PALS Flashcards
what type of airway tube do you use for kids
cuffed
risk of intubation in kids
pressure necrosis
cardiac arrest outweighs this risk
what is pressure necrosis
blockage of carotid bodies
mc cause of cardiac arrest for peds
respiratory
ventilation rate for peds
1 breath q 2-3 sec
how much air per breath for kids
just enough to see chest rise a little
what does EII stand for
evaluate
initial assessment
intervene
3 signs of life threatening situation for peds
apneic
mottled
cyanotic
3 kid vitals we care about
pulse
SpO2
bp
what happens to SpO2 and bp as kids get sicker
stable until they plummet
what happens to pulse rate as kids get sicker
tachycardic until plummet
what is the pediatric triangle
appearance
wob
circulation
appearance includes
TICLES:
tone
irritability
consolable
look (general impression)
eyesight/gaze
speech
2 major (indicate sicker pt) components of WOB
quality of breathing
breath sounds
minor component of WOB (we care less about it in terms of sickness)
RR
what are some examples of wob (4)
accessory muscle use
grunting
nasal flaring
seesaw breathing
2 indicators of circulation
cap refill
skin signs
pulse
formula for sbp goal for peds
70 + (2 x age)
definition of shock
inadequate tissue perfusion
major indicator of shock
delayed cap refill
unless kid was outside playing in snow
t/f: a kid can have delayed cap refill and not be hypotensive
T!
hypoxic parameter for peds
< 94%
even in higher elevations
what breath sound indicates an upper airway emergency
stridor
is stridor inspiratory or expiratory
inspiratory
upper airway emergencies are a __ issue
positioning
upper airway emergencies include (3)
croup
anaphylaxis
foreign body
4 sx of croup
steeple sign
seal like cough
nighttime cough
winter time (not really a sign but you get it)
croup usually affects what age group
18 months or younger
tx for anaphylaxis
epi
tx for foreign body
5 thrusts on back : 5 chest compressions
other strategy for foreign body
McGill’s
t/f: you can use intubation tube to try to shove FB lower down in peds
F!
you can only do this in adults
best way to open baby’s airway
1-2” towel roll between shoulder blades
breath sound that indicates lower airway emergency
wheezing
(same-same rales/ronchi/crackkles)
are lower airway emergencies inspiratory or expiratory
expiratory
lower airway emergencies are __ until proven otherwise
asthma
tx for asthma
albuterol
how do you differentiate btw asthma and other lower airway emergencies
albuterol
if it helps OR makes it worse, treat it as asthma
if albuterol does not make a difference for kid, consider __
bronchiolitis
tx for bronchiolitis
deep, aggressive nasal suctioning
mc cause of PNA in peds
aspiration
tx for pulmonary edema in kids
PEEP
push fluid back down into vasculature
3 types of shock in peds
hypovolemic
neurogenic
cardiogenic
4 sx of hypovolemic shock
dry mm
skin turgor
reduced lacrimation
reduced urine output
neurogenic shock is caused by
spinal cord injury
cardiogenic shock in peds is caused by
affected heart: CHF/cardiomyopathy
VS
speed induced (too fast/too slow)
tx for cardiogenic shock in peds
give fluids
don’t do this for adults
dose for defibrillation in peds
2,4,6,8
mc cause of bradycardia in peds
hypoxia
tx for bradycardia
epi
bradycardia caused by __ can not be treated w. epi
high grade heart blocks
tx for high grade heart blocks
go straight to pacing
2 signs of beginning stages of shock
mottling
cap refill
1st and 2nd organs affected by shock
- skin
- brain
what does ABCDEFG stand for
airway
breathing
circulation
don’t
ever
forget
glucose
mc CNS issue in kids
trauma
sign of CNS issue in kids
neurogenic cry → high pitched
only time sick kid will cry
neurogenic shock
how to distinguish metabolic vs CNS issue in kids
BG
how can you tell when shock has become unstable in peds
vitals plummet
vital esp important to identify uncompensated shock in peds
bp
compression depth for child
~2 in
OR
⅓ AP depth of chest
compression depth for infant
~1.5 in
OR
⅓ AP depth of chest
adult compression to breath ratio
30:2
2 rescuer compression to breath ratio for kids
15:2
1 rescuer compression to breath ratio for kids
30:2
tx for child/adult choking
abdominal thrusts
tx for infant choking
5 back blows:5 chest thrusts
what do you do if a choking adult/kid loses consciousness
start CPR
check to se if object is in airway after each round
6 components of shock management for peds
O2
SpO2
ECG
IV/IO
BLS
BG
management of non hemorrhagic hypovolemic shock for peds
20 mL/kg NS or LR bolus, repeat as needed
+/- colloid
management of hemorrhagic shock for peds
control bleeding
20 mL/kg NS or LR bolus, repeat 2-3 x
transfuse PRBCs PRN
management of anaphylactic shock for peds
epi
fluid bolus
albuterol
antihistamines/steroids
epi infusion
tx for neurogenic shock
20 mL/kg NS or LR bolus, repeat PRN
pressors
management of cardiogenic shock caused by broken heart (CHD/myocarditis/cardiomyopathy/poisoning)
5-10 mL/kg NS or LR, repeat PRN
inotropic/vasoactive infusion
consult
poison antidote
4 causes of obstructive shock
ductal dependent (LV outflow obstruction)
tension PTX
tamponade
PE
only WOB is affected
respiratory distress
appearance and WOB affected
respiratory failure
only circulation affected
shock
appearance and circulation affected
shock
only appearance affected
metabolic shock
appearance, wob, circulation all affected
cardiopulmonary failure
6 components of respiratory emergency management for peds
airway management
suction PRN
O2
SpO2
EKG
BLS
tx for croup (2)
nebulized epi
steroids
tx for anaphylaxis (4)
IM epi
albuterol
antihistamines
steroids
tx for aspiration/FB
position of comfort
consult
tx for bronchiolitis
nasal suction
+/- bronchodilator trial
tx for asthma
albuterol +/- ipatropium
steroids
Mg sulfate
IM epi if severe
terbutaline
tx for PNA
albuterol
abx
+/- PEEP
tx for ICP
avoid:
hypoxemia
hypercabia
hyperthermia
hypotn
