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Interventions 2 (RESP 319) > Mod 8 PALS > Flashcards

Mod 8 PALS Flashcards

1
Q

What should you assess for airway?

A

Patency

  • Can it be kept open manually?
  • Does it require a advanced airway?
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2
Q

What should you assess for breathing?

A
  • Is too fast or slow?
  • Increased resp. effort (WOB)?
  • Does it require an advanced airway?
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3
Q

Review slide 4 (circulation) and 5 (disability) assessment normals

A
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4
Q

What should you consider on your initial assessment when assessing elements of exposure?

A

When the patient has last experienced trauma. Check for:

  • Trauma
  • Burns
  • Fractures
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5
Q

How do you assess a pediatrics exposure to general trauma?

A
  • Skin temperature and color
  • Petechiae (pinpoint spots that look like bruising/rash)
  • Bruising
  • Internal body temp
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6
Q

What is your secondary assessment for pediatrics?

  • when do you perform it?
A

SPAM, performed when the patient is verified to not be in a life threatening condition.

  • Signs and symptoms
  • Past med history
  • Allergies
  • Medications
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7
Q

What are causes of respiratory failure in the upper airways for pediatrics?

A

Croup (swelling)

  • Foreign
  • Retropharyngeal abscess
  • Anaphylaxis
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8
Q

What are causes of respiratory failure in the lower airways for pediatrics?

A

Bronchiolitis and Asthma

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9
Q

What are causes of respiratory failure that are associated with Lung Tissue Disease for pediatrics?

A
  • Pneumonia
  • Pneumonitis
  • Pulmonary edema
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10
Q

What are causes of respiratory failure when involved with CNS issues for pediatrics?

A

Overdose and Head trauma

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11
Q

What are initial treatments for respiratory failure/distress when airways are suspected to be the cause?

A
  • Open and support airway
  • Suction
  • Consider advanced airway
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12
Q

What are the initial treatments for respiratory failure/distress for when considering breathing?

A
  • Monitor O2 sats
  • Supplemental O2
  • Nebulizers
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13
Q

What are the initial treatments for respiratory failure/distress for when circulation problems are suspected?

A

Monitor vitals and establish vascular access

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14
Q

What are treatments for Croup?

A
  • Dexamethasone
  • Oxygen (heliox)
  • Nebulized Epi
  • Intubate/Trachestomy
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15
Q

What are treatments for Foreign bodies in the airways?

A
  • Dexmethasone
  • Oxygen (Heliox)
  • Nebulized Epi
  • Intubate/Tracheotomy
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16
Q

What are treatments for Anaphylaxis?

A

Epinephrine IM

  • Nebulizers
  • Diphenhydramine
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17
Q

What are treatments for Bronchiolitis?

A

Suction and nebulizers. New Tx’s involve a less is more approach

  • Antibiotics can be given but are more supportive of cold symptoms that present with Bronchiolitis
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18
Q

What are Treatments for Pneumonia?

A
  • Dexmethasone
  • Oxygen (heliox)
  • Nebulized Epi
  • Intubate/Tracheostomy
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19
Q

What are treatments for Pneumonitis?

A

Antibiotics (if bacterial)

  • support breathing
  • Nebulizers
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20
Q

What are treatments for Pulmonary Edema?

A
  • Diuretics
  • Inotrope
  • Support breathing
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21
Q

What are treatments for overdose in children?

A
  • Nalaxone
  • Antidotes
  • Support Breathing
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22
Q

Teatments for Trauma in Pediatrics?

A
  • Neurosurgery
  • Reduce ICP
  • Support breathing
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23
Q

How can you reduce ICP? (6)

A
  • 30-45 degree head to bed (venous drainage)
  • Prevent hypoxia and hypotension by managing ventilation and O2 levels (hyperventilation)
  • Permissive hypothermia
  • Reduce metabolic demand on brain w/sedation and analgesia
  • CSF drainage via ventricular drain (EVD)
  • Increase MAP (maintain CPP)
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24
Q

What is Shock?

A

When peripheral tissues and organs do not get adequate O2 and nutrients.

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25
Q

What is Cardiogenic shock?

  • markers?
A

Heart is not pumping adequately

  • Contractility issues
  • Accompanied by increased WOB
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26
Q

What is Distributive Shock?

A

Blood vessel dilation

  • septic shock
  • Neurological shock
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27
Q

What is Hypovolemic Shock?

A

Low blood volume to cardiovascular system

  • due to hemorrhage or fluid shifting out of vasculature
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28
Q

What is obstructive shock?

A

Physical block of blood flow

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29
Q

Need to add more on slides 13-15 and need to review/add everything form 23 forward

A
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30
Q

What dosage of Atropine should be given to a kid < 5Kgs?

A

0.1mg (min dosage)

31
Q

what is the max dosage dose of Atropine given to a kid > 25kg?

32
Q

What are signs of a sinus tachycardia on a ECG?

A
  • Infants < 220bpm
  • Child < 180bpm
  • Slow onset of increased HR
  • Fever/Hypovolemia
  • Rate varies w/stim
  • Visible P waves
33
Q

How do you differentiate a developing SVT from sinus tachycardia?

A

HR will rapidly increase to 180 and beyond.

  • The P-waves will disappear
34
Q

What are signs of SVT on a ECG?

A
  • Infant HR > 220bpm
  • Child HR > 180
  • Abrupt start/stop
  • pulmonary edemas
  • Constant, fast rate
  • Absent P waves
35
Q

How can SVT lead to pulmonary edema?

  • What is the snowball affect?
A

The heart may not have enough time to fill adequately during diastole

  • Increase ventricular load and decreased diastolic time
  • Causes the heart’s stroke volume can be reduced, leading to a lower cardiac output.
  • Blood can pool in the alvoelar sacs, impairing O2 exchange = pink frothy secretions
36
Q

What QRS is considered too long?

A

QRS wider than 0.12 secs

37
Q

When do you use adenosine?

A

Tachycardias, you usually don’t use more than 2 doses (max dose)

38
Q

What are the shock energies used for Cardiac Arrest?

A
  • First shock: 2J/Kg
  • Second shock: 4J/Kg
  • Subsequent shocks: >4J/Kg
  • Max dose: 10J/Kg
39
Q

What is the dosage and frequency for Epi used for cardiac arrest if given by IV/IO?

A

0.01mg/kg repeated every 3-5 mins

40
Q

What is the dosage and frequency for Epi used for cardiac arrest if given by ETT?

41
Q

What is the dosage and frequency for Amiodarone used for cardiac arrest if given by IV/IO?

A

5mg/kg, but only up to 2 times.

42
Q

What shock energy pathway should you follow?

A

2,4,10 J/kg

  • You don’t want to to waste critical time shocking inefficiently.
  • AKA go big or go home after that point.
43
Q

What are the H’s and T’s of Cardiac Arrest?

A

Reversible causes of cardiac arrest

44
Q

What is the dosage and frequency that Atropine can be given IV/IO?

A

Min 0.1mg and Max 0.5 mg

  • may be repeated once q5mins
45
Q

What drugs are given for a bradycardia?

A

Amiodarine and one other (add later)

46
Q

What drugs are given for tachycardias?

A

Atropine and Epi

47
Q

What drugs are given for Ventricular tachy?

A

none, cardiovert

48
Q

How is Cardiogenic Shock distinguished from Hypovolemic shock?

A

Cardiogenic shock is usually accompanied by increased WOB

  • body attempts to raise HR and SV by pumping more blood.

Hypovolemia = less volume, which means that the hearts ability to pump is not affected. So rate may increase at some point, but WOB won’t occur as there is no extra effort to pump blood.

49
Q

What is Obstructive Shock?

A

Inadequate contractility of the heart BECAUSE of external forces preventing the heart from contracting

50
Q

What are some pathologies that may cause Obstructive Shock?

A
  • Cardiac tamponade
  • Tension pneumothorax
51
Q

What are potential causes of Hypovolemic Shock?

A
  • Hemorrhage
  • Water loss (dehydration) due to diarrhea or vomiting (third spacing)
52
Q

Why is Hypovolemic shock problematic?

  • Snowball affect?
A

Decreased blood = decreased preload to the heart which causes low blood pressure

  • Afterload will increase because vasoconstriction is stimulated in order to maintain adequate blood pressure.
53
Q

What are signs of Hypovolemic shock?

A
  • Possible tachypnea
  • Tachycardia
  • Adequate or Low Blood Pressure
  • Narrow pulse pressure
  • Slow capillary refill
  • Weak peripheral pulses w/normal central pulses
  • Decrease urine output
  • Decreased LOC
54
Q

What is the pathophysiology of Distributive Shock?

A

Blood inappropriately distributed in the vasculature

  • vasculature has relaxed and dilated to the point of inadequate BP
55
Q

What are 3 types of Distributive Shock?

A
  1. Septic Shock
  2. Anaphylactic Shock
  3. Neurogenic Shock
56
Q

How are preload, contractility, afterload in Septic Shock?

A
  1. Decreased preload
  2. Normal/decreased contractility
  3. Afterload varies
57
Q

How are preload, contractility, afterload in Anaphylactic Shock?

A
  1. Decreased preload
  2. Contractility varies
  3. Afterload is low in left ventricle and high right ventricle
58
Q

How are preload, contractility, afterload in Neurogenic Shock?

A
  1. Decreased preload
  2. Normal contractility
  3. Afterload is decreased
59
Q

What are treatments for Hypovolemic shock?

A

Give fluids (Isotonic Crystalloids -> Normal saline or lactated ringers)

  • 20 ml/kg bolus over 5-10mins
60
Q

What are treatments for general Distributive shock?

A

Give fluids, 20 ml/kg over 5-10 mins

61
Q

What are treatments for Septic shock?

A

Fluids, Antibiotics, Vasopressors

62
Q

What are treatments for Anaphylactic shock?

A

Epi, Antihistamines, Corticosteroids, Bronchodilators

63
Q

What are treatments for Cardiogenic shock?

A

Inotropes and fluids

64
Q

What are treatments for Obstructive shock?

A

Treat the cause (whatever is compressing the heart)

  • Pericardial drainage
  • Needle decompression
  • Fibrinolytic
65
Q

What rhythms suggest cardiac arrest?

A
  1. Asystole
  2. Pulseless Electrical Activity (PEA)
  3. Vfib
  4. Pulseless Vtach
66
Q

What are signs of Cardiopulmonary failure or cardiac arrest?

  • ABCDE?
67
Q

What rate should compressions be kept at for cardiac arrest?

A

Rate: 100-120 Compressions per min

  • minimize interruptions and achieve a depth of 1/3 of chest
68
Q

What ratio compression to ventilation ratio do we aim for if there is no advanced airway?

A
  • 30:2 compression to ventilation ratio for one provider
  • 15:2 compression to ventilation ratio for two providers
69
Q

How many breaths are given if there is a advanced airway?

A
  • 10-15 breaths per minute for one provider
  • 20-30 breaths per minute for two providers
70
Q

What should you do if there is increased ICP?

A
  • Avoid hypoxemia
  • Avoid hypercarbia
  • Avoid hyperthermia
  • Avoid hypotension
71
Q

Practice cases

A

https://learn.sait.ca/content/enforced/612444-202320RESP-319-A/course_files/PALS_Practice_Cases.pdf?ou=612444

72
Q

Defibrillation vs Cardioversion?

(needs confirmation)

A
  • Cardioversion = making one rhythm into another.
  • Synchronized cardioversion is where you shock the R wave.
  • Defib = unsynchronized cardioversion.

Interventions 2 (RESP 319) (25 decks)

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