ACLS for PICU

In my unit patients are transitioned to adult services between 18 - 21 years of age, depending upon the service. Having said that, we occasionally have older patients with complex cardiac anomalies whonare older than this.

We also, rarely, take an overflow patient that typically should have been admitted to an adult unit.

Also, PALS only works until the kid tops out at adult dosage's per their weight. After that, we use ACLS. I think PALS classifies a child as those under 8. I know in my PICU most of our patient population is under that 8 year mark, but we still get out fair share of congenital heart teens/adults, teen overdoses, and just general sick teens. I'd feel very unsafe without ACLS with these big kids around. What did you do for these teens in your original unit if they coded??

^^ what they said ^^

I've had patients in a bariatric bed in my unit- a little large for the PALS guidelines. I'm actually kind of surprised that all PICUs don't require it (mine doesn't)

I'm surprised the entire peds hospital doesn't require it. But when I bring it up at work, people look at me like I'm crazy. If they don't want to give us ACLS, then they need to quit admitting grown kids!

This is a great question. We were recently required to obtain ACLS and NRP for our PICU. I certainly don't mind having the extra knowledge. The lack of consistency in the way it's applied however leaves me scrathcing my head. I have called or emailed approximatley 10 different facilities. Some require ACLS some don't. Some defer to age when considering ACLS and some defer to weight. What I can find on the American Heart website is limited when it comes to identifying age weight dilemma. In essence there does not seem to be anything evidence based that I can find giving a clear guide as to when it is applicable. If anyone out there knows of any evidence based research or statement from American Heart that clarifies this I would be thrilled if they would share it.

Although not required by our management team, ACLS isvery helpful especially when you consider alot of our pediatric patients are outgrowing PALS.....anyone over 70 kg should be considered ACLS protocal.....The calculation of medications is different for over 70 kg...(an example is epi dosing where .01 mg/kg is standard dose, a 90 kg patient would recieve .9 mg under PALS protocal....under ACLS protocal the patient would be given 1 mg)....with ACLS anyone over 70 kg the dosing is all "adult"....you would never want to use pals guideline for meds as overmedication is very frequent.....use you imagination and u can see where the ACLS protocals for over 70 kg (some use over 12 years) can provide the more correct dosing

Imagine versed dosing of a 100 kg patient....0.1 mg/kg would have u giving the patient 10 mg...where adult dosing you might give 4-6 mg...Unfortunately the PICU nurse is gradually becoming and adult RN