PALS Flashcards
Initial impression, what to assess for
Consciousness
Breathing
Color
Normal respiratory rate for infants <1 year
30-60 bpm
Normal respiratory rate for toddler’s 1-3y
24 to 40 bpm
Normal respiratory rate for Preschoolers 4-5y
22 to 34 bpm
Normal respiratory rate for School age 6-12y
18 to 30 bpm
Normal respiratory rate for Adolescent 13 to 18years
12 to 16 bpm
Central apnea
no respiratory effort because of an abnormality or suppression of the brain or spinal cord
Obstructive apnea
there is inspiratory effort without airflow.
Mixed apnea
There are periods of obstructive apnea and periods of central apnea
Causes of tachypnea
high fever pain metabolic acidosis sepsis congestive heart failure severe anemia TPA
causes of bradypnea
muscle fatigue
central nervous system injury
hypothermia
medications
Mild to moderate breathing difficulty types of retractions
subcostal (retraction of the abd just below rib cage)
substernal (retraction of the abd at the bottom of breast bone)
intercostal (btwn ribs)
severe breathing difficulty types of retractions
Supraclavicular
Suprasternal
Sternal
Tidal volume
the volume of air inspired with each breath
Normal tidal volume #s
5 to 7ml/kg of body weight
what is stridor
coarse, higher pitched breathing sound heard on inspiration. A sign of upper airway obstruction
what is grunting
short, low pitched sound heard on expiration. It may be a response to fever. It helps keep small airways and alveolar sacs open.
What is wheezing
high pitched sound heard most often during expiration that is caused by airway obstruction. Caused by asthma or bronchiolitis.
Crackles/rales
crackling inspiratory sounds, indicate accumulation of alveolar fluid.
SpO2
the percentage of the child’s hgb that is saturated with o2.
Normal heart rate for newborn to 3 months
85 to 205
Normal heart rate 3 months to 2 years
100 to 190
Normal heart rate 2 years to 10 years
60 to 140
Normal heart rate greater than 10 years
60 to 100
Most common cause of bradycardia
hypoxia
GCS criteria
Eye opening (spontaneous, speech, pain, none) Orientation (oriented, confused, inapp words, incomphrehensible sounds, none) Ability to follow commands (obeys, localizes, withdraws, abnl flexion, extensor response, none)
Lowest acceptable systolic bp > 10 years
90 mmHg
Lowest acceptable systolic bp 1-10 years
70 mmHg + (2 x age in years)
Lowest acceptable systolic bp 1mo -1 year
70 mmHg
Lowest acceptable systolic bp newborn
60 mmHg
Normal urine output values
1 ml/Kg per h or 30 mL/h for adolescent
early signs of cardiopulmonary compromise
tachycardia and tachypnea
Method for assessing breathing RACE
Rate-tachypnea or
Airway sounds
Color– pink, pallid, cyanotic or mottled
Effort/mechanics–positioning/retractions etc
Time limit for suctioning at once
10 seconds, may cause bradycardia and hypoxia
What to do for foreign body for a pt that can speak and is awake
allow them to cough and clear the airway. make no attempts to remove it
What to do for foreign body if it is completely obstructed
remove only if object is visible. do not to blind finger sweeps
flow rate of nasal cannula
1-4 L/min to deliver O2 concentrations of 25-40%
flow rate for simple o2 mask
6-10 L/min to deliver O2 concentrations of 35-60%
flow rate for o2 mask w reservoir
the reservoir bag must be greater than the tidal volume and 90% o2 can be delivered if rate is 10-15 L/min
noninvasive positive pressure ventilation advantages
decreases work of breathing, improving oxygenation, avoiding complications of intubation.
Indications for noninvasive positive pressure ventilation
status asthmaticus, bronciolitis, acute pulmonary edema, neuromuscular disease. Patient must be stable, spontaneously breathing, alert, and cooperative.
Contraindications for noninvasive positive pressure
hemodynamically unstable, lethargic, vomiting, or w cardiac dysrhythmias
Settings for inspiratory positive airy pressure for CPAP or BIPAP
8-10 cmH2O. Titrate these settings upwards in 2 cmH2O increments until the desired effects are achieved
Settings for expiratory positive airy pressure for CPAP or BIPAP
3-5 cmH2O. Titrate these settings upwards in 2 cmH2O increments until the desired effects are achieved
How to monitor patients on BIPAP or CPAP once treatment is started
watch for worsening respiratory failure with serial lung exams, vital sign measurements, and oxygen saturation. If their respiratory status deteriorates or worsens, discontinue NIPPV and perform tracheal intubation.
Fluid resuscitation bolus amount
20 ml/Kg. Can give additional boluses up to 60 ml/kg until vital signs and perfusion are restored. Consider inotropy if further fluid is needed. If patient is septic, fluid boluses as large as >60 ml/kg may be required.
epinephrine dose and indication
0.01mg/kg IV/IO (1:10,000; 0.1ml/kg)
or
.1 mg/kg 1:1000 solution
bradycardia
atropine dose and indication
0.02 mg/kg IV/IO (Minimum dose: 0.1mg; maximum total dose for children: 1mg
bradycardia
SVT treatment
adenosine .1mg/kg
Wide QRS with pulse treatment
amiodarone 5mg/kg iv over 20 to 60 minutes
or
Procainamide 15 mg/kg over 30 to 60 mins
WIDE QRS (torsades de points) treatment
magnesium 25-50mg/kg over 10 mins
SAMPLE history
Symptoms Allergies Medications Past history Last intake Events that caused the incident
signs of potential signs of respiratory failure
Tachypnea Tachycardia Anxiety Retractions Nasal flaring
signs of probable respiratory failure
Lethargy
Head bobbing
Grunting
Cyanosis/pallor
signs of cardiopulmonary failure
Agonal breathing
bradycardia
signs of respiratory failure
slow breathing
bradycardia
Early signs of shock
tachycardia
decreased perfusion of skin (cool, pale mottled or delayed cap refill)
Altered mental status
Discrepancy in volume between peripheral and central pulse
Symptoms: brisk capillary refill and bounding central pulses
septic shock
what is compensated shock
patient showing signs of shock with a normal b/p
shock tx
maintain airway
administer high flow o2
maintain body temp
ECG and pulse ox
Admin fluid bolus 20 ml/kg NS or LR in under 20 min
Pressors for refractory, cardiac or septic shock
Reduce o2 demand by supporting breathing, controlling pain and anxiety, manage fever
what does low co2 mean during cardiac arrest
low perfusion
epinephrine dosing
.1 mg/kg 1:10,000
repeat every 3-5 minutes
site for io placement
proximal tibia on the medial aspect 2 finger widths below the tibial tuberosity
shock fluid resuscitation bolus amount
20ml/kg of an isotonic crystalloid solution
What things to check to assess a patients hydration status
mental status quality of pulses blood pressure heart rate cap refill urine output
In patients with septic shock, what can you give them and how much
Large fluid volumes 60ml/kg and can give with 5% albumin in 10 ml/kg doses
Dopamine dose for cardiogenic shock
5-10mcg/kg per min. titrate to desired effect
Dobutamine dose for cardiogenic shock
2-10mcg/kg per min but at doses greater than 10 mcg/kg it might cause hypotension because of afterload reduction and decreased svr it is works on selective beta adrenergic receptors
Epinephrine dose
0.1-1mcg/kg per min
Epinephrine effects
It is an inotropic agent that increases myocardial perfusion pressure. Low dose causes inc hr, decreased svr, decreased diastolic blood pressure bc of beta 1 and beta 2 receptors.
What does epinephrine cause at doses >.3mcg/kg per min
alpha adrenergic effects result in increased blood pressure
What receptors does norepinephrine act on
alpha and beta adrenergic receptors to produce inotropic effects and beta peripheral vasoconstriction to increase MAP
What is the dose for norepinephrine
01.-1mcg/kg per min
Minimal glucose level before giving dextrose
<60 mg/dl
Dextrose dose to raise blood sugar
.5 gm/kg
Use 2 mL/kg of a 25% dextrose solution
