have plenty of time to study at the moment, and believe me, I was grateful for that when I saw the book for the first time. This thing is twice the size of the ACLS manual!

I am making flashcards for the drugs and doses since there are a lot of different drugs than I am used to compared to ACLS and all of the doses are different. And the Broselow chart... am I going to see "The child falls in the purple range, what size ETT should be used" or am I going to see "The child is 10kg, what size ETT should be used?" Do I have to memorize what colors correspond to which weights, or is just knowing the child's weight enough to choose correctly sized equipment on the exam?

Advice from those of you who have survived tackling this beast would be helpful; this is a whole lot of brand new information for me. Thanks in advance. :)

[NotReady4PrimeTime, RN]

Good for you for stepping out of your comfort zone! You're quite right that PALS is very different from ACLS. I don't recall having to answer any questions about Broselow tapes on the exam, but if you remember to use the tape when you're doing your megacode, you'll definitely see the examiner nodding his/her head and ticking a box. Really the big things you should know are how to calculate BP ranges for children (2x their age in years +70 for the bottom end and 2x age in years + 90 for the upper end) and fluid deficits, how much fluid you can bolus before having to think about pressors, and doses for the most common meds given in a code situation. As for airway management, the pediatric trachea is roughly the same diameter as their pinky finger. When hand-ventilating, don't use too much pressure or too large volumes. The difference between an ETT that's in the trachea below the cords and one that's in the oropharynx might only be millimeters. Always remember to check a glucose. Urine output is a huge clue that the kid is heading for decompensation. Hypotension is a very late sign and if you get there, you might not be able to turn it around. Relative bradycardia is also an ominous sign. If the kid's been ticking along with a heart rate of 150 and now you're seeing 100, you need to start running your Hs and Ts. Technically that wouldn't quite be bradycardia, but the decrease of 33% is significant.

Have fun while you're practicing. Don't worry about making mistakes, because your team-mates will be there to help you out. You've got this!

[calivianya, BSN, RN]

Thanks so much for the advice, it's appreciated!