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Fa: Methods 2 > 8. PALS Scenarios > Flashcards

8. PALS Scenarios Flashcards

1
Q

the most common cause of bradycardia in kids

A

hypoxia and/or respiratory arrest

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2
Q

if there is bradycardia what is the priority over everything else?

A

effective ventilation

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3
Q

when are chest compressions indicated in children?

A

HR below 60

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4
Q

primary bradycardia

A

result of congenital or acquired heart conditions that slow depolarization in the electrical conducting system

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5
Q

secondary bradycardia

A 
any non cardiac condition that slows HR:
hypoxia
acidosis
hypothermia
drugs
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6
Q

when is atropine prioritized before epi?

A
  • there is an increase in vagal tone or vagal response is suspected
  • cholinergic drug toxicity
  • brady is due to AV block
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7
Q

should you use atropine as a premediation?

A

no evidence to support routine use of it as premed

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8
Q

PALS algorithm for bradycardia

A

monitors iv o2
support airway
start CPR if HR <60
Other options: epi/atropine/transcut pacing
Consider H&Ts

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9
Q

SVT rate infants

A

> 220

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10
Q

SVT rate children

A

> 180

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11
Q

sinus tachy

A

slower than SVT

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12
Q

algorithm for sinus tachy stable or unstable

A

monitors iv o2
find cause
treat cause

search for cause and treat

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13
Q

algorithm for stable SVT

A 
monitors iv o2
vagal maneuvers
adenosine up to 2 doses
SAMPLE
expert consult
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14
Q

first dose adenosine

A

100mcg/kg max 6mg

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15
Q

second dose adenosine

A

200mcg/kg max 12mg

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16
Q

algorithm for unstable SVT

A

same but cardiovert is #1

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17
Q

algorithm for vtach with pulse adequate perfusion

A 
M/IV/O
expert consult
lido, amiodarone, procainamide
find/treat cause
consider cardioversion
consider adenosine
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18
Q

which VTACH w/pulse should you consider adenosine to diagnose?

A

monomorphic VTACH when you cant tell if it is SVT or VTACH

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19
Q

algorithm for vtach with pulse poor perfusion

A 
prompt sync cardiovert
consider all VTACH w/good perfusion treatments
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20
Q

algorithm for vfib/pulseless vtach

A 
CPR
shock 2J/kg
CPR 2 min
reanalyze/check pulse
shock 4J/kg
cpr 2 min 
reanalze/check pulse
consider epi 10mcg/kg after 2 shock
consider antiarrhythmic after 3 shock
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21
Q

torsades special therapy

A

magnesium after 3 shock

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22
Q

algorithm for asystole/PEA

A

CPR 2 min
epi (ASAP)
consider advanced airway/H&Ts

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23
Q

what are the 4 types of airway scenarios

A

lower airway obst
upper airway obst
lung tissue disease
disordered control breathing

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24
Q

treatment for lower airway obstruction

A

supplemental o2
nebulized bronchodilator
airway suctioning
consider labs and diagnostics

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25
Q

asthma mild to moderate treatment

A

nebulized bronchodilator
corticosteriods
consider humidified o2

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26
Q

asthma moderate to severe treatment

A

subcut epi
subq terbutaline
consider magnesium, bipap, intubation

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27
Q

croup treatment

A

steroids
nebulized epi
humidified o2 and heliox
consider intubation

28
Q

ETT size for croup pts

A

1/2 size smaller to minimize injury

29
Q

anaphylaxis treatment

A

same as asthma and add:
20mL/kg crystalloid
histamine blocker (benadryl or pepcid)

30
Q

if a choking pt becomes unconscious what should you do?

???

A

immediately start CPR even if they have pulse

31
Q

treatment for infectious, chemical, and aspiration pneumonia

???

A 
diagnostic test
administer o2 and abx
obtain consult
support ventilation (PEEP,Cpap, intub?)
treat wheezing with nebulizer
reduce metabolic demand by normalizing temp
32
Q

cardiogenic pulmonary edema treatment

A

ventilatory support
consider diuretics/inotropes
consider abx if fever
reduce met demand by treating fever

33
Q

non cardiogenic pulmonary edema (ARDS)

A

bilateral infiltrates due to alveolar capillary membrane injury
no evidence of cardiac cause

can be pulmonary or systemic

34
Q

protocol for lung tissue disease

A 
diagnostic tests
o2
abx
early consult
support ventilation
breathing treatment
treat fever to decr met demand
35
Q

if pt has signs of infection and decr O2 sat, what is first treatment?

A

give abx

36
Q

treatment for disordered control of breathing caused by poisoning or OD

A

o2, support and assist airway
give antidote or poison control
(not if was used to treat seizure)
treat bradycardia
(IF bradycardia present that therapy is prioritized)

37
Q

treatment for disordered control of breathing caused by increased ICP

A

avoid hypoxemia, hypercardia, hyperthermia
-mild hyperventilation
osmotic agents
neuro consult

38
Q

when can hyperventialtion be considered in incr ICP

A

mild hyperventilation may be considered in first 48 hrs

39
Q

what can happen with too aggressive hyperventilation?

A

cerebral vasoconstriction
decr CO

40
Q

treatment for disordered control of breathing caused by neuromuscular disease

A

support and assist airway with bag mask or intubation

41
Q

therapeutic endpoints for shock management

A

normal vital signs
good signs of perfusion
normal labs

42
Q

treatment for hypovolemic shock

A

o2
fluid bolus
consider blood transfusion
control hemorrhage
start pressors
consider aline/central line

43
Q

treatment of obstructive shock intubated pt

A

DOPE pneumonic then other treatment

44
Q

treatment of obstructive shock tension pneumo

A

needle decomp.
chest tube

chest tube placement

45
Q

treatment of obstructive shock cardiac tamponade

A

pericardiocentesis
20 mL/kg fluid bolus

fluid bolus

46
Q

treatment of obstructive shock pulmonary embolism

A

20 mL/kg fluid bolus
consider thrombolytics and anticoags
expert consult

47
Q

treatment of obstructive shock ductal dependent lesion

A

prostaglandin E1
expert consult

expert consult

48
Q

treatment of septic (distributive) shock

A

M/IV/O
labs
identify type of shock in 10-15min
fluid boluses/vasopressors/abx (in first hr)
correct hypoglycemia and hypocalcemia
start invasive lines
consider stress dose steriods
consider intubation

49
Q

timeline to ID septic/distributive shcok

A

10-15 mins

50
Q

timeline to give abx in septic shock

A

within 1st hr

51
Q

cardiogenic shock treatment

A

M/IV/O
slower fluid bolus (5-10mL/kg)
consider inotropes/diuretic/vasodilator
expert consult

52
Q

TTM in comatose kids after OHCA ROSC

A

avoid fever/mx normothermia for 5 days
or
mx temp of 32-34C for 48hrs + 72 hrs normothermia

53
Q

TTM in comatose kids after IHCA ROSC

A

fever should be treated/avoided

54
Q

ROSC BP managment

A

SBP within 5th percentile for age with fluid boluses

55
Q

bradycardia scenario

A

normal lung sounds
no airway symptoms

56
Q

airway scenarios

A

some airway symptoms
+ bradycardia

57
Q

hypovolemia and cardiogenic shock similarities

A

poor perfusion
hypotension w/cold shock

58
Q

hypovolemic shock differences

A

normal lung sounds

59
Q

cardiogenic shock difference

A

crackles/rales in lower lobs

60
Q

cardiogenic shock and lung tissue disease

A

rales/crackles/pulm edema/grunting
hypoxia/decr SpO2

61
Q

cardiogenic shock difference from lung tissue disease

A

cold shock
- cool skin
- hypotension
- poor perfusion

62
Q

lung tissue difference

A

normal BP
fever

63
Q

septic vs lung tissue

A

fever
hypoxia/decr SpO2

64
Q

septic differences

A

poor perfusion
clear lung sounds
petechiae

65
Q

lung tissue difference from septic

A

normotensive
grunting/rales

Fa: Methods 2 (16 decks)

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