PALS Flashcards
high quality CPR
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
what are the criteria for Sudden Unexpected Postnatal Collapse (SUPC)
term or near-term (>35 weeks) who met the ff:
- well at birth
- collapses unexpectedly in state of cardiorespiratory extremis such that resuscitation with interval PPV required
- collapses within 7 days of life
- either dies, need ICU or develops encephalopathy
majority occur within 24 hours of birth, time of first breastfeed
what are the risk factors for SUPC?
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
agent for LTB/croup
Parainfluenza
Epiglottitis
HiB
Tracheitis
S. aureus
Bronchiolitis
RSV
low risk for BRUE?
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
Definition of SIRS and Sepsis in Pediatric patients
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)
IMCI and WHO criteria for severe infections in children
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
Vital signs according to age
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
AVPU
Alert
Verbal
Pain
Unresponsive
*not developmentally dependent
Secondary assessment
focused Hx and PE (head to toe)
SAMPLE
Signs and symptoms Allergies Medications Past medical history Last meal Events leading to situation
Tertiary assessment
done in hospital setting
ancillary, laboratory, radiographic assessment
CBC, LFT, Coagulation studies, ABG
chest radiograph to evaluate heart and lungs
6month old male with foreign body in the airway, what do you do?
less than 1 yr: 5 back blows, 5 chest thrusts
3yo female noted to have foreign body in the airway, what to do?
> 1yr old: 5 abdominal thrusts
(Heimlich maneuver)
If unconscious: child lying down
SVT with good perfusion
can attempt vagal maneuver
SVT with poor perfusion
rapidly convert heart rhythm to sinus rhythm
If SVT with IV access
Give Adenosine via IV (rapid onset)
If SVT ; no IV access
synchronized cardioversion using 0.5 to 1 joule
wide complex tachycardia
Ventricular tachycardia
Tx Cardioversion; inc dose to 2j/kg
chest compressions in less than 1 year old
place 2 thumbs on midsternum with hands encircling the thorax or place 2 fingers over sternum then compress
chest compressions in more than 1 year old
use heel of 1 hand or 2 hands like in adult resuscitation
How is apnea test done?
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
Documentation for Brain Death
- Etiology and irrevesibility of coma
- Absence of confounding factors: hypothermia, hypotension, hypoxia,
significant metabolic derangement, significant drug levels - Absence of motor response to noxious stimulation
- Absence of brainstem reflexes. Pupillary light reflex, oculocephalic/oculovestibular reflex, corneal reflex, cough reflex, gag reflex
- Absence of respiratory effort in response to an adequate stimulus; ABG values should be documented at the start and end of apnea test
Prolonged PR interval
First degree AV block
Progressive prolongation of the PR interval until a P wave is not followed by QRS complex
Second degree AV block
Mobitz type 1
some but not all P waves are blocked before they reach the ventricle; constant PR interval
Second degree AV block
Mobitz type II
Narrow QRS complex
Sinus tachycardia
Atrial flutter
Supraventricular tachycardia
Wide QRS complex
Supraventricular tachycardia with aberrant intraventricular conduction
Ventricular tachycardia
HR less than 220/min in infants;
<180/min in children
Sinus tachycardia
HR >/=220/min in infants;
>/= 180/min in children
Supraventricular tachycardia (SVT)
Treatment for Ventricular tachycardia with hypotension, altered mental status or signs of shock
Synchronized cardioversion
Treatment for Ventricular tachycardia without hypotension, altered mental status or signs of shock
Adenosine if regular rhythm and QRS monomorphic
Wide QRS complex
Ventricular tachycardia
Physiology of hypovolemic shock
Decreased preload will lead to decreased stroke volume and cardiac output
Physiology of cardiogenic shock
Decreased cardiac output due to abnormal cardiac function; pulmonary edema may occur
High or low SVR leads to maldistribution of blood flow; increased capillary permeability and decreased cardiac contractility
Septic shock
Tension pneumothorax and pericardial tamponade are causes of what type of shock?
Obstructive shock
Physiology of obstructive shock
Impired blood flow due to limited venous return to the heart or limited pumping of blood from the heart
Vasodilation, increased capillary permeability and pulmonary vasoconstriction lead to reduced cardiac output
Distributive shock
Anaphylaxis
