PICU: PALS, ACLS or Both?

haitham abo majed · May 31, 2007

yes please i need som power point presentation

Pediatric Critical Care Columnist · May 31, 2007

We are not required to have any of the above... in our self-described state-of-the-art world class center of excellence... full of obsolete or broken equipment. There was discussion of making it a requirement to have PALS for the whole of the children's hospital, but when the powers-that-be got a load of the price tag, they decided that maybe we didn't need it after all, even in PICU. It's so not necessary that our management won't even ensure people have time off to attend at their own expense.

AliRae · Jun 1, 2007

PALS for us, but not ACLS. I was helping a friend brush up for his ACLS renewal the other day and just chuckling to myself they whole time at how easy those "grownup" nurses have it. What? You mean I can just give the whole amp of something?!

marilynmom, LPN, NP · Jun 1, 2007

We are required to have PALS.

kcangel, LPN · Jun 2, 2007

Children's hospital - PALS for everyone!

Vicki_RN · Jun 2, 2007

Thank you for the responses! It sounds like ACLS is not a concern of PICU's. If you have any other experience with this, let me know.

kessadawn, BSN, RN · Jun 2, 2007

the children's hospital where i work requires all nurses to have pals. picu, ed and or are also required to have acls, and picu and ed take tncc (trauma certification). nicu requires a neonatal advanced life support, but i can't remember what it's called. the hospital provides us with the classes for free, and unless it's really busy, those classes usually count for your hours for the week, so you don't have to spend every single day at work that week trying to fit them in.

kessadawn, BSN, RN · Jun 2, 2007

we are not required to have any of the above... in our self-described state-of-the-art world class center of excellence... full of obsolete or broken equipment. there was discussion of making it a requirement to have pals for the whole of the children's hospital, but when the powers-that-be got a load of the price tag, they decided that maybe we didn't need it after all, even in picu. it's so not necessary that our management won't even ensure people have time off to attend at their own expense.

jan, that is really scary, and sad. :uhoh3: i can't imagine working in picu without those. our hospital also provides critical care classes, and you can audit them anytime for a refresher. really makes it easy to get your required ces.

i've never recertified outside of our hospital, are the courses really expensive? :confused:

Pediatric Critical Care Columnist · Jun 3, 2007

I totally agree that it's scary... and sad. I'm not even sure our residents and fellows have to have PALS. I've been to one or two codes run by them that have been absolute gong shows and might have been avoided if the physician had listened to the nurse! Today is an example; although not quite a code by the time I left, I predict it will progress to that before it's dark... 6 week old, normal and otherwise healthy infant comes to ER with variably compensated SVT. Gets a bunch of adenosine in ER, comes to us on 1L O2 and with only a single IV infusing some D5NS and amiodarone... no glucose or mag levels done. Has a 2:1 block, hypotension, lethargy and is dusky when not in SVT, good BP, LOC and color with a HR of 230... We poke for lytes and send them, kid's HR remains 210-220, she's pink and squirming. Fellow comes along and decides to give a dose of amiodarone IVP less than an hour after a PO dose of flecainide... kid goes from pink and interactive to mottled, cool and lethargic, HR in the 70s, sats in the 70's and BP around 64/30. Hmmm... amiodarone is contraindicated in 2nd and 3rd degree heart block, causes flecainide levels to double... By now baby's needing CPAP to get sats above 85, she's looking like $#!+ and they're not planning to intubate. The astute bedside nurse put the Quik-Combo pads right on the bed so that it will be easier to get her paced when she crumps... and our attending is wandering around with his hands in his pockets... State-of-the-art. World-class. Center of excellence. NOT!

British Import · Jun 9, 2007

Ouch. I feel for you.

We have to have BLS and PALS. I am taking a PICU course in the autumn, but this isn't required. I want to do it for my own self confidence and learning

suzanne4, RN · Jun 10, 2007

NRP is the neonatal resuscitation program.

I keep up all three of them, never know when they will come in handy. Remember that you can get kids weighing 200 pounds in PICU, they are there because they are 16 years old, and are a football player. When bigger than the nurse that is caring for them, size does matter. And then the ACLS protocols would be used, or you would be using more than the one amp because of size.

The extra training does not hurt. And PICUs also get newborns many times for one reason or another. Especially if they needed heart surgery, but they can still be a 28 or 30 weeker.