PALS

Question 1

Normal Respiratory Rates by Age

Answer 1

Infant (<1yr): 30-60/min
Toddler (1-3yr): 24-40/min
Preschooler (4-5yr): 22-34/min
School age (6-12yr): 18-30/min
Adolescent (13-18yr): 12-16/min

Question 2

Normal HR by Age

Answer 2

0-3mo: 85-205 awake; 80-160 asleep
3mo-2yr: 100-190 awake; 75-160 asleep
2-10yr: 60-140 awake; 60-90 asleep
>10yr: 60-100 awake; 50-90 asleep

Question 3

Definition of Hypotension by SBP and age

Answer 3

0-1mo: SBP less than 60

1-12mo: SBP less than 70

1-10yr: SBP less than 70 + (age in years x2)

> 10yr: SBP <90

Question 4

Compression Rate, Depth, Ratio

Answer 4

100/min, limit interruptions to less than 10sec, allow total chest recoil, compress to approx 1/3rd of chest (about 2in in children and 1.5in for infants)

ratio 30:2 for single rescuer and 15:2 for two rescuers

Question 5

Advanced Airway Ventilation Rate

Answer 5

1 breath every 6-8 seconds, or 8-10 breaths per minute

Question 6

Evaluate: Primary Assessment

Answer 6

ABCDE (airway, breathing, circulation, disability, exposure)

hands-on; includes brief physical assessment and vital signs/pulse ox

Question 7

Evaluate: Secondary Assessment

Answer 7

SAMPLE history (s/sx, allergies, medications, past medical history, last food/drink, events leading to presentation

second more focused physical exam

Question 8

Types and Severity of Respiratory Problems

Answer 8

Severity: respiratory distress vs respiratory failure

Types: Upper Airway Obstruction (stridor/gurgling), Lower Airway Obstruction (asthma/wheezing), Lung Tissue Disease (grunting/crackles), Disordered Control of Breathing (shallow breaths/irregular rate or effort)

Question 9

Circulatory Problems

Answer 9

arrythmia or shock

Question 10

Types & Severity of Shock

Answer 10

Hypovolemic
Obstructive (Thrombosis/Pneumothorax/Cardiac Tamponade)
Distributive (Septic/Anaphylactic/Neurogenic)
Cardiogenic (congenital heart dx, toxins, arrythmias, cardiomyopathy)

compensated (signs of poor perfusion but SBP is normal) versus hypotensive

Question 11

Respiratory Distress

Answer 11

tachypnea, increased work of breathing, nasal flaring, retractions, use of accessory muscles; or hypoventilation/bradypnea

Question 12

Respiratory Failure

Answer 12

inadequate oxygenation, ventilation, or both

cyanosis, changes in heart rate, stupor/coma

Question 13

Management of Croup (Upper Airway Obstruction)

Answer 13

dexamethasone, nebulized epi, assist breathing as needed

Question 14

Management of Anaphylaxis

Answer 14

IM epi, albuterol, antihistamines, corticosteroids

Question 15

Management of Asthma

Answer 15

albuterol and ipatropium
corticosteroids
subQ epi

Question 16

Fundamentals of Initial Shock Management

Answer 16

Positioning
Manage airway/breathing/oxygenation/ventilation
Establish vascular access (consider IO early)
Fluids (20mL/kg isotonic crystalloid bolus)
Monitor (VS, UO, LOC)
Frequent Reassessments
Lab Studies
Medications
Specialty consultation

Question 17

Sinus tach vs SVT

Answer 17

Sinus tach: infants less than 220/min; children less than 180/min

SVT: infants greater than 220/min; children greater than 180/min

Question 18

If a child is in V Tach…

Answer 18

If cardiopulmonary compromise (hypotension, AMS, signs of shock)- synchronized cardioversion at 0.5-1J/kg (inc to 2J/kg if ineffective)

If no cardiopulmonary compromise, consider adenosine if rhythm regular and monomorphic (0.1mg/kg, second dose 0.2mg/kg), then seek expert consultation (may use amio 5mg/kg over 20min-60min, OR procainamide 15mg/kg over 30-60min)

Question 19

If a child is in sinus tach…

Answer 19

Search for and treat cause

Question 20

If a child is in SVT…

Answer 20

Give adenosine 0.1mg/kg (second dose 0.2mg/kg). If ineffective, synchronized cardioversion at 0.5-1J/kg (may inc to 2J/kg if ineffective). Vagal maneuvers while setting this up, but do not delay meds or cardioversion)

Question 21

Management of Shock after ROSC

Answer 21

Maintain airway and oxygenation (consider advanced airway placement).

ID Contributing factors.

Consider 20mL/kg bolus isotonic crystalloid.

Consider epi or dopamine drip.

Monitor for and treat agitation and seizures. Monitor for and treat hypoglycemia. Assess ABGs, lytes, and calcium.

If remains comatose, consider therapeutic hypothermia.

Question 22

Maintenance IV Fluids

Answer 22

Infants less than 10kg: 4mL/kg/hour

Children 10-20kg: 4mL/kg/hour for the first 10kg, then an additional 2mL/kg per hour for each kg above 10kg

Children greater than 20kg: 4mL/kg/hour for first 10kg, then additional 2mL/kg/hour for 11-20, plus additional 1mL/kg/hour for each kg above 20.

Question 23

DOPE pneumonic for intubated patient who deteriorates

Answer 23

Displacement, obstruction, pneumothorax, equipment failure