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pediatric emergencies > PALS > Flashcards

PALS Flashcards

1
Q

high quality CPR

A

push hard (infant: 1.5in; 4cm)(child:2in; 5cm)
push fast 100-120bpm
allow complete chest recoil
minimize interruptions to less than 10 secs
avoid excessive ventilation
1 rescuer: 30:2
2 rescuers: 12:2

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2
Q

what are the criteria for Sudden Unexpected Postnatal Collapse (SUPC)

A

term or near-term (>35 weeks) who met the ff:

  1. well at birth
  2. collapses unexpectedly in state of cardiorespiratory extremis such that resuscitation with interval PPV required
  3. collapses within 7 days of life
  4. either dies, need ICU or develops encephalopathy

majority occur within 24 hours of birth, time of first breastfeed

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3
Q

what are the risk factors for SUPC?

A

prone position during skin to skin contact with mother

Additional: 
1st breathing attempt
cosleeping
mother in episiotomy position
primiparous mother
parents left alone with baby during first hour after birth
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4
Q

agent for LTB/croup

A

Parainfluenza

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5
Q

Epiglottitis

A

HiB

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6
Q

Tracheitis

A

S. aureus

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7
Q

Bronchiolitis

A

RSV

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8
Q

low risk for BRUE?

A 
age >60 days
GA >/= 32 weeks and post conceptional age >/=45 weeks
occurrence of only 1 BRUE
duration less than 1min
no CPR required
no concerning historical features
no concerning PE findings
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9
Q

Definition of SIRS and Sepsis in Pediatric patients

A

2 or more:
temp instability <35C or >38.5C
Respiratory dysfunction (tachypnea >2 SD, hypoxemia PaO2 <70mmHg)
Cardiac dysfunction (tachycardia >2SD, hop tension, delayed capillary refill)
Perfusion abnormalities (oliguria, lactic acidosis, altered mental status)

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10
Q

IMCI and WHO criteria for severe infections in children

A

Neuro: convulsions, drowsy, unconscious, dec activity, bulging fontanel
Respi: RR >60, grunting, severe chest indrawing, central cyanosis
Cardiac: poor perfusion, rapid and weak pulse
GI: jaundice, poor feeding, abdominal distention
Derma: Skin pustules, periumbilical erythema. purulence
MS: edema, erythema
Temp >/= 37.7 or <35.5C

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11
Q

Vital signs according to age

A

1.RR should not be more than 60cpm
2.Normal HR is 2-3x normal RR for age
3.BP systolic should be >/=60mmHg for neonates
1yr: >/= 70mmHg for 1 month
1-10yr: >/= 70mmHg +(2 x age)
>10yr: >/=90mmHg

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12
Q

AVPU

A

Alert
Verbal
Pain
Unresponsive

*not developmentally dependent

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13
Q

Secondary assessment

A

focused Hx and PE (head to toe)
SAMPLE

Signs and symptoms
Allergies
Medications
Past medical history
Last meal
Events leading to situation
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14
Q

Tertiary assessment

A

done in hospital setting
ancillary, laboratory, radiographic assessment
CBC, LFT, Coagulation studies, ABG
chest radiograph to evaluate heart and lungs

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15
Q

6month old male with foreign body in the airway, what do you do?

A

less than 1 yr: 5 back blows, 5 chest thrusts

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16
Q

3yo female noted to have foreign body in the airway, what to do?

A

> 1yr old: 5 abdominal thrusts
(Heimlich maneuver)
If unconscious: child lying down

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17
Q

SVT with good perfusion

A

can attempt vagal maneuver

18
Q

SVT with poor perfusion

A

rapidly convert heart rhythm to sinus rhythm

19
Q

If SVT with IV access

A

Give Adenosine via IV (rapid onset)

20
Q

If SVT ; no IV access

A

synchronized cardioversion using 0.5 to 1 joule

21
Q

wide complex tachycardia

A

Ventricular tachycardia

Tx Cardioversion; inc dose to 2j/kg

22
Q

chest compressions in less than 1 year old

A

place 2 thumbs on midsternum with hands encircling the thorax or place 2 fingers over sternum then compress

23
Q

chest compressions in more than 1 year old

A

use heel of 1 hand or 2 hands like in adult resuscitation

24
Q

How is apnea test done?

A

pre-oxygenate patient with 100% O2 for approximately 10min
adjust ventilation to achieve PaCO2 40mmHg
ABG obtained into 10min then every 5 min until target PaCO2 surpassed

*absence of respiratory effort with PaCO2 >/=60mmHg and >20mmHg above baseline is consistent with brain death

25
Q

Documentation for Brain Death

A
  1. Etiology and irrevesibility of coma
  2. Absence of confounding factors: hypothermia, hypotension, hypoxia,
    significant metabolic derangement, significant drug levels
  3. Absence of motor response to noxious stimulation
  4. Absence of brainstem reflexes. Pupillary light reflex, oculocephalic/oculovestibular reflex, corneal reflex, cough reflex, gag reflex
  5. Absence of respiratory effort in response to an adequate stimulus; ABG values should be documented at the start and end of apnea test
26
Q

Prolonged PR interval

A

First degree AV block

27
Q

Progressive prolongation of the PR interval until a P wave is not followed by QRS complex

A

Second degree AV block

Mobitz type 1

28
Q

some but not all P waves are blocked before they reach the ventricle; constant PR interval

A

Second degree AV block

Mobitz type II

29
Q

Narrow QRS complex

A

Sinus tachycardia
Atrial flutter
Supraventricular tachycardia

30
Q

Wide QRS complex

A

Supraventricular tachycardia with aberrant intraventricular conduction

Ventricular tachycardia

31
Q

HR less than 220/min in infants;

<180/min in children

A

Sinus tachycardia

32
Q

HR >/=220/min in infants;

>/= 180/min in children

A

Supraventricular tachycardia (SVT)

33
Q

Treatment for Ventricular tachycardia with hypotension, altered mental status or signs of shock

A

Synchronized cardioversion

34
Q

Treatment for Ventricular tachycardia without hypotension, altered mental status or signs of shock

A

Adenosine if regular rhythm and QRS monomorphic

35
Q

Wide QRS complex

A

Ventricular tachycardia

36
Q

Physiology of hypovolemic shock

A

Decreased preload will lead to decreased stroke volume and cardiac output

37
Q

Physiology of cardiogenic shock

A

Decreased cardiac output due to abnormal cardiac function; pulmonary edema may occur

38
Q

High or low SVR leads to maldistribution of blood flow; increased capillary permeability and decreased cardiac contractility

A

Septic shock

39
Q

Tension pneumothorax and pericardial tamponade are causes of what type of shock?

A

Obstructive shock

40
Q

Physiology of obstructive shock

A

Impired blood flow due to limited venous return to the heart or limited pumping of blood from the heart

41
Q

Vasodilation, increased capillary permeability and pulmonary vasoconstriction lead to reduced cardiac output

A

Distributive shock

Anaphylaxis

pediatric emergencies (1 decks)

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