PALS Flashcards
What are the first six interventions for respiratory emergencies?
Airway positioning Suctioning Oxygen Pulse oximetry ECG BLS as indicated
Four main types for airway emergencies
Upper airway emergencies
Lower airway emergencies
Lung tissue disease
Disordered control of breathing
Three upper airway emergencies
Croup
Anaphylaxis
Aspiration of a foreign body
Two types of lower airway emergency
Bronchiolitis
Asthma
Two types of lung tissue disease
Pneumonia
Pulmonary edema
Three types of disordered control of breathing
Increased ICP
Poisoning/Overdose
Neuromuscular disease
Croup treatment
Epi neb
Corticosteroids
Anaphylaxis respiratory treatment
IM epi
Salbutamol
Antihistamines
Corticosteroids
Aspiration foreign body treatment
Position of comfort
Speciality consultation
Bronchiolitis treatment
Nasal suctioning
Bronchodilator trial
Asthma treatment
Salbutamol Corticosteroids SQ epi Magnesium sulphate Salbutamol IV
Pneumonia treatment
Salbutamol
Antibiotics
Consider CPAP
Pulmonary edema treatment
Consider NIV
Consider ventilatory support with PEEP
Consider vasoactive support
Consider diuretic
Increased ICP treatment
Avoid hyoxemia
Avoid hypercarbia
Avoid hyperthermia
Poisoning/overdose treatment
Antidote
Contact poison control
Neuromuscular disease management
NIV or invasive ventilators support with PEEP
Six initial actions in shock management
Oxygen Pulse oximetry ECG IV/IO access BLS BGL
Four types of shock
Hypovolemic
Distributive
Cardiogenic
Obstructive
Two types of hypovolemic shock
Nonhemorrhagic
Hemorrhagic
Three types of distributive shock
Septic
Anaphylactic
Neurogenic
Two types of cardiogenic shock
Bradyarrythmia/tachyarrhythmia
Other - CHD, Myocarditis, cardiomyopathy, poisoning
Four types of obstructive shock
Ductal dependant
Tension pneumothorax
Cardiac tamponade
Pulmonary edema
Nonhemorrhagic shock treatment
20 ml/kg NS/LR prn
Consider colloid
Hemorrhagic shock treatment
Control external bleeding
20 ml/kg NS/LR repeat up to three times
Transfuse PRBCs
Septic shock treatment
Refer to septic shock management algorithm
Anaphylactic shock treatment
IM epi Fluid bolus 20 ml/kg Salbutamol Antihistamines, corticosteroids Epinephrine infusion
Neurogenic shock treatment
20 ml/kg NS/LR prn
Vasopressors
Cardiogenic shock treatment
Management algorithms
Brady/Tachy
Other cardiogenic shocks
5-10 ml/kg bolus prn
Vasoactive infusion
Expert consult
Ducal dependant shock treatment
Prostaglandin E
Expert consult
Tension pneumothorax shock treatment
Decompression
Tube thoracostomy
Cardiac tamponade shock treatment
Pericardiocentesis
20 ml/kg NS/LR
Pulmonary embolism shock treatment
20 ml/kg NS/LR prn
Consider thrombolitics, anticoagulants
Expert consult
Two initial actions in cardiac arrest
O2
Attach monitor
Which rhythm is shockable
VF/pVT
Reassess how often in cardiac arrest
2 minutes
PEA/asystole actions?
IV/IO access
2 minute cycles of CPR
Epi every 3-5
consider advanced airway
VF/pVT actions
IV/IO 2 minute cycles of CPR If shockable rhythm defibrillate Epi every 3-5 min Consider advanced airway Consider amiodarone or lidocaine Hs & Ts
Quality CPR criteria
1/3 of chest 100-120/min Minimize interruptions Avoid excess ventilation Rotate compressors every 2 minutes
Defibrillation energy dose
First shock: 2 J/kg
Second shock: 4 J/kg
Increase voltage to gradually to max of 10 J/kg
Cardiac arrest Epi dose
0.01 mg/kg q 3-5 min
Cardiac arrest amiodarone dose
5 mg/kg bolus May repeat up to 2 times
Cardiac arrest lidocaine
1 mg/kg loading dose
Estimating uncuffed endotracheal tube formula
(Age/4)+4
Cuffed endotracheal tube formula
(Age/4)+3.5
Cardiac arrest signs of rosc
Pulse/BP
Spontaneous arterial pressure wave on invasive monitoring
Cardiac arrest Hs
Hypovolema Hypoxia Hydrogen ion (acidosis) Hypoglycaemia Hypo/hyperkalemia Hypothermia
Cardiac arrest Ts
Tension pneumo Tamponade Toxin Thrombosis - cardiac Thrombosis - pulmonary
Cardiac arrest breaths per minute
10/min
1 every 6 seconds
Four signs of upper airway obstruction
Increased RR and effort
Stridor
Change in voice
Drooling, snoring or gurgling sounds
Five signs of lower airway obstruction
Increased RR and effort Decreased air movement on auscultation Prolonged exploratory phase Wheeze Cough
Six signs of lung tissue disease
Increased RR and effort Grunting Crackles Diminished breath sounds Tachycardia Hypoxemia despite O2 admin
Three signs of disordered control of breathing
Irregular rate and pattern of breathing
Shallow or inadequate effort
Apnea
Bradycardia 5 initial actions
Maintain patent airway Oxygen Monitor - rhythm, BP and Spo2 IV/IO 12-lead
Bradycardia with S/S if cardiopulmonary compromise treatment?
HR <60 despite O2 and ventilation then CPR
Bradycardia persists after 02, ventilation and CPR?
Epinephrine
Atropine
Consider TCP
Treat underpaying cause
Epi dose for Bradycardia
0.01 mg/kg q 3-5 min
Atropine dose for Bradycardia
0.02 mg/kg - 1 repeat
Min dose 0.1 mg
Max dose 0.5 mg
Three initial approach criteria
Appearance
Breathing
Circulation
Five initial actions in tachycardia
Maintain airway Oxygen Monitor IV/IO 12-lead - without delaying therapy
Five sinus tachycardia criteria
Compatible history P wave present/normal Variable R-R constant PR Infant rate <220 Child rate < 180
Five SVT criteria
Compatible history Abnormal or absent P waves HR not variable Infants rate >220 Child rate > 180
Possible VT with cardiopulmonary compromise treatment?
Synchronized cardioversion
Possible VT without cardiopulmonary compromise treatment?
Consider adenosine - in regular and monomorphic
Expert consult - amiodarone or procainamide
Probable sinus tachycardia treatment?
search for and treat cause
Probable SVT treatment?
Consider vagal maneuver
Consider adenosine
Consider cardioversion if adenosine unavailable or ineffective
Synchronized cardioversion dose?
Consider sedation
0.5-1 J/kg then increase to
2 J/kg
Adenosine SVT dose?
First dose: 0.1 mg/kg max of 6 mg
Second dose: 0.2 mg/kg max of 12 mg
Amiodarone SVT dose?
5 mg/kg over 20-60 min
Procainamide SVT dose?
15 mg/kg over 30-60 min
Procainamide is incompatible to administer with which drug?
Amiodarone
Amiodarone is incompatible to administer with which drug?
Procainamide
Normal HR for neonate awake/asleep?
Awake 100-205
Asleep 90-160
Normal HR for infant awake/asleep?
Awake 100-180
Asleep 90-160
Normal HR for toddler awake/asleep?
Awake 98-140
Asleep 80-120
Normal HR for preschooler awake/asleep?
Awake 80-120
Asleep 65-100
Normal HR for school aged awake/asleep?
Awake 75-118
Asleep 58-90
Normal RR for adolescent?
12-20
Normal RR for infant?
30-53
Normal RR for toddler?
22-37
Normal RR for preschooler?
20-28
Normal RR for school aged child?
18-25
Five sign of septic shock
Altered mental status Altered heart rate Altered temperature Altered perfusion Hypotension
Six actions of initial stabilization in sepsis
ABCs Monitor IV/IO Antibiotics Fluid bolus Antipyretic
Septic signs of shock do not persist past initial stabilization?
Consider critical care consult
Septic signs of shock persist beyond initial stabilization?
Obtain expert consult
Warm shock: norepinephrine
Cold shock: epinephrine
Dopamine is backup if other pressures are unavailable
Four sepsis critical care goals of therapy?
Scvo2 >70%
Adequate BP
Normalized HR
Adequate CO and organ perfusion
Sepsis Scvo2 <70, poor perfusion with cold extremities treatments despite epinephrine ? (6)
Fluid boluses
Transfusion if Hgb <100
Epinephrine infusion
If BP low consider adding norepinephrine
If BP normal consider milrinone or vasodilator
Consider inotrope
Sepsis with Scvo2 >70, poor perfusion and warm extremities despite norepinephrine? (3)
Fluid boluses prn
Continue Norepinephrine
Consider pressors and inotropes as needed
Sepsis Scvo2 >70 signs of shock resolves after initial vasopressor?
Monitor in ICU
Treat infection source
Management of shock after ROSC initial three actions?
Titrations FiO2 to SpO2 of 94-99%
Consider advanced airway
Target PCO2 appropriate for pt condition
Shock post ROSC three treatments for persistent shock?
Treat contributing factors (Hs, Ts)
Boluses 20 ml/kg
Consider inotropes or vasopressors
Three post ROSC hypotension shock medications?
Epinephrine
Dopamine
Norepinephrine
Four medications for post ROSC normotensive shock?
Dobutamine
Dopamine
Epinephrine
Milrinone
Post ROSC care after pressors and inotropic support? (6)
Treat agitation or seizures
Treat hypoglycaemia
Blood gas and electrolytes
If comatose targeted temperature management
Consider consult and transport to tertiary care
