APLS aide-memoire: girls Follow Us SIXTH EDITION

APLS aide-memoire: girls Supporting paediatric courses

ALSG’s paediatric education packages span the entire healthcare pathway for
ADVANCED ADVANCED PAEDIATRIC
LIFE SUPPORT (APLS)
PAEDIATRIC
paediatrics, from community care, right through to intensive and critical care.
A C D D RR HR BP
Guide C C
Age
Weight
ET tube
Joules Fluids
Adrenaline
0.1 ml/kg of
Lorazepam
0.1 mg/kg
Glucose
2 ml/kg
At rest
Breaths per
Beats per
minute
Systolic
APLS 6th Edition A comprehensive and structured approach
Pre-hospital Paediatric Life Support (PHPLS) RCPCH Endorsement
(kg) 4 20 ml/kg of applies to UK APLS
to emergency paediatric training

LIFE SUPPORT
1:10 000 Max 4 mg 10% Glucose minute 5th-95th 5th 50th 95th APLS is the internationally renowned manual on emergency paediatric care, written to courses only
J/kg (ml) Management of childhood emergencies prior to
(ml) (mg) (ml) 5th-95th centile centile centile centile centile support the face-to-face course both of which include:
hospital admission
1 month 4.5 3.5 9 20 90 0.5 0.5 9 25-50 120-170 65-75 80-90 105 • 2015 ILCOR update • NICE
3 months 6 3.5 10 30 120 0.6 0.6 12 25-45 115-160 65-75 80-90 105 • Trauma consensus 2014/15 • SIGN & Sepsis6 evidence
• Enhanced Human Factors • RCPCH and other specialty reviews
6 months 7 4 12 30 140 0.7 0.7 14 20-40 110-160 65-75 80-90 105 SIXTH EDITION
Child Protection:
copy, please Recognition and Response (CPRR)
A PRACTICAL APPROACH TO EMERGENCIES
ADVANCED
For more information
Child and to order your visit www.alsg.org/uk/Publications
12 months 9 4.5 13 40 180 0.9 0.9 18 20-40 110-160 70-75 85-95 105 Teaches to recognise theemail
indicators of possible
APLS instructors can order their
Protection free copy via the centre when teaching on a abuse
course.
18 months 10 4.5 13 40 200 1.0 1.0 20 20-35 100-155 70-75 85-95 105 or neglect

PAEDIATRIC
2 years 12 4.5 13 50 240 1.2 1.2 24 20-30 100-150 70-80 85-100 110 Visit us at stand no. 8
To hear more about APLS 6e and other ALSG courses, come and see us at stand no. 8
3 years 14 5 14 60 280 1.4 1.4 28 20-30 90-140 70-80 85-100 110
in the main hall.
4 years
5 years
6 years
16
18
20
5
5.5
5.5
14
14
15
60
80
80
320
360
400
1.6
1.8
2.0
1.6
1.8
2.0
32
36
40
20-30
20-30
20-30
80-135
80-135
80-130
70-80
80-90
80-90
85-100
90-110
90-110
110
110-120
110-120
Who we Child
are
Protection
Child Protection in Practice (CPiP)
Provides speciality trainees with competencies
ALSG aims to preserve life byrequired
providing for
education to clinicians.
their ongoing childWith training centres
protection
continents and in 44 countries across the world, ALSG works independently in these areas
on five
practice
LIFE SUPPORT
A PRACTICAL APPROACH TO EMERGENCIES
7 years 22 6 15 90 440 2.2 2.2 44 20-30 80-130 80-90 90-110 110-120 and collaborates with other organisations to develop and deliver courses for and to meet
8 years 25 6 16 100 500 2.5 2.5 50 15-25 70-120 80-90 90-110 110-120 local needs.
Neonatal, Adult and Paediatric Safe Transfer
9 years 28 6.5 16 120 500 2.8 2.8 56 15-25 70-120 80-90 90-110 110-120 Our volunteers
Transfers
and Retrieval (NAPSTaR)
10 years 32 6.5 17 130 500 3.2 3.2 64 15-25 70-120 80-90 90-110 110-120 ALSG works with nearly 11,000 volunteers in the UK and overseas; all of whom are medical
Providing a structured approach
professionals. ALSG volunteers are at the centre of our organisation and help us develop,
11 years 35 6.5 17 140 500 3.5 3.5 70 15-25 70-120 80-90 90-110 110-120 toclinicians.
the safe Our
transfer
manage and deliver courses to boardand retrievalallofofpatients
of Trustees, whom are volunteers,
12 years 43 7.5 18 150 500 4.3 4.0 86 12-24 65-115 90-105 100-120 125-140 many senior medical professionals, help guide and steer our organisation to be the very
14 years 50 8 21 150 500 5.0 4.0 100 12-24 60-110 90-105 100-120 125-140 best that it can.
Adult 70 8 24 120-150 500 10 ml 4 mg 100ml 12-24 60-110 90-105 100-120 ALSG UK SAFE
and Overseas Community
Course Centres
SAFE
Joules (i.e. 1 mg) Providing
Community
Over 300 training centres in 44 countries support
over five to healthcare
continents. You professionals
can see in
biphasic
the education
a full list of courses available and community setting
centres andthe
across public training
UK and to ensure
overseas at
www.alsg.org/uk that children and young people receive safe care
TIP:
Booking a course closer to home
If a child is particularly big go up one or two years; particularly small go down one or two years
To see our full list of courses and to book your next course simply scan this code using your

/ MITM032359
The final responsibility for delivery of the correct dose remains that of the physician
smart phone or visit us online at www.alsg.org/uk/attend
prescribing and administering the drug

2 2 6 5 0/7MLEA043093
To book or find out more
TIP: If a child is particularly big go up one or two years; particularly small go down one or two years Worldwide Headquarters:
The final responsibility for delivery of the correct dose remains that of the physician prescribing and administering the drug contact@alsg.org ALSG http://bit.ly/APLSfactsheet
Centre for Education 0161 794 1999
29-31 Ellesmere Street, Swinton, Manchester, M27 0LA

For a full summaryFor a full6e summary

and to bookof APLS 6e and to book your place on a course visit www.alsg.org/uk/apls

19 - 600001
Web: www.alsg.org
of APLS Tel: +(44) 161 794 1999 Fax: +(44) 161 794 9111
your place on a course visit http://bit.ly/APLSfactsheet
 SIXTH EDITION

APLS 6e: ADVANCED

key changes APLS aide-memoire: boys
Advanced Paediatric Life Support (APLS)
PAEDIATRIC So much more than resuscitation
(continued)
APLS aide-memoire: boys
LIFE SUPPORT
APLS continues to be •theNewleading course for paediatric specialists, the blended learning
Overall order: illness, trauma, cardiac Trauma • New lecture including trauma team approach
package not only focuses on resuscitation
• Simulations: but examines
team approach, emergency
longer, treatment options,
more of them, • Stabilisation as per the 2015 update
Rigorous challenging scenarios by following a
continual stabilisation techniques,
continuouslyasassessed
well as scrutinising the procedures required for a • Chest procedures including Seldinger D HR BP
structured approach A C D RR
transfer to a definitive• care environmentaide
No calculations: for memoire
the child.(see pull-out in centre of pack) • Imaging decision-making and stabilisation and transfer in simulations Guide C C Glucose Beats per Systolic

Content • Trauma consensus

A PRACTICAL APPROACH TO EMERGENCIES BENEFITS • Practical experiences
There is now to ensure
more emphasis life-saving
on the importancetreatment
of team preparation, Age
Weight
ET tube
Joules Fluids
Adrenaline
0.1 ml/kg of
Lorazepam
0.1 mg/kg
2 ml/kg
of
At rest
Breaths per
minute
equipmentare
decisions preparation
undertaken and effective handovers (kg) 4 20 ml/kg 5th-95th
• ILCOR guidelines 2015 1:10 000 Max 4 mg minute 5th 50th 95th
J/kg (ml) 10% Glucose centile
Teaching experience for over 25 years • Collars: Don’t fit well; allow 30 degrees of movement; painful. Children (ml) (mg) 5th-95th centile centile centile centile
• Evidence – NICE, SIGN, Sepsis6 Supported by APLS structure
protect themselves. andinjuries
Only 9 spinal practicein England & Wales in 2013, (ml)
Internationally recognised and taught in over 100 so evidence acquisition difficult. Current consensus was for head blocking
• Expert opinion – RCPCH and other specialty groups Birth 3.5 3.0/3.5 9 20 70 0.4 0.4 7 25-50 120-170 65-75 80-90 105
centres around the world and more than 83,000 as a visual indicator of injury.
• Instructor and course centre feedback 1 month 4.5 3.5 9 20 90 0.5 0.5 9 25-50 120-170 65-75 80-90 105
clinicians trained • New radiology guidelines: less focus on interpretation, more on selection;
Blended learning package
no bodyincluding e-modules,
radiation;practical face-to-face training with
Illness • New lecture
Course development chaired by leading
scans – less no trauma series: CXR P, ? C-spine/CT, 3 months 6.5 3.5 10 30 130 0.7 0.7 13 25-45 115-160 65-75 80-90 105
• Airway: now includes the difficult airway specialty faculty, course manual and supporting online materials for four years
no DPL, less FAST, ? CT; involve radiologist. Management should be 6 months 8 4 12 30 160 0.8 0.8 16 20-40 110-160 65-75 80-90 105
paediatric physician, Stephanie Smith, measured and appropriate.
• BLS, choking, rhythms and defibrillation station with vascular access
Emergency Paediatric and
Consultant Structured and sequential approach
– NICEtoguidelines
learning – watch and wait versus aggressive 12 months 9.5 4.5 13 40 200 1.0 1.0 19 20-40 110-160 70-75 85-95 105
fluids in &
90Clinical
minutesDirector • Head injury
early management 18 months 11 4.5 13 40 220 1.1 1.1 22 20-35 100-155 70-75 85-95 105
Working groups include specialistofpaediatric
• Importance andinhalation (in respiratory) and foreign body
foreign body Practical course includes lectures, demos, simulation training and safe environment to
• Haemorrhage - Quick all round check for massive haemorrhage and
emergency physiciansingestion (especially
from around button
the world – batteries) in toxins practice techniquestrigger for massive transfusion protocol: blood – crystalloid – FFP – cryo / 2 years 12 4.5 13 50 240 1.2 1.2 24 20-30 100-150 70-80 85-100 110
• Existence of episodic viral
benefiting from new approaches and global learningswheeze / wheezy bronchitis, as well platelets – TXA; Bolus 10ml/kg – blood early 3 years 14 5 14 60 280 1.4 1.4 28 20-30 90-140 70-80 85-100 110
as additional modes of providing respiratory gases (high-flow, Newly developed• continuous assessment and feedback on such
competencies
Fluids: consider local replacement policy, as 5ml/kg -crystalloid
proven benefits
+ 4 years 16 5 14 60 320 1.6 1.6 32 20-30 80-135 70-80 85-100 110
heated humidified) to learnings and outcomes
5ml/kg blood + 5ml/kg FFP
• Fewer cardiac cases are now presenting acutely, due to the 5 years 18 5.5 14 80 360 1.8 1.8 36 20-30 80-135 80-90 90-110 110-120
Endorsed by the Royal College of Paediatrics & Child Health (RCPCH) • Use of tranexamic acid 15mg/kg for mechanism of injury
improvement in antenatal diagnosis Key areas which need greater
(aiming understanding
to keep 1st clot) and clarity addressed immediately 6 years 21 5.5 15 80 420 2.1 2.1 42 20-30 80-130 80-90 90-110 110-120
with curriculum key capabilities covered in the course
• Fluid boluses should not be given routinely and only when there • Ketamine and rocuronium are accepted induction agents 7 years 23 6 15 100 460 2.3 2.3 46 20-30 80-130 80-90 90-110 110-120
are signsare
of circulatory Standard course materials across training programmes creating a consistent language
“The RCPCH pleased to insufficiency or shock. of
provide Endorsement There are many Life
the Advanced
circumstances where fluids may be harmful, including in febrile amongst clinicians at all levels 8 years 25 6 16 100 500 2.5 2.5 50 15-25 70-120 80-90 90-110 110-120
Support Group (ALSG) Advanced Paediatric Life Support (APLS) course.
children where there is no immediate intensive care. Cardiac • New lecture including newborn
9 years 28 6.5 16 120 500 2.8 2.8 56 15-25 70-120 80-90 90-110 110-120
APLS provides the knowledge and skills necessary for recognition and Standardised and • systematic
Simulationsapproach
include newborn
to caring for a seriously ill or injured child
• Crystalloids remain first choice, but in trauma blood should 10 years 31 6.5 17 130 500 3.1 3.1 62 15-25 70-120 80-90 90-110 110-120
effective treatment and stabilisation of children with life threatening • BVM preferred technique of choice for healthcare professionals. It is
be given sooner
emergencies, using a structured, sequential approach and aims to teach, recognised
Integrated consideration that tracheal
and feedback intubation
on Human is the (non-technical
Factors most secure airway,
skills)but this
underpin 11 years 35 6.5 17 140 500 3.5 3.5 70 15-25 70-120 80-90 90-110 110-120
• The importance of reassessment, review of blood gases and lactate should only be undertaken by those who are experienced and confident.
practice and test the acquisition and use of these technical skills.” the clinical aspects of the course material
to guide treatment are crucial • Presence of signs of life more important than pulse checks, which are 12 years 43 7.5 18 150 500 4.3 4.0 86 12-24 65-115 90-105 100-120 125-140
RCPCH, Vicegeneralised
• The acute Presidentseizure
for Education & Professional
management Development
has not changed, International spreadnotoriously
of Working difficult.
GroupIfensures
in any doubt, provide
course life support
materials benefit from new 14 years 50 8 21 150 500 5.0 4.0 100 12-24 60-110 90-105 100-120 125-140
other than allowing the role of paraldehyde to be reintroduced • In hospital settings, number of staff allows many procedures to take place
approaches and global learnings Adult 70 24 120-150 500 10 ml 4 mg 100ml 12-24 60-110 90-105 100-120 125-140
• CPD
In the UK,approved
buccal midazolam is now licensed as Buccolam®, simultaneously. Monitored and tailored by the team leader.
8 Joules (i.e. 1 mg)
and fosphenytoin is no longer available – the availability of drugs • Depthmodules
Access to online learning measurements are provided
and course updatesforfor
compressions and the use
four years following completion biphasic
and the exact order of drugs used in seizures varies between of feedback tools are considered beneficial (although expensive)
of the course(s) ensuring access to updates and refresher opportunities
countries. Currently there is a trial of IV phenytoin v levetiracetam • SVT cardioversion is now initially 1J/kg
Paediatric Life Support
taking place.(PLS)
Paediatric e-book• for
Hypothermia recognised
ease of access on mobiletool devices
to minimise
whichsecondary cerebral
is updated injuryin line
regularly TIP:
PLS provides a planned• structure
The guidelines for DKA have changed
and understanding to further limit
of the necessary maintenance
skills required for initial in adults and newborns. Latest trials show may be a place for this in If a child is particularly big go up one or two years; particularly small go down one or two years
with course updates
fluids, limit bolus fluids and minimise the incidence of cerebral oedema. paediatrics, thus two temperature ranges may be used. Must ensure
recognition and stabilisation of children with life threatening emergencies,
Fluid boluses are not now routinely included within maintenance,whilst recognising that fever is controlled after any arrest. TIP:ofIfthe
The final responsibility for delivery a child
correctis particularly
dose remains thatbig gophysician
of the up one or two years; particularly small go down one or two years
Access to a paediatric e-library including video resources showing rarely seen conditions prescribing andThe
administering the drug
individual roles within anasemergency or trauma
the maintenance team andare
fluid volumes responsibilities
now much reduced to senior clinicians.
(to 50-60%). • No single predictor for duration of cardiopulmonary resuscitation final responsibility for delivery of the correct dose remains that of the physician prescribing and administering the drug

For a full summary of APLS 6e and to book your place on a course visit www.alsg.org/uk/apls
For a full summary of APLS 6e and to book
For a full summary of the changes visit www.alsg.org/uk/apls your place on a course visit http://bit.ly/APLSfactsheet