8. PALS Scenarios Flashcards
the most common cause of bradycardia in kids
hypoxia and/or respiratory arrest
if there is bradycardia what is the priority over everything else?
effective ventilation
when are chest compressions indicated in children?
HR below 60
primary bradycardia
result of congenital or acquired heart conditions that slow depolarization in the electrical conducting system
secondary bradycardia
any non cardiac condition that slows HR: hypoxia acidosis hypothermia drugs
when is atropine prioritized before epi?
- there is an increase in vagal tone or vagal response is suspected
- cholinergic drug toxicity
- brady is due to AV block
should you use atropine as a premediation?
no evidence to support routine use of it as premed
PALS algorithm for bradycardia
monitors iv o2
support airway
start CPR if HR <60
Other options: epi/atropine/transcut pacing
Consider H&Ts
SVT rate infants
> 220
SVT rate children
> 180
sinus tachy
slower than SVT
algorithm for sinus tachy stable or unstable
monitors iv o2
find cause
treat cause
search for cause and treat
algorithm for stable SVT
monitors iv o2 vagal maneuvers adenosine up to 2 doses SAMPLE expert consult
first dose adenosine
100mcg/kg max 6mg
second dose adenosine
200mcg/kg max 12mg
algorithm for unstable SVT
same but cardiovert is #1
algorithm for vtach with pulse adequate perfusion
M/IV/O expert consult lido, amiodarone, procainamide find/treat cause consider cardioversion consider adenosine
which VTACH w/pulse should you consider adenosine to diagnose?
monomorphic VTACH when you cant tell if it is SVT or VTACH
algorithm for vtach with pulse poor perfusion
prompt sync cardiovert consider all VTACH w/good perfusion treatments
algorithm for vfib/pulseless vtach
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
torsades special therapy
magnesium after 3 shock
algorithm for asystole/PEA
CPR 2 min
epi (ASAP)
consider advanced airway/H&Ts
what are the 4 types of airway scenarios
lower airway obst
upper airway obst
lung tissue disease
disordered control breathing
treatment for lower airway obstruction
supplemental o2
nebulized bronchodilator
airway suctioning
consider labs and diagnostics
asthma mild to moderate treatment
nebulized bronchodilator
corticosteriods
consider humidified o2
asthma moderate to severe treatment
subcut epi
subq terbutaline
consider magnesium, bipap, intubation
croup treatment
steroids
nebulized epi
humidified o2 and heliox
consider intubation
ETT size for croup pts
1/2 size smaller to minimize injury
anaphylaxis treatment
same as asthma and add:
20mL/kg crystalloid
histamine blocker (benadryl or pepcid)
if a choking pt becomes unconscious what should you do?
???
immediately start CPR even if they have pulse
treatment for infectious, chemical, and aspiration pneumonia
???
diagnostic test administer o2 and abx obtain consult support ventilation (PEEP,Cpap, intub?) treat wheezing with nebulizer reduce metabolic demand by normalizing temp
cardiogenic pulmonary edema treatment
ventilatory support
consider diuretics/inotropes
consider abx if fever
reduce met demand by treating fever
non cardiogenic pulmonary edema (ARDS)
bilateral infiltrates due to alveolar capillary membrane injury
no evidence of cardiac cause
can be pulmonary or systemic
protocol for lung tissue disease
diagnostic tests o2 abx early consult support ventilation breathing treatment treat fever to decr met demand
if pt has signs of infection and decr O2 sat, what is first treatment?
give abx
treatment for disordered control of breathing caused by poisoning or OD
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)
treatment for disordered control of breathing caused by increased ICP
avoid hypoxemia, hypercardia, hyperthermia
-mild hyperventilation
osmotic agents
neuro consult
when can hyperventialtion be considered in incr ICP
mild hyperventilation may be considered in first 48 hrs
what can happen with too aggressive hyperventilation?
cerebral vasoconstriction
decr CO
treatment for disordered control of breathing caused by neuromuscular disease
support and assist airway with bag mask or intubation
therapeutic endpoints for shock management
normal vital signs
good signs of perfusion
normal labs
treatment for hypovolemic shock
o2
fluid bolus
consider blood transfusion
control hemorrhage
start pressors
consider aline/central line
treatment of obstructive shock intubated pt
DOPE pneumonic then other treatment
treatment of obstructive shock tension pneumo
needle decomp.
chest tube
chest tube placement
treatment of obstructive shock cardiac tamponade
pericardiocentesis
20 mL/kg fluid bolus
fluid bolus
treatment of obstructive shock pulmonary embolism
20 mL/kg fluid bolus
consider thrombolytics and anticoags
expert consult
treatment of obstructive shock ductal dependent lesion
prostaglandin E1
expert consult
expert consult
treatment of septic (distributive) shock
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
timeline to ID septic/distributive shcok
10-15 mins
timeline to give abx in septic shock
within 1st hr
cardiogenic shock treatment
M/IV/O
slower fluid bolus (5-10mL/kg)
consider inotropes/diuretic/vasodilator
expert consult
TTM in comatose kids after OHCA ROSC
avoid fever/mx normothermia for 5 days
or
mx temp of 32-34C for 48hrs + 72 hrs normothermia
TTM in comatose kids after IHCA ROSC
fever should be treated/avoided
ROSC BP managment
SBP within 5th percentile for age with fluid boluses
bradycardia scenario
normal lung sounds
no airway symptoms
airway scenarios
some airway symptoms
+ bradycardia
hypovolemia and cardiogenic shock similarities
poor perfusion
hypotension w/cold shock
hypovolemic shock differences
normal lung sounds
cardiogenic shock difference
crackles/rales in lower lobs
cardiogenic shock and lung tissue disease
rales/crackles/pulm edema/grunting
hypoxia/decr SpO2
cardiogenic shock difference from lung tissue disease
cold shock
- cool skin
- hypotension
- poor perfusion
lung tissue difference
normal BP
fever
septic vs lung tissue
fever
hypoxia/decr SpO2
septic differences
poor perfusion
clear lung sounds
petechiae
lung tissue difference from septic
normotensive
grunting/rales
