AHA Pediatric Algorithms Flashcards
What criteria to decide if pt is stable vs unstable
*think: kids get SCARS
Shock SS (i.e. no peripheral pulse), CP, AMS, resp distress, sudden collapse
What heart rate is SVT for an infant?
> 220 bpm
What HR = SVT for a child
> 180 bpm
You want to cardiovert a ped pt. What are the steps
- Limb leads + pads
- Sync
- Energy select (0.5-1J/kg)
- Charge
- Hold until cardiovert
- resync after every cardiovert
Ventilation rate infant (no adv airway)
Every 3-5s
Ventilation rate child (no adv airway)
Every 3-5s
Ventilation rate for infant or ped w/ adv airway in place
Every 2-3s w/ continuous compressions
What is the purpose of epi during an arrest?
Optimize perfusion pressure
From the initial onset of CPR on pediatrics. How soon should 1st dose epi be given?
W/ in 5 min
Fluid bolus dose for septic shock pediatric
10-20ml/kg
When to give narcan for a pediatric OD?
When pt has gasping breathings w/ pulse
Where to check pulse on an unresponsive infant?
Brachial
When to begin compressions on an infant arrest?
When HR < 60 w/ shock SS despite O2 & BVM interventions
How deep to compress an infant?
1/3 chest depth or 1.5in @ 100-120 bpm
Infant compression rate for single vs 2 person rescuer
X1 = 30:2
X2 = 15:2 (w/ double thumb technique)
Where to do compressions on an infant?
Use 2 fingers, press just below nipple line.
What separates child vs adults in the eyes of AHA?
Puberty:
Boys = chest/pit hairs
Girls = breasts
Compression depth and ratio for children CPR
2in or 1/3 chest depth
X1 = 30:2
X2 =. 15:2
Where to do compressions on a child during CPR
@ lower half of sternum
What’s the age limit for child AED pads?
child = <8yr
You are alone and come up on a pediatric arrest that was unwitnessed. What do you do?
Shout + 5 cycles CPR, then activate EMS & AED
You are alone and witness a pediatric cardiac arrest. What do you do?
Activate EMS & get AED first. THEN begin CPR
Child is alert and choking. What do you do?
Fist above navel w/ upward thrusts.
Child that was previously choking has now become unresponsive. What do you do?
Activate EMS, begin compression, check for object in airway every time you ventilate
Alert infant is currently choking. What do you do?
5 back slaps + 5 Chest compressions. Hold the head lower that chest.
Previously alert choking infant has now become unresponsive. What do you do?
CPR. Check for object in airway everytime you ventilate. Do 5 cycles then activate EMS
Child has lower LOC, rapid/bad respirations, a lot/no resp effort, low SPO2 & cyanosis. Resp distress or failure?
Respiratory failure
What VS will tell you a respiratory child has impending arrest
Bradycardia
When performing the ABCDE primary assessment on a child. What is included in the D portion?
D = disability: AVPU, pupils, BGL
What is the minimum BGL for neonates vs infants vs kids
Neonate = minimum 45 mg/dL
Infants + kids = minimum 60 mg/dL
What is the proper sequence checking a pulse and defibrillating a cardiac arrest (ped & adult)
15s prior to defibrillating, charge the machine and confirm pulse placement.
Then cease compressions, confirm pulse, analyze rhythm & shock if necessary
What are the 4 types of respiratory emergencies in pediatrics
Upper airway obstruction
Lower airway obstruction
Lung tissue disease
Disordered control of breathing
Sick pediatric is grunting with consistently low SPO2 despite O2. What would you suspect?
Possible pneumonia
What is the minimum air flow rate for a BVM
10L
how long to suction a child vs infant
child = <10s
Infant = <5s
When bagging becomes difficult & airway becomes compromised what mnemonic can you use to trouble shoot?
DOPE
Displacement, obstruction, pneumo, equipment failure
whats a simple trick to remember adult vs child vs infant respiratory rates
20-30-40
Adult = around 12
Child = around 30
Infant = around 40
You notice tracheal tugging on a pediatric respiratory distress. What does that mean?
Tracheal tugging = possible aspiration/obstruction within. Trachea will tug towards the affected side
What are the 4 main groups of shock?
Hypovolemic
Obstructive
Distributive
Cardiogenic
Pediatric pt is in probable sepsis. What main Rx?
Antibiotics asap (wi/in 1st hour), fluids
Pt has possible cardiogenic shock. What Rx?
Fluid bolus of 5-10ml/kg over 10-20min
How to determine normal vs minimum BP in child 1-10 years old
Normal = 90 + (2x age)
Minimum = 70 + (2 x age)
Your pediatric pt is in hypovolemic shock and you are unable to palpate a peripheral pulse. What’s your main concern with obtaining a blood pressure
Auto BP will be inaccurate w/ no distal pulse present
What is a simple way to understand hypotension in pediatrics
0-1m = <60
1m-1yr = <70
> 10 = <90 SBP
What is a simple way to determine ballpark HR in adult vs child vs infant
80-100-120
Adult = 80
Child = 100
Infant = 120
Which types of pediatric pts get fluids
All shock pts get rapid fluids except cardiogenic shock pts. They get a slower & lower dose
What’s the fluid bolus dose and rate for child/infant vs neonate pts
Child/infant = 20mL/kg over 10-20min
Neonates = slower fluid bolus (10-20mL/kg)
You decide to administer fluids on your pediatric shock pt. How would you give them a rapid bolus
Use the push pull method: 3 way stop cock, hooked up to pt, saline bag, & appropriate size syringe
What pneumonic is used to determine hemodynamic instability in children?
SCARS
Shock SS (w/ or w/out hypotension), CP, AMS, resp distress, sudden collapse
What are the main arrhythmias you’d expect to find in children
Sinus bradycardia, AV block, sinus tach, SVT
You’ve just gotten ROSC on a pediatric pt and want to administered fluid bolus
5-10ml/kg over 10-20min
What are two ways to regulate pt temperature after ROSC
Option 1 = 5 days normothermia
Option 2 = 2 days hypothermia then 3 days normothermia
What kind of meds can you push via a pediatric IO?
All meds & fluids. Even dextrose
How can you confirm correct placement of an IO
No swelling w/ infusion. Aspiration is not reliable
Where is the main spot for IO drill on a ped?
Proximal tibia: flat spot medial to tibial tuberosity
What are the contraindications to an IO
- Fx/crush at injury site
- Fragile bones
- previous attempts in same bone
- Infection in overlying tissues
Your pediatric cardiac arrest requires defibrillation. What Joules?
think 2-4-6-8 defibrillate
- 1st = 2-4J/kg
- 2nd = 4 J/kg
- after = 4-10J/kg
What IV location/administration is required for SVT
High access, Rapid IV push followed by flush DT short half life of adenosine
What are some good ways to vagal a child? An infant?
Child = blow on finger or syringe
Infant = ice to the face
What’s the energy dose to cardiovert a child
0.5-1 J/kg
Subsequent shock = 2 J/kg
During a pediatric arrest, what’s the dosage of epi? Max dose?
0.01 mg/kg or 0.1mL/kg of the 0.1mg/ml concentration. MAX dose 1mg
You’re working a cardiac arrest and are unable to get access. How else would you administer epi?
Endotracheal: 0.1mg/kg (0.1mL/kg of 1 mg/mL concentration)
What’s the dose of amiodarone IV/IO for a pediatric cardiac arrest
5mg/kg bolus. Repeat up to 3 total doses for refractory VF/pulseless VT
What’s the dosage of lidocaine IV/IO dose
Initial 1mg/kg loading dose
How is the pediatric cardiac arrest algorithm different vs adult algorithm
Everything is the same except kids in VF/pVT. You can give either amiodarone or lidocaine
What are the main steps of the pediatric bradycardia algorithm
- Rule out SCARS (shock SS, CP, altered, resp distress, sudden collapse
- No scars = monitor
- Yes scars = bag, O2,
- CPR if HR < 60/min
- Epi/Atropine/pacing
What’s the epi dose (ETT & IVP) for a pediatric in bradycardia
IV/IO = 0.01 mg/kg (0.1mL/kg or 0.1mg/mL) every 3-5min
ETT= 0.1mL/kg or 1mg/mL
What’s the atropine IV/IO dose for bradycardia
0.02mg/kg. Repeat only 1 time. Minimum dose 0.1mg and max dose 0.5mg
AHA dictates the cardiac arrest dosage of epi is 0.01mg/kg or 0.1mL/kg of 0.1mg/mL concentration. What does this mean?
If you pull 1mg of 1:10,000 concentration epi into a 10mL syringe w/NS. 1mL of that solution = 0.1mg
What are the basic steps of the pediatric tachycardia algorithm
- MOVAB (monitor, O2, VS, Airway/access, breathing)
- Determine if sinus Tachycardia or SVT
- If SVT rule out SCARS (shock SS, CP, AMS, Resp distress, Sudden collapse)
Your pediatric pt has sinus tachy cardia. What Rx?
Search & treat causes
How to Rx unstable pediatric SVT
- Determine if wide vs narrow (wide >0.09s)
- Wide = cardiovert (possible vtach)
- Narrow = adenosine or cardiovert
In narrow complex, unstable pediatric SVT, when would you use adenosine vs cardioversion
Adenosine = if IV/IO access available
Cardiovert = no access or adenosine ineffective
You determine that your pediatric pt has stable SVT. How do you treat this?
- Determine if wide vs narrow complex (wide >0.09s)
- Narrow = probable SVT = vagal & adenosine if IV/IO
- Wide = possible vTach = adenosine if regular/monomorphic. Call med Ctrl if not.
Run through neonate care algorithm
- Determine APGAR after birth
- Good APGAR = baby to mom
- Bad APGAR = intervene & follow algorithm
How to Rx a neonate w/ bad APGAR
- Bag & SPO2 titrate as necessary
- If HR < 60 despite interventions, CPR & intubate
- If HR still <60, epi. Consider causes (hypovolemia or pneumo)
What is the target SPO2 after birth at the following minute increments: 1-2-3-4-5-10
1 = 60-65%
2 = 65-70%
3= 70-75%
4= 75-80%
5 = 80-85%
10 = 85-95%
What drugs for croup?
Racemic epi & steroids
What drugs for anaphylaxis
Epi, albuterol, antihistamines, steroids
What Rx for ICP
Manage SPO2, temp & ETCO2
What Rx for OD/poisoning in peds
Call poison control
Rx for asthma in peds
Albuterol + Ipratropium, steroids, sub Q epi, mag sulfate, terbutaline
What Rx for Pulmonary edema in peds
Consider PEEP/CPAP
Rx for bronchiolitis
Nasal suctioning, bronchodilator
What Rx for pneumonia in kids
Albuterol, antibiotics, CPAP
What’s the pediatric bolus dose lidocaine? What about the infusion dose
Bolus = 1mg/kg
Infusion = 1mL/kg/hr or 20mcg/kg/min
How to estimate ETT size in ped?
Uncuffed (<8) = (Age/4) +4
Cuffed = (age/4) + 3.5
What classifies as WIDE complex QRS for peds?
When QRS >0.09s
