9) PALS Flashcards
What are the characteristics of Croup?
Slow onset, prefers sitting up, barking cough, no drooling, fever 101-102°F, viral
What are the characteristics of Epiglottitis?
Rapid onset, prefers sitting up/tripod position, no barking cough, drooling, fever 102-104°F, bacterial
What is the treatment for Croup?
Primary assessment, Saline neb, Epi neb, Corticosteroids (Dexamethasone, Solu-Medrol), Advanced airway
What is the treatment for Epiglottitis?
Primary assessment, Position of comfort, Avoid agitation, Nothing in mouth, Saline neb/blow-by, Transport ASAP, ET tube as last resort
What is the dosing for nebulized Racemic Epinephrine?
Racemic Epi 2.25%: 0.5 mL + 4 mL NS
What is the dosing for nebulized Epi 1:1,000?
Epi 1:1,000: 1 mL + 4 mL NS
What is the dosing for nebulized Epi 1:10,000?
Epi 1:10,000: 5 mL (no dilution)
What are the signs of Respiratory Distress?
Maintainable airway, tachypnea, good air movement, tachycardia, pallor, anxiety/agitation
What are the signs of Respiratory Failure?
Not maintainable, bradypnea/apnea, poor/absent air movement, bradycardia, cyanosis, lethargy/unresponsive
What is the pathophysiology of Bronchiolitis/Asthma?
Bronchoconstriction, inflammation, mucus production
What lung sounds are associated with Bronchiolitis/Asthma?
Wheezing
What is the treatment for Bronchiolitis/Asthma?
Albuterol/Atrovent neb, Epi 1:1,000, Dexamethasone
What is the difference between Compensated and Decompensated Shock?
Compensated Shock: Possibly hours until progression; Decompensated Shock: Minutes until progression
What are the types of Shock?
Distributive: Anaphylaxis, septic, neurogenic; Hypovolemic: Hemorrhagic, nonhemorrhagic; Obstructive: Tension pneumo, cardiac tamponade, PE; Cardiogenic: Congenital heart defects, myocarditis, arrhythmias
What are the systolic BP hypotension thresholds for term neonates?
Term neonates: <60 mmHg
What are the systolic BP hypotension thresholds for infants (1mo-1yr)?
Infants (1mo-1yr): <70 mmHg
What are the systolic BP hypotension thresholds for children (1-10yrs)?
Children (1-10yrs): <70 + (2 × age) mmHg
What are the systolic BP hypotension thresholds for children (>10yrs)?
Children (>10yrs): <90 mmHg
What is the treatment for Shock?
IV/IO therapy + fluid bolus (20 mL/kg IV/IO push); Monitor V/S + lung sounds after each bolus
What are the common causes and signs of Tension Pneumothorax?
Common Cause: Trauma; S/S: JVD, tracheal deviation, absent breath sounds, hypotension
What is the treatment for Tension Pneumothorax?
Needle decompression
18G over 3 rd rib
Where is the needle placement for Tension Pneumothorax?
2nd ICS MCL or 5th ICS AAL
What is the needle size for Tension Pneumothorax?
14-18g
What is the initial treatment for seizures?
Protect airway, O2/suction; IV/IO, check glucose
What are the dosages for Benzodiazepines in seizure treatment?
Midazolam: 0.1 mg/kg (max single dose 5 mg); Diazepam: 0.1 mg/kg (max single dose 5 mg); Lorazepam: 0.05-0.1 mg/kg (max single dose 4 mg)
What is the first medication for Pediatric Bradycardia?
Epinephrine (0.01 mg/kg IV/IO)
What is the medication for increased vagal tone in Pediatric Bradycardia?
Atropine (0.02 mg/kg, min 0.1 mg)
What is the first treatment for Unstable SVT in Pediatric Tachycardia?
Adenosine; 1st dose: 0.1 mg/kg (max 6 mg RIVP); 2nd dose: 0.2 mg/kg (max 12 mg RIVP)
What is the treatment for Unstable VT in Pediatric Tachycardia?
Cardioversion; 1st shock: 0.5-1 J/kg; If ineffective: 2 J/kg
What is the first medication for Pediatric Cardiac Arrest?
Epinephrine (0.01 mg/kg IV/IO)
What are the reversible causes in Pediatric Cardiac Arrest (H’s & T’s)?
Hypoxia, hypovolemia, hypoglycemia, acidosis, hypo/hyperkalemia; Tension pneumo, tamponade, toxins, thrombosis (PE/MI)
What are the defibrillation dosages for Pediatric Cardiac Arrest?
1st shock: 2 J/kg; 2nd shock: 4 J/kg; Subsequent: Up to 10 J/kg
IV Fluid Boluses for Hypovolemia/Distributive Shock
20 mL/kg over 5-10 min
IV Fluid Boluses for Cardiogenic Shock
5-10 mL/kg over 10-20 min
IV Fluid Boluses for Poisoning (CCB/BB)
5-10 mL/kg over 10-20 min
IV Fluid Boluses for DKA (Compensated Shock)
10-20 mL/kg over 60-120 min
Categories of Congenital Heart Defects
Increased pulmonary blood flow, Decreased pulmonary blood flow, Obstructed blood flow
Causes of Altered Mental Status (AMS)
Alcohol, Epilepsy, Insulin, Opiates, Uremia, Trauma, Temp, Infection, Poisoning, Psychogenic, Shock, Stroke, Seizure
AEIOU-TTIPPSSS
Seizures in Infants
Abnormal gaze, sucking, “bicycling” motions
Seizures in Older Children
Repetitive muscle contractions, unresponsiveness
1st Line Meds for Pediatric Tachycardia - Adenosine
0.1 mg/kg RIVP (max 6 mg), rapid flush; 0.2 mg/kg RIVP (max 12 mg), rapid flush
Amiodarone for Pediatric Tachycardia - Life-Threatening Ventricular Arrhythmia Treatment
5 mg/kg IV/IO over 20-60 min (max single dose 300 mg); Can repeat up to 15 mg/kg (max 2.2 g in adolescents) per 24 hrs
Lidocaine for Pediatric Tachycardia - Life-Threatening Ventricular Arrhythmia Treatment
1 mg/kg IV/IO; Refractory VT: Additional 0.5 mg/kg (max 3 mg/kg); Maintenance: 20-50 mcg/kg/min
Treatment Steps for Pediatric Cardiac Arrest
CPR, Epi, consider defibrillation (based on rhythm)
What are the indications for nebulized epinephrine?
Used for croup to reduce airway swelling. Monitor for rebound effect after treatment.
What are the signs of mild respiratory distress?
Increased work of breathing, normal mentation.
What are the signs of moderate respiratory distress?
Retractions, grunting, nasal flaring, anxiety.
What are the signs of severe respiratory distress/failure?
Cyanosis, decreased LOC, bradypnea, apnea.
What is the pathophysiology of asthma?
Bronchoconstriction, inflammation, mucus plugging.
What is the pathophysiology of bronchiolitis?
Viral infection (usually RSV), causes inflammation of bronchioles.
What are additional signs and symptoms of anaphylaxis?
Stridor, urticaria, angioedema, hypotension. Late sign: Shock with profound hypotension.
What is the fluid resuscitation protocol in pediatric shock?
If no response to 20 mL/kg bolus, repeat up to 60 mL/kg. Exceptions: Cardiogenic shock (start with 5-10 mL/kg).
What is the formula for neonatal BP monitoring?
Formula: <70 + (2 × Age in years) mmHg = hypotensive. Neonates (<1mo): Hypotension at <60 mmHg.
What is the cardioversion dose for SVT in pediatrics?
0.5-1 J/kg.
What is the cardioversion dose for unstable VT in pediatrics?
2 J/kg.
What are the treatment steps for pediatric bradycardia?
Oxygenation first (hypoxia = common cause). Epinephrine (0.01 mg/kg IV/IO q3-5 min). Atropine (0.02 mg/kg IV/IO, min 0.1 mg) (only if vagal origin). Pacing if refractory.
What are the H’s in H’s & T’s (PALS Focused)?
Hypoxia, Hypovolemia, Hypothermia, Hypoglycemia, Hydrogen ion (acidosis), Hypo/Hyperkalemia.
What are the T’s in H’s & T’s (PALS Focused)?
Tension pneumothorax, Tamponade, Toxins, Thrombosis (PE/MI), Trauma.
What is the pediatric defibrillation dosing for the first shock?
2 J/kg.
What is the pediatric defibrillation dosing for the second shock?
4 J/kg.
What is the maximum dose for pediatric defibrillation?
10 J/kg.
