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
