8. PALS Scenarios Flashcards by Kira Harms

the most common cause of bradycardia in kids

hypoxia and/or respiratory arrest

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

effective ventilation

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when are chest compressions indicated in children?

HR below 60

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primary bradycardia

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

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secondary bradycardia

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

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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

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should you use atropine as a premediation?

no evidence to support routine use of it as premed

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PALS algorithm for bradycardia

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

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SVT rate infants

> 220

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SVT rate children

> 180

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sinus tachy

slower than SVT

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algorithm for sinus tachy stable or unstable

monitors iv o2
find cause
treat cause

search for cause and treat

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algorithm for stable SVT

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

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first dose adenosine

100mcg/kg max 6mg

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second dose adenosine

200mcg/kg max 12mg

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algorithm for unstable SVT

same but cardiovert is #1

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algorithm for vtach with pulse adequate perfusion

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

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

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

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algorithm for vtach with pulse poor perfusion

prompt sync cardiovert
consider all VTACH w/good perfusion treatments

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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

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torsades special therapy

magnesium after 3 shock

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algorithm for asystole/PEA

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

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what are the 4 types of airway scenarios

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

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treatment for lower airway obstruction

supplemental o2
nebulized bronchodilator
airway suctioning
consider labs and diagnostics

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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