6. PALS Flashcards
cardiac scenarios
Vfib/pulseless Vtach
SVT/Vtach w/pulse
aystole/PEA
bradycardia
respiratory scenartios
lower airway obstruction
upper airway obstruction
lung tissue disease
disordered control of breathing
shock scenartios
hypovolemia
obstructive
septic
cardiogenic
bradycardia neonate
< 80 bpm
bradycardia infant/child
< 60 bpm
broselow tape
approximates weight and drug doses based on child length
adult defib pads are used on pts
8+ years old
defib 8+ year old
AED w/adult AED pads
defib 1-8 year old
- AED w/peds pads and dose attenuator
- man defib w/peds pads
- AED w/adult pads
defib < 1 year old
- man defib w/peds pads
- AED w/peds pads
- AED w/adult pads
croup
inflammation of larynx/vocal cords
cause of croup
virus
mild croup
barking cough
mod croup
stridor
retractions at rest
sev croup
significant agitation
decr air entry
CPR > 8 yr old
2-handed
CPR 1-8 year old
2 handed
or 1 handed
CPR infant 2+ rescuers
thumb encircling
CPR infant lone rescuer
2 finger
or
thumb. encircling
when can you consider 1 handed CPR for infant
cannot get adequate depth with other techniques
neonates cpr depth
1.5 inch
infants cpr depth
1.5 inch
kids 1+ cpr depth
2 inch
kids 1+ cpr cycles: 1 rescuer
5 cycles
30:2
kids 1+ cpr cycles 2+ rescuers
5 cycles
15:2
kids 1+ cpr cycles intubated
100-120 compressions/min
20-30 breaths per min
infants cpr cycle 1 rescuer
5 cycles
30:2
infants CPR cycle 2 rescuers
5 cycles
15:2
infants cpr intubated
100-120 compression/min
20-30 breaths/min
neonates cpr 1 rescuer: respiratory arrest
3:1 ratio
neonates cpr 1 rescuer: cardiac arrest
15:2
neonates cpr 2 rescuers: respiratory arrest
3:1
neonates cpr 2 rescuers: cardiac
15:2
neonates cpr intubated
100-120 compressions/min
20-30 breaths/min
when is cyanosis aparent
at least 5 g/dL of hb are desaturated
if you are more anemic will you be cyanotic faster or slower
slower because a higher % of Hb will need to be desaturated
if you are anemic what SpO2 must be present before cyanosis
lower SpO2
defib peds: 1st dose
2 J/kg
defib peds: 2nd dose
4 J/kg
defib peds: 3+ dose
up to 10 J/kg
cardioversion peds: 1st shock
0.5-1 J/kg
cardioversion peds: 2nd shock
2 J/kg
neonates hypoglycemia
< 45 mg/dL
infants/children hypoglycemia
< 60 mg/dL
hypoglycemia S+S
poor perfusion
hypotension
tachycardia
sweating
irritability
lethargy
glu dosing for hypoglycemia
0.5-1 g/kg
D25W glucose
250 mg/mL
how many mL of D25W = 1 g glucose
4 mL = 1 g
how many mL of D5W = 1 g glucose
20 mL = 1 g
how many mL of D50W = 1 g glucose
2 mL = 1g
neonate hTN
SBP < 60
infant hTN
SBP < 70
children hTN
SBP < 70 + (age*2)
children 10+ hTN
SBP < 90
mottling
patchy discoloration of skin caused by areas of vasoconstriction mixed with areas of vasodilation
mottling mechanism
irregular supply of oxy blood
mottling can indicate
imminent death
good peripheral perfusion (vasodilation)
- good pulse
- flushed color
- cap refil
- warm skin
- awake and alert
brisk cap refil
<= 2 seconds
flash cap refill
< 2 seconds
poor perfusion
- weak pulse
- pale/cyanotic
- delayed cap refil
- cold extremities
- decr responsiveness
- met acidosis
- incr lactate
- decr urine output
delayed cap refill
> 5 sec
petechiae and purpura
purple discolorations caused by small vessel bleeding under the skin
petechiae and purpura indicate
low plts
DIC
septic shock
“refractory” to treatment
do not improve or respond to specific therapy
“fluid refractory hypotension”
hypotension despite fluid admin
“NE refractory shock”
child in shock unresponsive to NE therapy
resp distress
incr RR
able to move air
abnormal airway sounds
pallor
tachycardia
improves with initial therapy
resp failure
labored breathing
signs of shock
- cyanosis
- bradycardia
requires intervention to prevent resp/cardiac arrest
may not respond to inital treatments
indications for bag mask ventilation or intubation
low SpO2
abnormal airway sounds
poor signs of perfusion
bradycardia
anxiety
lethargy
etcac
acryocyanosis
blue hand/feet/mouth/lips
most common cause of brady in kids
apnea
apnea
cessation of breathin for 20 seconds
febrile
> = 38C
treatment for feber
abx
hypoxemia
SpO2 <= 94% on room air
permissive hypoxemia
SpO2 < 94% that might be appropriate or normal
permissive hypoxemia example
TOF
normal cap refil
<=2 seconds
prolonged cap refil
> 5 seconds
common causes of prolonged cap refil
dehyhdration
shock
hypothermia
SVT infants
> 220 bpm
SVT children
> 180 bpm
infant O2 consumption
6-8 mL/kg/min
adult O2 consumptionj
3-4 mL/kg/min
what SpO2 on 100% fio2 indicated need for intervention
<90% on 100% FiO2
ScvO2
25-30% lower than SaO2
ScvO2 if SaO2 is normal
70-75%
urine output infants/young child
1.5-2 mL/kg/hr
adolescents
1 mL/kg/hr
quiet tachypnea
fast RR
not accompanied by signs of labored breathing or respiratory distress
cause of quiet tachypena
non-pulmonary issues
-fever
-pain
- metabolic acidosis
peds have ____ tongue
peds have ____ occiput
larger tongue
larger occiput
infant head positioning when giving breaths
neutral/sniffing
individual small airway has _______ resistance
greater resistance
TOTAL resistance in small airway
lower resistance because there are more small airways
larger airways (upper airways) are more prone to
turbulent airflow
airflow during normal resipration
laminar
lower resistance
ways airflow can become turbulent
partial airway obstruction
labored/incr resp efforts/crying
turbulence ______ airway resistance which _______ work of breathing
turbulence incr airway resistance with incr work of breathing
lower gas density = _______ % laminar flow = ______ resistance
lower gas density = higher % laminar flow =. lower resistance
laminar flow resistance to airflow
inversely proportional to airway radius^4
decr airway radius =
incr Resistance^4
turbulent flow resistance to airflow
inversely proportional to airway radius^5
respiratory muscles that LIFT ribcage
all of them
primary inspiratory muscles
diaphragm
external intercostals
accessory inspiratory muscles
muscles in neck
- sternocleidomastoid
- scalene
pecs
- pec major/minor
primary expiratory muscles
non - expiration is passive
accessory expiratory muscle
internal intercostals
abdominals
- rectus abdominis
- external oblique
- internal oblique
- transversus abdominis
chest wall in peds
compliant
chest movement during diaphragm contraction
tugged inward during deep breathing
lung hyperinflation
diaphragm flattens
= less effective ventilation