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Fa: Methods 2 > 6. PALS > Flashcards

6. PALS Flashcards

1
Q

cardiac scenarios

A

Vfib/pulseless Vtach
SVT/Vtach w/pulse
aystole/PEA
bradycardia

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2
Q

respiratory scenartios

A

lower airway obstruction
upper airway obstruction
lung tissue disease
disordered control of breathing

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3
Q

shock scenartios

A

hypovolemia
obstructive
septic
cardiogenic

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4
Q

bradycardia neonate

A

< 80 bpm

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5
Q

bradycardia infant/child

A

< 60 bpm

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6
Q

broselow tape

A

approximates weight and drug doses based on child length

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7
Q

adult defib pads are used on pts

A

8+ years old

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8
Q

defib 8+ year old

A

AED w/adult AED pads

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9
Q

defib 1-8 year old

A
  1. AED w/peds pads and dose attenuator
  2. man defib w/peds pads
  3. AED w/adult pads
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10
Q

defib < 1 year old

A
  1. man defib w/peds pads
  2. AED w/peds pads
  3. AED w/adult pads
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11
Q

croup

A

inflammation of larynx/vocal cords

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12
Q

cause of croup

A

virus

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13
Q

mild croup

A

barking cough

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14
Q

mod croup

A

stridor
retractions at rest

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15
Q

sev croup

A

significant agitation
decr air entry

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16
Q

CPR > 8 yr old

A

2-handed

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17
Q

CPR 1-8 year old

A

2 handed
or 1 handed

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18
Q

CPR infant 2+ rescuers

A

thumb encircling

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19
Q

CPR infant lone rescuer

A

2 finger
or
thumb. encircling

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20
Q

when can you consider 1 handed CPR for infant

A

cannot get adequate depth with other techniques

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21
Q

neonates cpr depth

A

1.5 inch

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22
Q

infants cpr depth

A

1.5 inch

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23
Q

kids 1+ cpr depth

A

2 inch

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24
Q

kids 1+ cpr cycles: 1 rescuer

A

5 cycles
30:2

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25
Q

kids 1+ cpr cycles 2+ rescuers

A

5 cycles
15:2

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26
Q

kids 1+ cpr cycles intubated

A

100-120 compressions/min
20-30 breaths per min

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27
Q

infants cpr cycle 1 rescuer

A

5 cycles
30:2

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28
Q

infants CPR cycle 2 rescuers

A

5 cycles
15:2

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29
Q

infants cpr intubated

A

100-120 compression/min
20-30 breaths/min

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30
Q

neonates cpr 1 rescuer: respiratory arrest

A

3:1 ratio

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31
Q

neonates cpr 1 rescuer: cardiac arrest

A

15:2

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32
Q

neonates cpr 2 rescuers: respiratory arrest

A

3:1

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33
Q

neonates cpr 2 rescuers: cardiac

A

15:2

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34
Q

neonates cpr intubated

A

100-120 compressions/min
20-30 breaths/min

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35
Q

when is cyanosis aparent

A

at least 5 g/dL of hb are desaturated

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36
Q

if you are more anemic will you be cyanotic faster or slower

A

slower because a higher % of Hb will need to be desaturated

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37
Q

if you are anemic what SpO2 must be present before cyanosis

A

lower SpO2

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38
Q

defib peds: 1st dose

A

2 J/kg

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39
Q

defib peds: 2nd dose

A

4 J/kg

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40
Q

defib peds: 3+ dose

A

up to 10 J/kg

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41
Q

cardioversion peds: 1st shock

A

0.5-1 J/kg

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42
Q

cardioversion peds: 2nd shock

A

2 J/kg

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43
Q

neonates hypoglycemia

A

< 45 mg/dL

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44
Q

infants/children hypoglycemia

A

< 60 mg/dL

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45
Q

hypoglycemia S+S

A

poor perfusion
hypotension
tachycardia
sweating
irritability
lethargy

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46
Q

glu dosing for hypoglycemia

A

0.5-1 g/kg

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46
Q

D25W glucose

A

250 mg/mL

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47
Q

how many mL of D25W = 1 g glucose

A

4 mL = 1 g

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48
Q

how many mL of D5W = 1 g glucose

A

20 mL = 1 g

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49
Q

how many mL of D50W = 1 g glucose

A

2 mL = 1g

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50
Q

neonate hTN

A

SBP < 60

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51
Q

infant hTN

A

SBP < 70

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52
Q

children hTN

A

SBP < 70 + (age*2)

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53
Q

children 10+ hTN

A

SBP < 90

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54
Q

mottling

A

patchy discoloration of skin caused by areas of vasoconstriction mixed with areas of vasodilation

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55
Q

mottling mechanism

A

irregular supply of oxy blood

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56
Q

mottling can indicate

A

imminent death

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57
Q

good peripheral perfusion (vasodilation)

A
  1. good pulse
  2. flushed color
  3. cap refil
  4. warm skin
  5. awake and alert
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58
Q

brisk cap refil

A

<= 2 seconds

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59
Q

flash cap refill

A

< 2 seconds

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60
Q

poor perfusion

A
  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
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61
Q

delayed cap refill

A

> 5 sec

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62
Q

petechiae and purpura

A

purple discolorations caused by small vessel bleeding under the skin

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63
Q

petechiae and purpura indicate

A

low plts
DIC
septic shock

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64
Q

“refractory” to treatment

A

do not improve or respond to specific therapy

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65
Q

“fluid refractory hypotension”

A

hypotension despite fluid admin

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66
Q

“NE refractory shock”

A

child in shock unresponsive to NE therapy

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67
Q

resp distress

A

incr RR
able to move air
abnormal airway sounds
pallor
tachycardia
improves with initial therapy

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68
Q

resp failure

A

labored breathing
signs of shock
- cyanosis
- bradycardia
requires intervention to prevent resp/cardiac arrest
may not respond to inital treatments

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69
Q

indications for bag mask ventilation or intubation

A

low SpO2
abnormal airway sounds
poor signs of perfusion
bradycardia
anxiety
lethargy
etcac

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70
Q

acryocyanosis

A

blue hand/feet/mouth/lips

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71
Q

most common cause of brady in kids

A

apnea

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72
Q

apnea

A

cessation of breathin for 20 seconds

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73
Q

febrile

A

> = 38C

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74
Q

treatment for feber

A

abx

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75
Q

hypoxemia

A

SpO2 <= 94% on room air

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76
Q

permissive hypoxemia

A

SpO2 < 94% that might be appropriate or normal

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77
Q

permissive hypoxemia example

A

TOF

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78
Q

normal cap refil

A

<=2 seconds

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79
Q

prolonged cap refil

A

> 5 seconds

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80
Q

common causes of prolonged cap refil

A

dehyhdration
shock
hypothermia

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81
Q

SVT infants

A

> 220 bpm

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82
Q

SVT children

A

> 180 bpm

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83
Q

infant O2 consumption

A

6-8 mL/kg/min

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84
Q

adult O2 consumptionj

A

3-4 mL/kg/min

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85
Q

what SpO2 on 100% fio2 indicated need for intervention

A

<90% on 100% FiO2

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86
Q

ScvO2

A

25-30% lower than SaO2

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87
Q

ScvO2 if SaO2 is normal

A

70-75%

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88
Q

urine output infants/young child

A

1.5-2 mL/kg/hr

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89
Q

adolescents

A

1 mL/kg/hr

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90
Q

quiet tachypnea

A

fast RR
not accompanied by signs of labored breathing or respiratory distress

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91
Q

cause of quiet tachypena

A

non-pulmonary issues
-fever
-pain
- metabolic acidosis

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92
Q

peds have ____ tongue
peds have ____ occiput

A

larger tongue
larger occiput

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93
Q

infant head positioning when giving breaths

A

neutral/sniffing

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94
Q

individual small airway has _______ resistance

A

greater resistance

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95
Q

TOTAL resistance in small airway

A

lower resistance because there are more small airways

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96
Q

larger airways (upper airways) are more prone to

A

turbulent airflow

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97
Q

airflow during normal resipration

A

laminar
lower resistance

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98
Q

ways airflow can become turbulent

A

partial airway obstruction
labored/incr resp efforts/crying

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99
Q

turbulence ______ airway resistance which _______ work of breathing

A

turbulence incr airway resistance with incr work of breathing

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100
Q

lower gas density = _______ % laminar flow = ______ resistance

A

lower gas density = higher % laminar flow =. lower resistance

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101
Q

laminar flow resistance to airflow

A

inversely proportional to airway radius^4

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102
Q

decr airway radius =

A

incr Resistance^4

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103
Q

turbulent flow resistance to airflow

A

inversely proportional to airway radius^5

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104
Q

respiratory muscles that LIFT ribcage

A

all of them

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105
Q

primary inspiratory muscles

A

diaphragm
external intercostals

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106
Q

accessory inspiratory muscles

A

muscles in neck
- sternocleidomastoid
- scalene
pecs
- pec major/minor

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107
Q

primary expiratory muscles

A

non - expiration is passive

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108
Q

accessory expiratory muscle

A

internal intercostals
abdominals
- rectus abdominis
- external oblique
- internal oblique
- transversus abdominis

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109
Q

chest wall in peds

A

compliant

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110
Q

chest movement during diaphragm contraction

A

tugged inward during deep breathing

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111
Q

lung hyperinflation

A

diaphragm flattens
= less effective ventilation

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112
Q

DOPE

A

Displacement
Obstruction
Pneumothorax
Equipment failure

113
Q

Displacement

A

ETT in place?

114
Q

Obstruction

A

ETT kinked?
mucus plug?

115
Q

Pneumothorax

A

bilateral breath sounds?

116
Q

when do you say DOPE

A

intubated pt deteriorates

117
Q

percussion exam

A

L middle finger on body surface
tap w/R middle finger

118
Q

resonant sounds

A

normal lung w/percussion

119
Q

hyperresonant sounds

A

tension pneumothorax

120
Q

wheezing

A

high pitched
expiration

121
Q

wheezing cause

A

bronchoconstriction

122
Q

Rales

A

intermittent popping sound

123
Q

rales cause

A

fluid in distal airways or atelectasis

124
Q

rales can suggest

A

cardiogenic shock
lung tissue disease

125
Q

rales in hypotensive pt

A

cardiogenic shock

126
Q

rales in febrile pt

A

lung tissue disease

127
Q

Rhonchi

A

low pitched
snoring
bubbling

128
Q

rhonchi causes

A

secretions in larger airways

129
Q

stridor

A

high pitched
inspiration

130
Q

stridor indicates

A

upper airway obstruction
- foreign body
- croup
- upper airway edema

131
Q

grunting

A

low pitch
expiration

132
Q

grunting means the pt is

A

closing glotting earlier than usual

PEEP

133
Q

grunting can indicate

A

impending respiratory failyre

134
Q

grunting is seen in

A

lung tissue disease
- pulm edema
- pneumonia
- ARDS

135
Q

head bobbing chin lift

A

inspiration

136
Q

head bobbing chin galls

A

expiration

137
Q

nasal flaring

A

nostrils dilated during inhalation

138
Q

disordered control of breathing

A

irregular RR
insufficient repiratory effort

139
Q

disordered control of breathing can lead to

A

hypoxemia
hypercarbia

140
Q

causes of disordered control of breathing

A

med overdose
seizure w/incr ICP
neuro problems

141
Q

retractions

A

inward movement of chest wall during inspuration

142
Q

cause of retrations

A

incr airawy resistance

143
Q

substernal/subcostal retractions

A

mild-mod breathing difficulty

144
Q

suprasternal/supraclavicular retractions

A

severe breathing difficulty

145
Q

seesaw respiration

A

more severe form of retraction
chest wall inward/abdomen expands during inspiration

146
Q

seesaw respiration typically indicates

A

upper airway obstruction

147
Q

seesaw respiration can also indicate

A

severe lower airway obstruction
lung tissue disease
disordered control of breathing

148
Q

seesaw respiration is common in children with

A

neuromusclar weakness

149
Q

retractions + inspiratory snoring/stridor

A

upper airway obstruction
- croup
- foreign body

150
Q

retractions + expiratory wheezing

A

lower airway obstruction
- asthma
- bronchiolitis

151
Q

retractions + grunting/labored respirations

A

lung tissue dz
pulm edema f/cardiogenic shock

152
Q

abnormal inspiratory sounds indicate

A

upper airway obstruction

153
Q

abnormal expiratory sounds indicate

A

lower airway obstruction

154
Q

when is suctioning contraindicated?

A

croup
(infection induced edema)

155
Q

croup treatment

A

racemic epi nebulizer

156
Q

lung tissue dz

A

lungs become stiff due to fluid accumulation in alveoli

157
Q

common conditions of lung tissue dz

A

pneumonia
pulm edema
ARDS

158
Q

lung tissue dz S+S

A

grunting
rales
fever

159
Q

ALL airway scenarios contain

A

hypoxemia
poor chest rise/air movement
breathing w/accessory muscles
early tachycardia
late bradycardia

160
Q

signs of labored breathing/respiratory distress is found in which scenarios?

A

upper airway
lower airway
lung tissue

161
Q

signs of upper airway

A

stridor
inspiratory snoring
hoarseness
barking cough
drooling
gurgling

162
Q

signs of lower airway

A

expiratory wheezing

163
Q

signs of lung tissue dz

A

grunting
crackles/rales
fever

164
Q

signs of disordered control of breathing

A

normal/shallow breath sounds
abnormal resp pattern
possible central apnea

165
Q

how to distinguish between airway and cardiac or shock scenarios

A

airway scenarios will not have hypotension

166
Q

how to distinguish between airway and bradycardia scenario

A

airway will have abnormal breath sounds

bradycardia will have normal breath sounds

167
Q

treatment for ALL airway scenarios

A

supp O2 if SpO2 < 94%
assist airway/consider intubation
suction secretions
monitor EKG
treat bradycardia (if present)

168
Q

treatment for upper airway obstruction

A

heliox
humidified O2
racemic epi
steroids

169
Q

treatment for lower airway

A

albuterol
bronchodilators
consider labs/CXR
consider diuretics (pulm edema)

170
Q

bronchodilators

A

iaprotropium
magnesium
terbutaline

171
Q

treatment for lung tissue dz

A

albuterol
bronchodilators
consider labs/CXR
consider diuretics (pulm edema)
Abx (if febrile)

172
Q

treatment for disordered control of breathing

A

reversal agents
(unless seizure meds)

173
Q

can you use racemic epi for lower airway obstructions?

A

yes for bronchospasm if all other breathing treatments fail

174
Q

heliox density

A

lower than O2

175
Q

heliox probability of laminar flow

A

higher probablility of laminar flow due to lower density generating less airway resistance

176
Q

most common use for heliox in pals

A

croup

177
Q

humidified O2 advantages

A

decr chance of coughing
loosen mucus

178
Q

humidified O2 is used in

A

mod-sev croup
asthma

179
Q

racemic epi effects

A

airway vasoconstriction
dec vascular permeability
decr swelling/edem

180
Q

racemic epi causes

A

bronchodilation

181
Q

is mg a first or second line bronchodilator

A

2nd line
used when pts fail to respond to conventional bronchodilator therapy

182
Q

mg SE

A

hypotension

183
Q

treatment for disordered breathing caused by incr ICP

A

mannitol
hypertonic (3%) saline

184
Q

iapotropium class

A

anticholinergic
bronchodilator

185
Q

can you mix iapotropium and albuterol?

A

yes

186
Q

narcan

A

reverses respiratory depression from narcotic overdose

187
Q

narcan SE

A

incr HR
incr BP
acute pulm edema
cardiac arrhythmias
seizures

188
Q

how can you lower narcan SE risk

A

IM injection may slow drug onset

189
Q

PEEP

A

6-10 cmH2O

190
Q

excessive PEEP SE

A

decr venous return
decr CO
decr O2 delivery

191
Q

uncuffed ETT

A

(age/4) +4

192
Q

cuffed ETT

A

(age/4)+3

193
Q

ETT insertion depth (<2 years old)

A

ID*3

194
Q

ETT insertion depth (>2 years old)

A

(age/2) + 12

195
Q

which tubes are recommended

A

cuffed

196
Q

ETT cuff inflation pressure

A

< 20-25 cmH2O

197
Q

ETT dosing

A

2-3x IV dose

198
Q

ETT dosing for Epi

A

10x IV dose

199
Q

rapid crystalloid bolus

A

20 mL/kg over 5-20 mins

(10 mins if severe/hypotensive)

200
Q

rapid bolus indication

A

hypotensive
hypovolemic
obstructive
distreibutive

201
Q

smaller/slower bolus

A

5-10 mL/kg over 10-20 mins

202
Q

smaller/slower bolus indications

A

cardiogenic shock
heart failure
BB/CCB overdose
pulm edema
DKA

203
Q

how long should you continue fluid boluses

A

until conditions improve or signs of respiratory distress develop

204
Q

when are colloids considered?

A

hypovolemia/hypotension after 3 crystalloid boluses

205
Q

risk of higher colloid doses

A

coagulopathies

206
Q

which is better crystalloid or colloid

A

volume is key
but maybe slight advantage to crystalloid

207
Q

first line treatment for poor pefusion/hypotension

A

fluid bolus

208
Q

what should you do before giving fluids

A

check breath sounds in lower lobes

209
Q

what if you hear rales before giving fluids?

A

hold fluids
or
admin slowly

210
Q

are fluids good for febrile pts?

A

febrile pts do better with less fluids because febrile pts are vasodilated

211
Q

are fluids good for septic pts?

A

yes - aggressively hydrate w/10-20 mL/kg boluses

frequently assess pt for respiratory distress

212
Q

hypotenive
hypovolemic
obstructive
distributive

A

20 mL/kg bolus
over 5-20 mins

213
Q

cardiogenic shock

A

5-10 mL/kg
over 10-20 mins

214
Q

CCB/BB overdose

A

5-10 mL/kg
over 10-20 mins

215
Q

DKA w/compensated shock

A

10-20 mL/kg
over 1-2 hrs

216
Q

febrile illness (no shock)

A

restrict fluids

217
Q

septic shock

A

10-20 mL/kg
over 5-20 mins
reassess after each bolus
stop if respiratory disress

218
Q

blood products recommended if Hb

A

Hb < 7 g/dL

219
Q

goal of transfusion

A

Hb > 10 g/dL

220
Q

pals recommends giving blood to `

A

hypotensive kids who are bleeding after 2-3 fluid boluses of 20 ml/kg

221
Q

initial dose of PRBCs

A

10 ml/kg

222
Q

when do you naturally develop anti-blood antibodies?

A

6 months

223
Q

do you need to be exposed to antigen to develop ABO antibody?

A

no - it happens naturally

224
Q

do you need to be exposed to antigen to develop RH antibody?

A

yes

225
Q

Type A antigen

A

A

226
Q

Type A antibody

A

anti-B

227
Q

Type B antigen

A

B

228
Q

Type B antibody

A

anti-A

229
Q

Type AB antigen

A

A
B

230
Q

Type AB antibody

A

none

231
Q

Type O antigen

A

none

232
Q

Type O antibody

A

anti-A
anti-B

233
Q

universal donor

A

Type O-

234
Q

universal receiver

A

Type AB+

235
Q

5 main Rh antigemsd

A

C
c
D
E
e

236
Q

RhD

A

+ blood type

237
Q

will type A blood have a tranfusion reaction to type B blood on first exposure?

A

yes - anti-B antibodies are already present

238
Q

will Rh- pts have a transfusion reaction ot Rh+ blood on first exposure

A

no - it will only happen on second exposure

239
Q

emergently, males can receive

A

O+
O-

240
Q

ermergently, females can receive

A

O-

241
Q

estimated water weight in kids (PALS)

A

100% of total body weight

242
Q

estimated water weight in kids (reality)

A

70-80%

243
Q

1% volume loss =

A

10 mL/kg water loss

244
Q

what % of total fluid volume in human body is blood?

A

10%

245
Q

losing all of your blood results in

A

10% estimated weight loss
100 mL/kg volume depletion

246
Q

do older or younger children tolerate volume loss better?

A

younger children bc they have a higher % of body weight as water (more volume to lose)

247
Q

mild dehydration: adolescent

A

3%
30 mL/kg

248
Q

mod dehydration: adolescent

A

5-6%
50-60 mL/kg

249
Q

sev dehydration: adolescent

A

7-9%
70-90 mL/kg

250
Q

mild dehydration: infant

A

5%
50 mL/kg

251
Q

mod dehydration: infant

A

10%
100 mL/kg

252
Q

sev dehydration: infant

A

15%
150 mL/kg

253
Q

clinically significant dehydration

A

5% volume depletion
5% EWL
50 mL/kg fluid deficit

254
Q

hypovolemic/hypotensive shock volume loss

A

10% volume depletion
10% EWL
100 mL/kg fluid deficit

255
Q

first step in PALS

A

check appearance and responsiveness

256
Q

check appearance

A

appearance
work of breathing
circulation (color)

257
Q

PALS initial assessment

A

check appearance

258
Q

treat conscious pt

A

monitors
perfusion
IV
O2
auscultate

(primary assessment)

259
Q

unconscious pt

A

Responsiveness
Activate EMS/AED
Circ/breathing/CPR
Defib

260
Q

fever w/abnormal lungs

A

lung tissue disease
treat w/:
support airway
abx

261
Q

fever w/normal lungs

A

sepsis
treat w/:
abx
fluids
pressors

262
Q

hypotension w/abnormal lungs

A

cardiogenic shock
treat w:
inotropes
small fluid boluses

263
Q

hypotension w/normal lungs

A

hypovolemic shock
treat w/rapid fluid boluses

264
Q

secondary assessment

A

SAMPLE
+/- H/Ts

265
Q

SAMPLE

A

Signs/Symptoms
Allergies
Meds
Past med history
Last meal
Events

266
Q

which pts is SAMPLE used for?

A

ALL of them

267
Q

which pts is H&Ts used for?

A

unstable pts

268
Q

H & Ts

A

hypovolemia
hypoxia
hypothermia
hypoglycemia
hypokalemia
hyperkalemia
H+ acidosis

Tamponade
Thrombosis
Tension pneumo
Trauma
Toxins

269
Q

labs/diagnostic tests

A

CXR
ABD
U/S

270
Q

EII cycle

A

evaluate
identify
intervene

continuous - constant reevaluation after every intervention

271
Q

causes of Low CO

A

hypovolema
bradycardia
decr contractility

272
Q

General symptoms of low CO

A

hypotension
poor perfusion
cold shock
narrow PP
oliguria

273
Q

cold shock

A

vasoconstriction
weak pulse

274
Q

narrow pulse pressure

A

low SBP (low stroke volume)
high DBP (vasoconstriction)

275
Q

symptoms of Low CO w/decr contractility

A

pulm edema
rales/grunting
jugular venous distension

276
Q

symptoms of low afterload

A

high CO (high SV)
warm shock (good pulse)
wide PP
decr preload
brisk cap refill
flushed skin
delayed cap refill if hTN
angioedema

277
Q

wide pulse pressure

A

low DBP from vasodilation

278
Q

most common cause of vasoconstriction in PALS

A

decr CO in hypovolemic or cardiogenic shock

279
Q

symptoms of high afterload (Vasoconstriction)

A

cold shock
weak pulses
delayed cap refill
pale skin

Fa: Methods 2 (15 decks)

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