PALS Flashcards
Neonate age
Up to 28 days
Problems in neonates
Respiratory distress •Jaundice •Vomiting •Fever •Sepsis •Meningitis •Physical/sexual abuse
Problems in infants 1-5 months
Respiratory distress •Fever •SIDS •Vomiting/diarrhea •Sepsis •Meningitis •Physical/sexual abuse
Infant 6-12 months
Fever, febrile seizures •Vomiting/diarrhea •Broncholitis •Croup Sepsis •Meningitis •Respiratory distress(foreign body aspiration) •Abuse •FBAO •Falls/injury MVA
Child 1-3 years
Fever/febrile seizure •Vomiting/diarrhea •Resp distress (asthma, croup) Sepsis •Meningitis •Ingestions •FBAO Falls/injury MVA •Abus
ABCDE
Airway
Breathing
Circulation
Disability (AVPU/ pupils/ BGL)
Exposure (temperature/ skin)
Hypoxemia
- Inadequate oxygenation of blood
* A room air Sp02 of
4 D’s of Epiglottis
- Difficulty swallowing
- Drooling
- Distress
- Dyspnea
Infant facts
Most have doubled their birth weight and heart size at 4-6 months
•Mouth breather at between 3-6 months
Fears:
•separation and strangers
Approach:
•Provide consistent caretakers
•Happy parents = happy baby
•Minimize separation from parent
4 types of respiratory problems in the identify stage
Upper Airway Obstruction
Lower Airway Obstruction
Lung Tissue Disease
Disordered Control of Breathing
Severity of Respiratory problems
Respiratory Distress
Respiratory Failure
4 Types of Circulatory Problems
Hypovolemic Shock
Distributive Shock
Cardiogenic Shock
Obstructive Shock
Two severities of shock
Compensated
Hypotensive
Rr for infant
30-60
RR for Infant 1-3yrs
24-40
RR for Preschooler 4-5
22-34
RR for School age child 6-12
18-30
RR for Adolescent 13-18
12-16
SV (stroke volume) is determined by what factors?
Preload
Contractility
After-load
CO (Cardiac Output)=
SVxHR
S&S of decreased Cardiac Output
Tachycardia
Cool, pale,diaphoretic
Delayed Cap refill
Weak peripheral pulses
Oliguria
Vomiting
Hypotension formula
Anything less than
70 + (age in years * 2)
After-load
The pressure ventricles have to overcome or push against to pump out blood
4 main types of Shock
Hypovolemic
Cardiogenic
Distributive
Obstructive
Causes of Hypovolemic shock
Hemorrhage
Diarrhea
Vomiting
Osmotic Diuretic use
Third Spacing
Burns
Hypovolemic shock Effects on Cardiac Output
Preload: decreased
Contractility: Normal or increased
Afterload: Increased
S&S of Hypovolemic Shock
Wuiet Tachypnea
Tachycardia
Narrow pulse pressure
Delayed Cap refill
Pale, cool, diaphoretic
Oliguria
Changes in mentation
Normal Cap refill time
Less than 2 seconds
Types of distributive shock
Septic
Anaphylactic
Neurogenic (spinal)
Most common type of distributive shock
Septic
Septic shock
Vasodilation and venodilation cause blood to pool (petechi or purpura)
S&S of Septic Shock
Warm flushed skin (warm shock)
Pale mottles skin (cold shock)
Hypotension with widened pulse pressure
Bounding peripheral pulses
Petechi or purpura rash
Effect of septic shock on Cardiac Output
Preload: decreased
Contractility: normal to decreased
Afterload: variable
Anaphylactic shock
Multisystem allergic response
Veno and vasodilation
Increased capillary permeability
Pulmonary vasoconstriction
Anaphylactic shock effect on Cardiac Output
Preload: decreased
Contractility: variable
Afterload: L ventricle decreased/ R ventricle increased
Neurogenic shock
Loss of sympathetic signals to smooth muscle (particularly in blood vessels)
Uncontrolled vasoconstriction and tachycardia prevented
S&S of Neurogenic shock
Hypotension with widened pulse pressure
Normal or bradycardic HR
Neurogenic shock effect on cardiac output
Preload: decreased
Contractility: normal
Afterload: decreased
Fluid replacement for:
Hypovolemic
Distributive
Obstructive
20ml/kg PRN
Rapidly over 5-10min
Fluid replacement for:
DKA
10-20ml/kg
Over 1 hr
Fluid replacement for:
Cardiogenic
Poisoning
Calcium channel blocker OD
Beta blocker OD
5-10ml/kg PRN
slowly over 10-20min
Causes of cardiogenic shock
Congenital heart defect
Myocarditis
Cardiomyopathy
Arrhythmias
Poisons/toxins
Myocardial injury
S&S of cardiogenic shock
Retractions, nasal flaring, grunting (pulmonary Edema)
Cyanosis
Pale, cool, diaphoretic
Narrow pulse pressure
Mentation changes
Delayed cap refil
Effects of cardiogenic shock on cardiac output
Preload: variable
Contractility: decreased
Afterload: increased
Causes of obstructive shock
Cardiac tamponade
Tension Pneumothorax
Ductal dependant lesions
Pulmonary embolism
Becks triad
Three signs of cardiac tamponade
Pulsus paradoxus
JVD
muffled or diminished heart sounds
Signs of cardiac tamponade
Pulsus parodoxus
JVD
muffled or diminished heart sounds
Signs of Tension Pneumothorax
JVD
hyper-resonance
Diminished breath sounds on affected side
Tracheal deviation (late)
Leading cause of bradycardia in children
Hypoxia
Primary Bradycardia
Congenital or acquired heart conditions causing bradycardia
Use Atropine here
Secondary Bradycardia
Bradycardia that results in a NON CARDIAC condition that alter the normal function of the heart
Hypoxia, acidosis, hypotension, hypothermia, and drug effects.
USE EPI HERE
Normal QRS in Children
Less than 0.09
SVT rate in children
180
Infant SVT rate
220bpm
Infant vagal maneuver
Ice pack to the face 15-20 seconds
PALS Tachycardia Synchronized Cardio Version
Begin 0.5-1J/kg. if that is not effective then increase to 2J/kg
Three things to look at on initial arrival
Consciousness
Breathing
Color
Leading cause of symptomatic bradycardia in children?
Tissue hypoxia
Two most common potentially reversible causes of bradycardia
Hypoxia
Increased vagal tone
Neonate hypotension
Less than 60
Infants hypotension (1mon-12mon)
Less than 70
Hypotension in children older than 10
Less than 90
