Rescue 3 · 14 min · ground

Pediatric near-drowning

PALICC-2 · 92–97% (PALICC-2; 88–92% ok in severe PARDS if PEEP is optimized) · PALICC-2: 6–8 mL/kg if PIP ≤28 or ΔP ≤15; 4–6 if pressures high · Pplat ≤28 · ΔP ≤15 (trainer) · PaCO2 ~35–45

6-year-old, unrestrained submersion in a farm pond, 4 minutes down. ROSC after two doses epi. 5.0 cuffed tube. Wet, cold, foamy.

Handoff

Weight 22 kg. They bagged big. You can see the chest bounce. PALICC-2: start ~6–8 mL/kg (about 130–175 mL) if PIP ≤28 or ΔP ≤15. Cut to 4–6 if pressures climb. PEEP for the wet lung. Don’t blow a pneumo in a small chest.

1
VT 6–8 mL/kg if PIP ≤28 / ΔP ≤15 (about 130–175 mL on 22 kg)
PALICC-2. If Pplat or ΔP climb, cut to 4–6 mL/kg. Adult 500 mL will volutrauma this chest in one minute.
2
PIP / Pplat ≤ 28 and ΔP ≤ 15 (PALICC-2)
If you cannot stay there, drop VT toward 4–6. Rate defends pH.
3
Age-right rate 20–24
Don't leave adult 16 on the screen.

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