Note: Your progress in watching these videos WILL NOT be tracked. These training videos are the same videos you will experience when you take the full ProPALS program. You may begin the training for free at any time to start officially tracking your progress toward your certificate of completion.

In this lesson, we'll go over the medication magnesium sulfate, sometimes referred to as simply mag sulfate, and all of its effects, including indications, precautions and contraindications, and pediatric dosages.

Magnesium sulfate affects the SA node by slowing down its impulse rate, and it also reduces the automaticity in partially depolarized cells. Magnesium sulfate causes vasodilation, and when administered rapidly, can also create hypotension.

Magnesium Sulfate Indications

Now let's take a look at magnesium sulfate indications.

Magnesium sulfate is effective as an anticonvulsant/antiarrhythmic and is used to treat polymorphic ventricular tachycardia with a pulse

Magnesium sulfate is recommended for use in cardiac arrest only in cases of torsades de pointes or suspected cases of hypomagnesemia. Whenever you see these present in pediatric patients, this is when you would use magnesium sulfate.

Magnesium Sulfate Precautions and Contraindications

Magnesium sulfate is contraindicated for pediatric patients with central nervous system depression or hypermagnesemia. And caution must be taken when used on patients with renal impairment as well.

Pediatric Dosage of Magnesium Sulfate

Now let's look at the pediatric dosage of magnesium sulfate.

For the treatment of torsades, the pediatric dose is between 25 and 50mg/kg via IV with a maximum dose of 2 grams.

A Word About Identifying Respiratory Problems by Severity

We'll be digging into respiratory arrest and specific upper and lower airway issues in the following Case Studies section of your ProPALS course. So, consider this a bit of a preview of things to come, but with some additional information thrown in.

Identifying the severity of a respiratory problem in pediatric patients will help you decide the most appropriate interventions. It's important to be aware and alert for signs of, specifically, respiratory distress and respiratory failure.

In this lesson, we'll highlight respiratory distress and respiratory failure.

Identifying Respiratory Distress in Pediatric Patients

Respiratory distress is a clinical state characterized by an increase in respiratory rate and effort. Respiratory distress can span a wide spectrum, from mild tachypnea with increased effort to severe distress with impending respiratory failure.

A description of the severity of respiratory distress in pediatric patients will typically include a description of the respiratory rate and effort, the mental status of the child, and the quality of their breathing sounds. It's important to understand that signs of severe respiratory distress can also indicate respiratory failure.

The Signs of Respiratory Distress in Pediatric Patients

Signs of mild respiratory distress include:

  • Mottling
  • Mild tachypnea
  • A mild increase in respiratory effort (such as nasal flaring and retractions)
  • Abnormal airway sounds (such as stridor, wheezing, and grunting)

Signs of severe respiratory distress (and possible respiratory failure) include:

  • Abnormal airway sounds
  • Pale and cool skin or cyanosis
  • Marked tachypnea and apnea
  • A significant or insufficient respiratory effort (such as hypoventilation or bradypnea)
  • Low oxygen saturation (hypoxemia) despite high-flow supplementary oxygen
  • A decreased level of consciousness (such as the patient being less responsive or completely unresponsive)

Respiratory distress is usually apparent when the pediatric patient attempts to maintain adequate gas exchange despite their airway obstruction, lung tissue disease, or reduced lung compliance. As the patient tires or as respiratory effort or function (or both) deteriorate, adequate gas exchange cannot be maintained. When this happens, clinical signs of respiratory failure will develop.

Identifying Respiratory Failure in Pediatric Patients

Respiratory failure is a clinical state of insufficient oxygenation and ventilation, and sometimes both. Respiratory failure is usually recognized by the patient's abnormal appearance and behavior (especially an altered level of consciousness, which may be characterized by a depressed level of consciousness or agitation), reduced responsiveness, and poor color.

Even though respiratory failure is often the result of a progression of respiratory distress, it can also occur with little or no respiratory effort. And at times, the recognition of respiratory failure may require laboratory testing (such as blood gas) to confirm your diagnosis. However, in other pediatric patients, the clinical examination will be sufficient to identify the patient's respiratory failure.

Signs of Severe Respiratory Distress and Probable Respiratory Failure

Signs of severe respiratory distress include:

  • Marked tachypnea
  • Tachycardia
  • Cyanosis
  • An increase or decrease in respiratory effort
  • Poor distal air movement
  • Low oxygen saturation (hypoxemia) despite high-flow oxygen administration

Signs of probable respiratory failure include:

  • Cyanosis
  • A decreased level of consciousness
  • Absent distal air movement
  • Very rapid, or insufficient, respiratory rate or possible apnea
  • A significant, insufficient, or absent respiratory effort
  • Extreme tachycardia; bradycardia will often indicate a life-threatening deterioration
  • Low oxygen saturation (hypoxemia) despite high-flow supplementary oxygen

Respiratory failure can be the result of upper or lower airway obstruction, lung tissue disease, and disordered control of breathing (such as apnea or shallow and slow respirations). When the patient's respiratory effort is insufficient, respiratory failure can occur without the typical signs of respiratory distress, as listed above.

Respiratory failure is a clinical state that requires immediate intervention to prevent the patient's deterioration into cardiac arrest.