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CFD Paramedic Course > AHA Pediatric Algorithms > Flashcards

AHA Pediatric Algorithms Flashcards

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1
Q

What criteria to decide if pt is stable vs unstable

A

*think: kids get SCARS

Shock SS (i.e. no peripheral pulse), CP, AMS, resp distress, sudden collapse

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2
Q

What heart rate is SVT for an infant?

A

> 220 bpm

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3
Q

What HR = SVT for a child

A

> 180 bpm

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4
Q

You want to cardiovert a ped pt. What are the steps

A
  1. Limb leads + pads
  2. Sync
  3. Energy select (0.5-1J/kg)
  4. Charge
  5. Hold until cardiovert
  • resync after every cardiovert
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5
Q

Ventilation rate infant (no adv airway)

A

Every 3-5s

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6
Q

Ventilation rate child (no adv airway)

A

Every 3-5s

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7
Q

Ventilation rate for infant or ped w/ adv airway in place

A

Every 2-3s w/ continuous compressions

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8
Q

What is the purpose of epi during an arrest?

A

Optimize perfusion pressure

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9
Q

From the initial onset of CPR on pediatrics. How soon should 1st dose epi be given?

A

W/ in 5 min

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10
Q

Fluid bolus dose for septic shock pediatric

A

10-20ml/kg

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11
Q

When to give narcan for a pediatric OD?

A

When pt has gasping breathings w/ pulse

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12
Q

Where to check pulse on an unresponsive infant?

A

Brachial

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13
Q

When to begin compressions on an infant arrest?

A

When HR < 60 w/ shock SS despite O2 & BVM interventions

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14
Q

How deep to compress an infant?

A

1/3 chest depth or 1.5in @ 100-120 bpm

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15
Q

Infant compression rate for single vs 2 person rescuer

A

X1 = 30:2

X2 = 15:2 (w/ double thumb technique)

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16
Q

Where to do compressions on an infant?

A

Use 2 fingers, press just below nipple line.

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17
Q

What separates child vs adults in the eyes of AHA?

A

Puberty:

Boys = chest/pit hairs

Girls = breasts

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18
Q

Compression depth and ratio for children CPR

A

2in or 1/3 chest depth

X1 = 30:2
X2 =. 15:2

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19
Q

Where to do compressions on a child during CPR

A

@ lower half of sternum

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20
Q

What’s the age limit for child AED pads?

A

child = <8yr

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21
Q

You are alone and come up on a pediatric arrest that was unwitnessed. What do you do?

A

Shout + 5 cycles CPR, then activate EMS & AED

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22
Q

You are alone and witness a pediatric cardiac arrest. What do you do?

A

Activate EMS & get AED first. THEN begin CPR

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23
Q

Child is alert and choking. What do you do?

A

Fist above navel w/ upward thrusts.

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24
Q

Child that was previously choking has now become unresponsive. What do you do?

A

Activate EMS, begin compression, check for object in airway every time you ventilate

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25
Q

Alert infant is currently choking. What do you do?

A

5 back slaps + 5 Chest compressions. Hold the head lower that chest.

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26
Q

Previously alert choking infant has now become unresponsive. What do you do?

A

CPR. Check for object in airway everytime you ventilate. Do 5 cycles then activate EMS

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27
Q

Child has lower LOC, rapid/bad respirations, a lot/no resp effort, low SPO2 & cyanosis. Resp distress or failure?

A

Respiratory failure

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28
Q

What VS will tell you a respiratory child has impending arrest

A

Bradycardia

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29
Q

When performing the ABCDE primary assessment on a child. What is included in the D portion?

A

D = disability: AVPU, pupils, BGL

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30
Q

What is the minimum BGL for neonates vs infants vs kids

A

Neonate = minimum 45 mg/dL

Infants + kids = minimum 60 mg/dL

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31
Q

What is the proper sequence checking a pulse and defibrillating a cardiac arrest (ped & adult)

A

15s prior to defibrillating, charge the machine and confirm pulse placement.

Then cease compressions, confirm pulse, analyze rhythm & shock if necessary

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32
Q

What are the 4 types of respiratory emergencies in pediatrics

A

Upper airway obstruction

Lower airway obstruction

Lung tissue disease

Disordered control of breathing

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33
Q

Sick pediatric is grunting with consistently low SPO2 despite O2. What would you suspect?

A

Possible pneumonia

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34
Q

What is the minimum air flow rate for a BVM

A

10L

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35
Q

how long to suction a child vs infant

A

child = <10s

Infant = <5s

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36
Q

When bagging becomes difficult & airway becomes compromised what mnemonic can you use to trouble shoot?

A

DOPE

Displacement, obstruction, pneumo, equipment failure

37
Q

whats a simple trick to remember adult vs child vs infant respiratory rates

A

20-30-40

Adult = around 12

Child = around 30

Infant = around 40

38
Q

You notice tracheal tugging on a pediatric respiratory distress. What does that mean?

A

Tracheal tugging = possible aspiration/obstruction within. Trachea will tug towards the affected side

39
Q

What are the 4 main groups of shock?

A

Hypovolemic

Obstructive

Distributive

Cardiogenic

40
Q

Pediatric pt is in probable sepsis. What main Rx?

A

Antibiotics asap (wi/in 1st hour), fluids

41
Q

Pt has possible cardiogenic shock. What Rx?

A

Fluid bolus of 5-10ml/kg over 10-20min

42
Q

How to determine normal vs minimum BP in child 1-10 years old

A

Normal = 90 + (2x age)

Minimum = 70 + (2 x age)

43
Q

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

A

Auto BP will be inaccurate w/ no distal pulse present

44
Q

What is a simple way to understand hypotension in pediatrics

A

0-1m = <60

1m-1yr = <70

> 10 = <90 SBP

45
Q

What is a simple way to determine ballpark HR in adult vs child vs infant

A

80-100-120

Adult = 80

Child = 100

Infant = 120

46
Q

Which types of pediatric pts get fluids

A

All shock pts get rapid fluids except cardiogenic shock pts. They get a slower & lower dose

47
Q

What’s the fluid bolus dose and rate for child/infant vs neonate pts

A

Child/infant = 20mL/kg over 10-20min

Neonates = slower fluid bolus (10-20mL/kg)

48
Q

You decide to administer fluids on your pediatric shock pt. How would you give them a rapid bolus

A

Use the push pull method: 3 way stop cock, hooked up to pt, saline bag, & appropriate size syringe

49
Q

What pneumonic is used to determine hemodynamic instability in children?

A

SCARS

Shock SS (w/ or w/out hypotension), CP, AMS, resp distress, sudden collapse

50
Q

What are the main arrhythmias you’d expect to find in children

A

Sinus bradycardia, AV block, sinus tach, SVT

51
Q

You’ve just gotten ROSC on a pediatric pt and want to administered fluid bolus

A

5-10ml/kg over 10-20min

52
Q

What are two ways to regulate pt temperature after ROSC

A

Option 1 = 5 days normothermia

Option 2 = 2 days hypothermia then 3 days normothermia

53
Q

What kind of meds can you push via a pediatric IO?

A

All meds & fluids. Even dextrose

54
Q

How can you confirm correct placement of an IO

A

No swelling w/ infusion. Aspiration is not reliable

55
Q

Where is the main spot for IO drill on a ped?

A

Proximal tibia: flat spot medial to tibial tuberosity

56
Q

What are the contraindications to an IO

A
  • Fx/crush at injury site
  • Fragile bones
  • previous attempts in same bone
  • Infection in overlying tissues
57
Q

Your pediatric cardiac arrest requires defibrillation. What Joules?

A

think 2-4-6-8 defibrillate

  • 1st = 2-4J/kg
  • 2nd = 4 J/kg
  • after = 4-10J/kg
58
Q

What IV location/administration is required for SVT

A

High access, Rapid IV push followed by flush DT short half life of adenosine

59
Q

What are some good ways to vagal a child? An infant?

A

Child = blow on finger or syringe

Infant = ice to the face

60
Q

What’s the energy dose to cardiovert a child

A

0.5-1 J/kg

Subsequent shock = 2 J/kg

61
Q

During a pediatric arrest, what’s the dosage of epi? Max dose?

A

0.01 mg/kg or 0.1mL/kg of the 0.1mg/ml concentration. MAX dose 1mg

62
Q

You’re working a cardiac arrest and are unable to get access. How else would you administer epi?

A

Endotracheal: 0.1mg/kg (0.1mL/kg of 1 mg/mL concentration)

63
Q

What’s the dose of amiodarone IV/IO for a pediatric cardiac arrest

A

5mg/kg bolus. Repeat up to 3 total doses for refractory VF/pulseless VT

64
Q

What’s the dosage of lidocaine IV/IO dose

A

Initial 1mg/kg loading dose

65
Q

How is the pediatric cardiac arrest algorithm different vs adult algorithm

A

Everything is the same except kids in VF/pVT. You can give either amiodarone or lidocaine

66
Q

What are the main steps of the pediatric bradycardia algorithm

A
  1. Rule out SCARS (shock SS, CP, altered, resp distress, sudden collapse
  2. No scars = monitor
  3. Yes scars = bag, O2,
  4. CPR if HR < 60/min
  5. Epi/Atropine/pacing
67
Q

What’s the epi dose (ETT & IVP) for a pediatric in bradycardia

A

IV/IO = 0.01 mg/kg (0.1mL/kg or 0.1mg/mL) every 3-5min

ETT= 0.1mL/kg or 1mg/mL

68
Q

What’s the atropine IV/IO dose for bradycardia

A

0.02mg/kg. Repeat only 1 time. Minimum dose 0.1mg and max dose 0.5mg

69
Q

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?

A

If you pull 1mg of 1:10,000 concentration epi into a 10mL syringe w/NS. 1mL of that solution = 0.1mg

70
Q

What are the basic steps of the pediatric tachycardia algorithm

A
  1. MOVAB (monitor, O2, VS, Airway/access, breathing)
  2. Determine if sinus Tachycardia or SVT
  3. If SVT rule out SCARS (shock SS, CP, AMS, Resp distress, Sudden collapse)
71
Q

Your pediatric pt has sinus tachy cardia. What Rx?

A

Search & treat causes

72
Q

How to Rx unstable pediatric SVT

A
  1. Determine if wide vs narrow (wide >0.09s)
  2. Wide = cardiovert (possible vtach)
  3. Narrow = adenosine or cardiovert
73
Q

In narrow complex, unstable pediatric SVT, when would you use adenosine vs cardioversion

A

Adenosine = if IV/IO access available

Cardiovert = no access or adenosine ineffective

74
Q

You determine that your pediatric pt has stable SVT. How do you treat this?

A
  1. Determine if wide vs narrow complex (wide >0.09s)
  2. Narrow = probable SVT = vagal & adenosine if IV/IO
  3. Wide = possible vTach = adenosine if regular/monomorphic. Call med Ctrl if not.
75
Q

Run through neonate care algorithm

A
  1. Determine APGAR after birth
  2. Good APGAR = baby to mom
  3. Bad APGAR = intervene & follow algorithm
76
Q

How to Rx a neonate w/ bad APGAR

A
  1. Bag & SPO2 titrate as necessary
  2. If HR < 60 despite interventions, CPR & intubate
  3. If HR still <60, epi. Consider causes (hypovolemia or pneumo)
77
Q

What is the target SPO2 after birth at the following minute increments: 1-2-3-4-5-10

A

1 = 60-65%

2 = 65-70%

3= 70-75%

4= 75-80%

5 = 80-85%

10 = 85-95%

78
Q

What drugs for croup?

A

Racemic epi & steroids

79
Q

What drugs for anaphylaxis

A

Epi, albuterol, antihistamines, steroids

80
Q

What Rx for ICP

A

Manage SPO2, temp & ETCO2

81
Q

What Rx for OD/poisoning in peds

A

Call poison control

82
Q

Rx for asthma in peds

A

Albuterol + Ipratropium, steroids, sub Q epi, mag sulfate, terbutaline

83
Q

What Rx for Pulmonary edema in peds

A

Consider PEEP/CPAP

84
Q

Rx for bronchiolitis

A

Nasal suctioning, bronchodilator

85
Q

What Rx for pneumonia in kids

A

Albuterol, antibiotics, CPAP

86
Q

What’s the pediatric bolus dose lidocaine? What about the infusion dose

A

Bolus = 1mg/kg

Infusion = 1mL/kg/hr or 20mcg/kg/min

87
Q

How to estimate ETT size in ped?

A

Uncuffed (<8) = (Age/4) +4

Cuffed = (age/4) + 3.5

88
Q

What classifies as WIDE complex QRS for peds?

A

When QRS >0.09s

CFD Paramedic Course (12 decks)

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