pals Flashcards
prolonged cap refill means…
low cardiac output
dehydration
shock sometimes presents normal
hypothermia
weak pulses
need rapid intervention to prevent cardiac arrest
skin color and temp
when perfusion deteriorates –> hands/feet are first to become cold, pale, dusky, mottled
consider temp of environment
use back of hand to assess
slide hand up extemityy to determine line of change from cool to warm *monitor line to determine kids response to therapy**
inadequate o2 delivery –> mottling, pallor, cyanosis
unequal pupils
d/t increased ICP
eye injury
slow constriction/none –> d/t increased ICP
hypoglycemia
60 mg/dl or less
may lead to brain injury if not recognized and effectively treated
anatomy of physiology of resp system of child
airway is smaller
larynx is funnel shaped
tongue and epiglottis is relatively large greater risk for airway obstruction
airway is always anterior to esophagus
cricoid cartilage = only fully circular ring
acute resp problems
CNS disease (seizures, head trauma)
- impair resp control leading to decreased resp rate
- muscle weakness can impair O2 and vent
Children have higher metabolic rate so O2 demand is higher
- HYPOXEMIA AND TISSUE HYPOXIA CAN DEVELOP MORE RAPIDLY
Conditions that decrease airway size, increasing resistance
edema
bronchoconstriction
secretions
mucus
mediastinal mass impinging on large/small airways
causes of lower lung compliance
pneumothorax
ARDS *fibrosis *Pulmonary edema -> lead to increase in water content in the interstitial space and alveoli
pleural effusion
pneumonia
how to assess for effectiveness of O2 and ventilation
visible chest rise with each breath
o2 sat
exhaled co2
hr
bp
distal air entry
signs of improvement or deterioration (appearance, color, agitation)
if you cannot achieve effective ventilation…
reposition/reopen the airway
verify mask size and ensure a tight face-mask seal
suction the airway if needed
check the O2 source
check vent bag and mask
treat gastric inflation
consider 2 person bag mask vent and insert OPA
Gastric inflation etiology
frequently develops during bag-mask vent
More likely to develop if…
A partial airway obstruction is present
High airway pressures are needed, such as child with poor lung compliance
Bag-mask ventilation rate is too fast
Tidal volume delivered is excessive
Peak inspiratory pressure created is excessive
Child is unconscious or is in cardiac arrest (gastro-esophageal sphincter opens at a lower than normal pressure)
ways to minimize gastric inflation
** remember this can impair ventilation*
vent at a rate of 1 breath every 2-3 seconds (20-30 breaths per min)
use a manometer, deliver breath over about 1 second
deliver enough volume and pressure to produce visible chest rise
advanced providers may gastric decompress by insert NG/OG tube
consider administering circoid pressure
When to discontinue cricoid p4ressure
tracheal obstruction compromising BMV occurs
speed/ease of intubation is compromised
Stable SVT objectives/interventions
instruct/guide child in blowing through a narrowed straw, bearing down and grunting (vagal maneuvers)
rapid bolus technique of adenosine
synchronized cardioversion if needed
Intervene
- activate ERS
- administer O2
- apply pads/leads, turn on monitor
- apply o2
- establish IV
- vagal maneuvers
- record rhythm strip, administer first dose adenosine 0.1mg/kg rapid IV push … if no response give a second dose followed by rapid saline flush
- may consider provider synchronized cardioversion with sedation
** look for s/s of heart failure enlarged liver, extra heart sounds/murmurs, crackles/rales
unstable SVT interventions/objectives
potential vagal maneuver for infant is ice to the face ** only do if this does not delay care **
rapid bolus of adenosine
discuss indications for synchronized cardioversion –> infant has poor perfusion, hypotension, altered mental status and s/s of shock
intervene
- activate ERS
- 100% o2 nonrebreathing face mask
- cardiac monitor
- pulse ox
Vfib objectives/interventions
safe shock delivery with appropriate dose, minimal interruption of chest compressions
describe correct dose of epi used
appropriate antiarrhythmic –> amiodarone or lidocaine
intervene
- CPR
- epi 0.01mg/kg IV/IO and administer chest compressions (repeat every 3-5 mins)
- if shockable rhythm persists then administer antiarrhythmic for persistent VF/pulseless VT (amiodarone 5mg/kg IV bolus or lidocaine 1mg/kg)
- consider endotracheal intubation, especially if unable to provide adequate vent with BVM
disordered control of breathing
identify resp distress vs resp failure
summarize s/s of disordered control of breathing (inadequate spontaneous resp effort with very slow, irregular, shallow breaths)
correct interventions –> open airway and BVM with 100% o2
intervene
- verify chest rise with BVM, monitor response
- consider insertion of OPA or NPA
- treat fever with antipyretic
- monitor LOC, spontaneous resp effort and airway protective mechanisms
- once spontaneous RR and depth are adequate cease BVM and provid NRB with 100% o2
- frequently reass
- check glucose
bradycardia
- BVM with 100% o2
- begin chest compressions if HR does not increase to 60/min or greater and signs of poor perfusion
- obtain vascular access
- administer epi 0.01 mg/kg, rapid saline flush
vtach manifestations and tx
irregular, coarse waveforms of different shapes… ventricles are quivering and there is no contractions or cardiac output which may be fatal
causes: MI, electrolyte imbalance, dig tox, stimulations
manifestations: pt usually awake (unlike vfib), chest pain, lethargy, anxiety, syncope, palpitations
tx: o2, antidyshythmic amiodarone
no pulse: CPR, possible intubation… epi, vasopressin, amiodarone
vfib manifesations and tx
rapid, disorganized pattern of electrical activity in the ventricle in which electrical impulses arise from many different foci
CHAOTIC and IRREGULAR
manifesations: LOC, may not have pulse/BP, resp stopped, CA/death
tx: CPR, o2, defib, possible intubation, drug therapy *vasoconstriction:epinephrine, antiarrhythmic: amiodaron, lidocaine, possibly mag
a-fib manifesations/tx
look for irregular R-R intervals, usually rate is greater than 100, no p waves present
uncoordinated electrical activity, atria is quivering
tx: stable pt: O2, beta blockers, CCB, dig, amiodarone, anticoagulants to prevent clots
unstable: O2, cardioversion
PVCs
early premature conduction of QRS complex, regular rhythm but can be interrupted by early P wave, QRS is sharp, bizarre, abnormal
tx: may not be harmful to client with healthy heart, O2, correct electrolyte imbalance, d/c or adjust drug causing tox, decrease stress/pain
atrial flutter
hearts upper chambers beat too quickly but reg rhythm
SAW TOOTH, normal QRS complex
tx: stable: drugs –> CCB, antiarrhythmics, anticoags
unstable: cardioversion
