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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
asthma mild to moderate treatment
nebulized bronchodilator corticosteriods consider humidified o2
26
asthma moderate to severe treatment
subcut epi subq terbutaline consider magnesium, bipap, intubation
27
croup treatment
steroids nebulized epi humidified o2 and heliox consider intubation
28
ETT size for croup pts
1/2 size smaller to minimize injury
29
anaphylaxis treatment
same as asthma and add: 20mL/kg crystalloid histamine blocker (benadryl or pepcid)
30
if a choking pt becomes unconscious what should you do? ???
immediately start CPR even if they have pulse
31
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 ```
32
cardiogenic pulmonary edema treatment
ventilatory support consider diuretics/inotropes consider abx if fever reduce met demand by treating fever
33
non cardiogenic pulmonary edema (ARDS)
bilateral infiltrates due to alveolar capillary membrane injury no evidence of cardiac cause can be pulmonary or systemic
34
protocol for lung tissue disease
``` diagnostic tests o2 abx early consult support ventilation breathing treatment treat fever to decr met demand ```
35
if pt has signs of infection and decr O2 sat, what is first treatment?
give abx
36
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)
37
treatment for disordered control of breathing caused by increased ICP
avoid hypoxemia, hypercardia, hyperthermia -mild hyperventilation osmotic agents neuro consult
38
when can hyperventialtion be considered in incr ICP
mild hyperventilation may be considered in first 48 hrs
39
what can happen with too aggressive hyperventilation?
cerebral vasoconstriction decr CO
40
treatment for disordered control of breathing caused by neuromuscular disease
support and assist airway with bag mask or intubation
41
therapeutic endpoints for shock management
normal vital signs good signs of perfusion normal labs
42
treatment for hypovolemic shock
o2 fluid bolus consider blood transfusion control hemorrhage start pressors consider aline/central line
43
treatment of obstructive shock intubated pt
DOPE pneumonic then other treatment
44
treatment of obstructive shock tension pneumo
needle decomp. chest tube | chest tube placement
45
treatment of obstructive shock cardiac tamponade
pericardiocentesis 20 mL/kg fluid bolus | fluid bolus
46
treatment of obstructive shock pulmonary embolism
20 mL/kg fluid bolus consider thrombolytics and anticoags expert consult
47
treatment of obstructive shock ductal dependent lesion
prostaglandin E1 expert consult | expert consult
48
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
49
timeline to ID septic/distributive shcok
10-15 mins
50
timeline to give abx in septic shock
within 1st hr
51
cardiogenic shock treatment
M/IV/O slower fluid bolus (5-10mL/kg) consider inotropes/diuretic/vasodilator expert consult
52
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
53
TTM in comatose kids after IHCA ROSC
fever should be treated/avoided
54
ROSC BP managment
SBP within 5th percentile for age with fluid boluses
55
bradycardia scenario
normal lung sounds no airway symptoms
56
airway scenarios
some airway symptoms + bradycardia
57
hypovolemia and cardiogenic shock similarities
poor perfusion hypotension w/cold shock
58
hypovolemic shock differences
normal lung sounds
59
cardiogenic shock difference
crackles/rales in lower lobs
60
cardiogenic shock and lung tissue disease
rales/crackles/pulm edema/grunting hypoxia/decr SpO2
61
cardiogenic shock difference from lung tissue disease
cold shock - cool skin - hypotension - poor perfusion
62
lung tissue difference
normal BP fever
63
septic vs lung tissue
fever hypoxia/decr SpO2
64
septic differences
poor perfusion clear lung sounds petechiae
65
lung tissue difference from septic
normotensive grunting/rales

Fa: Methods 2 (16 decks)

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