6. PALS Flashcards
1
Q
cardiac scenarios
A
Vfib/pulseless Vtach
SVT/Vtach w/pulse
aystole/PEA
bradycardia
2
Q
respiratory scenartios
A
lower airway obstruction
upper airway obstruction
lung tissue disease
disordered control of breathing
3
Q
shock scenartios
A
hypovolemia
obstructive
septic
cardiogenic
4
Q
bradycardia neonate
A
< 80 bpm
5
Q
bradycardia infant/child
A
< 60 bpm
6
Q
broselow tape
A
approximates weight and drug doses based on child length
7
Q
adult defib pads are used on pts
A
8+ years old
8
Q
defib 8+ year old
A
AED w/adult AED pads
9
Q
defib 1-8 year old
A
- AED w/peds pads and dose attenuator
- man defib w/peds pads
- AED w/adult pads
10
Q
defib < 1 year old
A
- man defib w/peds pads
- AED w/peds pads
- AED w/adult pads
11
Q
croup
A
inflammation of larynx/vocal cords
12
Q
cause of croup
A
virus
13
Q
mild croup
A
barking cough
14
Q
mod croup
A
stridor
retractions at rest
15
Q
sev croup
A
significant agitation
decr air entry
16
Q
CPR > 8 yr old
A
2-handed
17
Q
CPR 1-8 year old
A
2 handed
or 1 handed
18
Q
CPR infant 2+ rescuers
A
thumb encircling
19
Q
CPR infant lone rescuer
A
2 finger
or
thumb. encircling
20
Q
when can you consider 1 handed CPR for infant
A
cannot get adequate depth with other techniques
21
Q
neonates cpr depth
A
1.5 inch
22
Q
infants cpr depth
A
1.5 inch
23
Q
kids 1+ cpr depth
A
2 inch
24
Q
kids 1+ cpr cycles: 1 rescuer
A
5 cycles
30:2
25
kids 1+ cpr cycles 2+ rescuers
5 cycles
15:2
26
kids 1+ cpr cycles intubated
100-120 compressions/min
20-30 breaths per min
27
infants cpr cycle 1 rescuer
5 cycles
30:2
28
infants CPR cycle 2 rescuers
5 cycles
15:2
29
infants cpr intubated
100-120 compression/min
20-30 breaths/min
30
neonates cpr 1 rescuer: respiratory arrest
3:1 ratio
31
neonates cpr 1 rescuer: cardiac arrest
15:2
32
neonates cpr 2 rescuers: respiratory arrest
3:1
33
neonates cpr 2 rescuers: cardiac
15:2
34
neonates cpr intubated
100-120 compressions/min
20-30 breaths/min
35
when is cyanosis aparent
at least 5 g/dL of hb are desaturated
36
if you are more anemic will you be cyanotic faster or slower
slower because a higher % of Hb will need to be desaturated
37
if you are anemic what SpO2 must be present before cyanosis
lower SpO2
38
defib peds: 1st dose
2 J/kg
39
defib peds: 2nd dose
4 J/kg
40
defib peds: 3+ dose
up to 10 J/kg
41
cardioversion peds: 1st shock
0.5-1 J/kg
42
cardioversion peds: 2nd shock
2 J/kg
43
neonates hypoglycemia
< 45 mg/dL
44
infants/children hypoglycemia
< 60 mg/dL
45
hypoglycemia S+S
poor perfusion
hypotension
tachycardia
sweating
irritability
lethargy
46
glu dosing for hypoglycemia
0.5-1 g/kg
46
D25W glucose
250 mg/mL
47
how many mL of D25W = 1 g glucose
4 mL = 1 g
48
how many mL of D5W = 1 g glucose
20 mL = 1 g
49
how many mL of D50W = 1 g glucose
2 mL = 1g
50
neonate hTN
SBP < 60
51
infant hTN
SBP < 70
52
children hTN
SBP < 70 + (age*2)
53
children 10+ hTN
SBP < 90
54
mottling
patchy discoloration of skin caused by areas of vasoconstriction mixed with areas of vasodilation
55
mottling mechanism
irregular supply of oxy blood
56
mottling can indicate
imminent death
57
good peripheral perfusion (vasodilation)
1. good pulse
2. flushed color
3. cap refil
4. warm skin
5. awake and alert
58
brisk cap refil
<= 2 seconds
59
flash cap refill
< 2 seconds
60
poor perfusion
1. weak pulse
2. pale/cyanotic
3. delayed cap refil
4. cold extremities
5. decr responsiveness
6. met acidosis
7. incr lactate
8. decr urine output
61
delayed cap refill
> 5 sec
62
petechiae and purpura
purple discolorations caused by small vessel bleeding under the skin
63
petechiae and purpura indicate
low plts
DIC
septic shock
64
"refractory" to treatment
do not improve or respond to specific therapy
65
"fluid refractory hypotension"
hypotension despite fluid admin
66
"NE refractory shock"
child in shock unresponsive to NE therapy
67
resp distress
incr RR
able to move air
abnormal airway sounds
pallor
tachycardia
improves with initial therapy
68
resp failure
labored breathing
signs of shock
- cyanosis
- bradycardia
requires intervention to prevent resp/cardiac arrest
may not respond to inital treatments
69
indications for bag mask ventilation or intubation
low SpO2
abnormal airway sounds
poor signs of perfusion
bradycardia
anxiety
lethargy
etcac
70
acryocyanosis
blue hand/feet/mouth/lips
71
most common cause of brady in kids
apnea
72
apnea
cessation of breathin for 20 seconds
73
febrile
>= 38C
74
treatment for feber
abx
75
hypoxemia
SpO2 <= 94% on room air
76
permissive hypoxemia
SpO2 < 94% that might be appropriate or normal
77
permissive hypoxemia example
TOF
78
normal cap refil
<=2 seconds
79
prolonged cap refil
> 5 seconds
80
common causes of prolonged cap refil
dehyhdration
shock
hypothermia
81
SVT infants
> 220 bpm
82
SVT children
> 180 bpm
83
infant O2 consumption
6-8 mL/kg/min
84
adult O2 consumptionj
3-4 mL/kg/min
85
what SpO2 on 100% fio2 indicated need for intervention
<90% on 100% FiO2
86
ScvO2
25-30% lower than SaO2
87
ScvO2 if SaO2 is normal
70-75%
88
urine output infants/young child
1.5-2 mL/kg/hr
89
adolescents
1 mL/kg/hr
90
quiet tachypnea
fast RR
not accompanied by signs of labored breathing or respiratory distress
91
cause of quiet tachypena
non-pulmonary issues
-fever
-pain
- metabolic acidosis
92
peds have ____ tongue
peds have ____ occiput
larger tongue
larger occiput
93
infant head positioning when giving breaths
neutral/sniffing
94
individual small airway has _______ resistance
greater resistance
95
TOTAL resistance in small airway
lower resistance because there are more small airways
96
larger airways (upper airways) are more prone to
turbulent airflow
97
airflow during normal resipration
laminar
lower resistance
98
ways airflow can become turbulent
partial airway obstruction
labored/incr resp efforts/crying
99
turbulence ______ airway resistance which _______ work of breathing
turbulence incr airway resistance with incr work of breathing
100
lower gas density = _______ % laminar flow = ______ resistance
lower gas density = higher % laminar flow =. lower resistance
101
laminar flow resistance to airflow
inversely proportional to airway radius^4
102
decr airway radius =
incr Resistance^4
103
turbulent flow resistance to airflow
inversely proportional to airway radius^5
104
respiratory muscles that LIFT ribcage
all of them
105
primary inspiratory muscles
diaphragm
external intercostals
106
accessory inspiratory muscles
muscles in neck
- sternocleidomastoid
- scalene
pecs
- pec major/minor
107
primary expiratory muscles
non - expiration is passive
108
accessory expiratory muscle
internal intercostals
abdominals
- rectus abdominis
- external oblique
- internal oblique
- transversus abdominis
109
chest wall in peds
compliant
110
chest movement during diaphragm contraction
tugged inward during deep breathing
111
lung hyperinflation
diaphragm flattens
= less effective ventilation
112
DOPE
Displacement
Obstruction
Pneumothorax
Equipment failure
113
Displacement
ETT in place?
114
Obstruction
ETT kinked?
mucus plug?
115
Pneumothorax
bilateral breath sounds?
116
when do you say DOPE
intubated pt deteriorates
117
percussion exam
L middle finger on body surface
tap w/R middle finger
118
resonant sounds
normal lung w/percussion
119
hyperresonant sounds
tension pneumothorax
120
wheezing
high pitched
expiration
121
wheezing cause
bronchoconstriction
122
Rales
intermittent popping sound
123
rales cause
fluid in distal airways or atelectasis
124
rales can suggest
cardiogenic shock
lung tissue disease
125
rales in hypotensive pt
cardiogenic shock
126
rales in febrile pt
lung tissue disease
127
Rhonchi
low pitched
snoring
bubbling
128
rhonchi causes
secretions in larger airways
129
stridor
high pitched
inspiration
130
stridor indicates
upper airway obstruction
- foreign body
- croup
- upper airway edema
131
grunting
low pitch
expiration
132
grunting means the pt is
closing glotting earlier than usual
PEEP
133
grunting can indicate
impending respiratory failyre
134
grunting is seen in
lung tissue disease
- pulm edema
- pneumonia
- ARDS
135
head bobbing chin lift
inspiration
136
head bobbing chin galls
expiration
137
nasal flaring
nostrils dilated during inhalation
138
disordered control of breathing
irregular RR
insufficient repiratory effort
139
disordered control of breathing can lead to
hypoxemia
hypercarbia
140
causes of disordered control of breathing
med overdose
seizure w/incr ICP
neuro problems
141
retractions
inward movement of chest wall during inspuration
142
cause of retrations
incr airawy resistance
143
substernal/subcostal retractions
mild-mod breathing difficulty
144
suprasternal/supraclavicular retractions
severe breathing difficulty
145
seesaw respiration
more severe form of retraction
chest wall inward/abdomen expands during inspiration
146
seesaw respiration typically indicates
upper airway obstruction
147
seesaw respiration can also indicate
severe lower airway obstruction
lung tissue disease
disordered control of breathing
148
seesaw respiration is common in children with
neuromusclar weakness
149
retractions + inspiratory snoring/stridor
upper airway obstruction
- croup
- foreign body
150
retractions + expiratory wheezing
lower airway obstruction
- asthma
- bronchiolitis
151
retractions + grunting/labored respirations
lung tissue dz
pulm edema f/cardiogenic shock
152
abnormal inspiratory sounds indicate
upper airway obstruction
153
abnormal expiratory sounds indicate
lower airway obstruction
154
when is suctioning contraindicated?
croup
(infection induced edema)
155
croup treatment
racemic epi nebulizer
156
lung tissue dz
lungs become stiff due to fluid accumulation in alveoli
157
common conditions of lung tissue dz
pneumonia
pulm edema
ARDS
158
lung tissue dz S+S
grunting
rales
fever
159
ALL airway scenarios contain
hypoxemia
poor chest rise/air movement
breathing w/accessory muscles
early tachycardia
late bradycardia
160
signs of labored breathing/respiratory distress is found in which scenarios?
upper airway
lower airway
lung tissue
161
signs of upper airway
stridor
inspiratory snoring
hoarseness
barking cough
drooling
gurgling
162
signs of lower airway
expiratory wheezing
163
signs of lung tissue dz
grunting
crackles/rales
fever
164
signs of disordered control of breathing
normal/shallow breath sounds
abnormal resp pattern
possible central apnea
165
how to distinguish between airway and cardiac or shock scenarios
airway scenarios will not have hypotension
166
how to distinguish between airway and bradycardia scenario
airway will have abnormal breath sounds
bradycardia will have normal breath sounds
167
treatment for ALL airway scenarios
supp O2 if SpO2 < 94%
assist airway/consider intubation
suction secretions
monitor EKG
treat bradycardia (if present)
168
treatment for upper airway obstruction
heliox
humidified O2
racemic epi
steroids
169
treatment for lower airway
albuterol
bronchodilators
consider labs/CXR
consider diuretics (pulm edema)
170
bronchodilators
iaprotropium
magnesium
terbutaline
171
treatment for lung tissue dz
albuterol
bronchodilators
consider labs/CXR
consider diuretics (pulm edema)
Abx (if febrile)
172
treatment for disordered control of breathing
reversal agents
(unless seizure meds)
173
can you use racemic epi for lower airway obstructions?
yes for bronchospasm if all other breathing treatments fail
174
heliox density
lower than O2
175
heliox probability of laminar flow
higher probablility of laminar flow due to lower density generating less airway resistance
176
most common use for heliox in pals
croup
177
humidified O2 advantages
decr chance of coughing
loosen mucus
178
humidified O2 is used in
mod-sev croup
asthma
179
racemic epi effects
airway vasoconstriction
dec vascular permeability
decr swelling/edem
180
racemic epi causes
bronchodilation
181
is mg a first or second line bronchodilator
2nd line
used when pts fail to respond to conventional bronchodilator therapy
182
mg SE
hypotension
183
treatment for disordered breathing caused by incr ICP
mannitol
hypertonic (3%) saline
184
iapotropium class
anticholinergic
bronchodilator
185
can you mix iapotropium and albuterol?
yes
186
narcan
reverses respiratory depression from narcotic overdose
187
narcan SE
incr HR
incr BP
acute pulm edema
cardiac arrhythmias
seizures
188
how can you lower narcan SE risk
IM injection may slow drug onset
189
PEEP
6-10 cmH2O
190
excessive PEEP SE
decr venous return
decr CO
decr O2 delivery
191
uncuffed ETT
(age/4) +4
192
cuffed ETT
(age/4)+3
193
ETT insertion depth (<2 years old)
ID*3
194
ETT insertion depth (>2 years old)
(age/2) + 12
195
which tubes are recommended
cuffed
196
ETT cuff inflation pressure
< 20-25 cmH2O
197
ETT dosing
2-3x IV dose
198
ETT dosing for Epi
10x IV dose
199
rapid crystalloid bolus
20 mL/kg over 5-20 mins
(10 mins if severe/hypotensive)
200
rapid bolus indication
hypotensive
hypovolemic
obstructive
distreibutive
201
smaller/slower bolus
5-10 mL/kg over 10-20 mins
202
smaller/slower bolus indications
cardiogenic shock
heart failure
BB/CCB overdose
pulm edema
DKA
203
how long should you continue fluid boluses
until conditions improve or signs of respiratory distress develop
204
when are colloids considered?
hypovolemia/hypotension after 3 crystalloid boluses
205
risk of higher colloid doses
coagulopathies
206
which is better crystalloid or colloid
volume is key
but maybe slight advantage to crystalloid
207
first line treatment for poor pefusion/hypotension
fluid bolus
208
what should you do before giving fluids
check breath sounds in lower lobes
209
what if you hear rales before giving fluids?
hold fluids
or
admin slowly
210
are fluids good for febrile pts?
febrile pts do better with less fluids because febrile pts are vasodilated
211
are fluids good for septic pts?
yes - aggressively hydrate w/10-20 mL/kg boluses
frequently assess pt for respiratory distress
212
hypotenive
hypovolemic
obstructive
distributive
20 mL/kg bolus
over 5-20 mins
213
cardiogenic shock
5-10 mL/kg
over 10-20 mins
214
CCB/BB overdose
5-10 mL/kg
over 10-20 mins
215
DKA w/compensated shock
10-20 mL/kg
over 1-2 hrs
216
febrile illness (no shock)
restrict fluids
217
septic shock
10-20 mL/kg
over 5-20 mins
reassess after each bolus
stop if respiratory disress
218
blood products recommended if Hb
Hb < 7 g/dL
219
goal of transfusion
Hb > 10 g/dL
220
pals recommends giving blood to `
hypotensive kids who are bleeding after 2-3 fluid boluses of 20 ml/kg
221
initial dose of PRBCs
10 ml/kg
222
when do you naturally develop anti-blood antibodies?
6 months
223
do you need to be exposed to antigen to develop ABO antibody?
no - it happens naturally
224
do you need to be exposed to antigen to develop RH antibody?
yes
225
Type A antigen
A
226
Type A antibody
anti-B
227
Type B antigen
B
228
Type B antibody
anti-A
229
Type AB antigen
A
B
230
Type AB antibody
none
231
Type O antigen
none
232
Type O antibody
anti-A
anti-B
233
universal donor
Type O-
234
universal receiver
Type AB+
235
5 main Rh antigemsd
C
c
D
E
e
236
RhD
+ blood type
237
will type A blood have a tranfusion reaction to type B blood on first exposure?
yes - anti-B antibodies are already present
238
will Rh- pts have a transfusion reaction ot Rh+ blood on first exposure
no - it will only happen on second exposure
239
emergently, males can receive
O+
O-
240
ermergently, females can receive
O-
241
estimated water weight in kids (PALS)
100% of total body weight
242
estimated water weight in kids (reality)
70-80%
243
1% volume loss =
10 mL/kg water loss
244
what % of total fluid volume in human body is blood?
10%
245
losing all of your blood results in
10% estimated weight loss
100 mL/kg volume depletion
246
do older or younger children tolerate volume loss better?
younger children bc they have a higher % of body weight as water (more volume to lose)
247
mild dehydration: adolescent
3%
30 mL/kg
248
mod dehydration: adolescent
5-6%
50-60 mL/kg
249
sev dehydration: adolescent
7-9%
70-90 mL/kg
250
mild dehydration: infant
5%
50 mL/kg
251
mod dehydration: infant
10%
100 mL/kg
252
sev dehydration: infant
15%
150 mL/kg
253
clinically significant dehydration
5% volume depletion
5% EWL
50 mL/kg fluid deficit
254
hypovolemic/hypotensive shock volume loss
10% volume depletion
10% EWL
100 mL/kg fluid deficit
255
first step in PALS
check appearance and responsiveness
256
check appearance
appearance
work of breathing
circulation (color)
257
PALS initial assessment
check appearance
258
treat conscious pt
monitors
perfusion
IV
O2
auscultate
(primary assessment)
259
unconscious pt
Responsiveness
Activate EMS/AED
Circ/breathing/CPR
Defib
260
fever w/abnormal lungs
lung tissue disease
treat w/:
support airway
abx
261
fever w/normal lungs
sepsis
treat w/:
abx
fluids
pressors
262
hypotension w/abnormal lungs
cardiogenic shock
treat w:
inotropes
small fluid boluses
263
hypotension w/normal lungs
hypovolemic shock
treat w/rapid fluid boluses
264
secondary assessment
SAMPLE
+/- H/Ts
265
SAMPLE
Signs/Symptoms
Allergies
Meds
Past med history
Last meal
Events
266
which pts is SAMPLE used for?
ALL of them
267
which pts is H&Ts used for?
unstable pts
268
H & Ts
hypovolemia
hypoxia
hypothermia
hypoglycemia
hypokalemia
hyperkalemia
H+ acidosis
Tamponade
Thrombosis
Tension pneumo
Trauma
Toxins
269
labs/diagnostic tests
CXR
ABD
U/S
270
EII cycle
evaluate
identify
intervene
continuous - constant reevaluation after every intervention
271
causes of Low CO
hypovolema
bradycardia
decr contractility
272
General symptoms of low CO
hypotension
poor perfusion
cold shock
narrow PP
oliguria
273
cold shock
vasoconstriction
weak pulse
274
narrow pulse pressure
low SBP (low stroke volume)
high DBP (vasoconstriction)
275
symptoms of Low CO w/decr contractility
pulm edema
rales/grunting
jugular venous distension
276
symptoms of low afterload
high CO (high SV)
warm shock (good pulse)
wide PP
decr preload
brisk cap refill
flushed skin
delayed cap refill if hTN
angioedema
277
wide pulse pressure
low DBP from vasodilation
278
most common cause of vasoconstriction in PALS
decr CO in hypovolemic or cardiogenic shock
279
symptoms of high afterload (Vasoconstriction)
cold shock
weak pulses
delayed cap refill
pale skin
