PALS Flashcards
In CPR during which you have an advanced airway, what is the rate of ventilation?
Continuous at 8-10 breaths per minute
In ventricular fibrillation, what are the doses of shock you might use?
- First: 2 J/kg
- Second: 4 J/kg
- Third and subsequent shocks: 4-10 J/kg with max of adult dose
What are code doses of epinephrine?
- IV or IO: 0.01 mg/kg every 3-5 minutes
- ETT: 0.1 mg/kg
What are the H’s and T’s?
Hypoxia Hypovolemia Hyper-/hypokalemia Hypothermia H+ (acidosis) Tamponade Tension PTX Thrombosis Toxins
What are shocking doses in synchronized cardioversion?
- First: 0.5 J/kg
- Subsequent: 2 J/kg
Adenosine doses for SVT are what?
- First 0.1 mg/kg (max 6 mg)
- Second 0.2 mg/kg (max 12 mg)
What is the SVT dose of amiodarone?
5 mg/kg over 20 minutes
True or false: give adenosine to stable VT.
True
Cardiovert if unstable
What are the treatments for stable and unstable SVT?
Stable: vagal maneuvers -> adenosine
Unstable: cardiovert
What is the pediatric dose of amiodarone?
5 mg/kg
What is the pediatric dose of lidocaine?
1 mg/kg
In pediatric bradycardia, ________ is the first line agent.
epinephrine (unless there is known AV block, in which case it is atropine)
Infants should be given what type of resuscitative fluid?
Isotonic
What is the PALS dose of atropine?
0.02 mg/kg IV
What is the formula for ET tube size in children?
- Uncuffed: Age/4 + 4
- Cuffed: Age/4 + 3.5
Rescue breaths for children during resuscitation with a bag-mask or ETT in place are ________.
every 2-3 seconds
The proper depth for pediatric chest compressions is __________.
1/3 the depth of the chest or 2 inches
If you find an infant unresponsive and no one else is around, how long should you do CPR before going to get an AED?
2 minutes
Review the rescue breaths given by age and rescuer number.
- Adults: always 30:2
- Infants and children with only one rescuer: 30:2
- Infants and children with two rescuers: 15:2
When you are giving bag-mask breaths, always check for _____________.
chest rise
When should you use the pediatric pads?
When the child is less than 1 year old or 10 kg in weight
in a resuscitation event, what type of ETT is preferred for children?
Cuffed
Cuffed tubes have been shown to have decreased need for reintubation, better capnography, and decreased risk of aspiration.
Routine cricoid pressure has been shown to increase ________.
the rate of intubation failure
In which patients should you give naloxone?
In those with a pulse but absent or agonal breathing
Which pulses should you check in PALS?
- Children: carotid
- Babies: brachial
The AHA defines “child” as ____________.
1 year to puberty (with puberty being defined as underarm hair or breasts if the child’s puberty status is not known)
What should guide your placement of an air mask?
The top part of the mask should be applied to the bridge of the nose.
Each breath should be delivered over _________.
1 second
True or false: AEDs can be used on someone lying in snow or a small puddle.
True
Silent cough is a sign of ____________.
choking
The proper way to relieve choking in a child is to ___________.
perform the abdominal thrust
What is the proper positioning for the abdominal thrust?
Stand behind the child. Locate the navel and place your fist with your thumb toward their abdomen. Grab your fist with your other hand. Thrust inward and upward until the object is expelled or the person becomes unresponsive. If they become unresponsive then perform CPR.
How is CPR on a choking child different from other cases of CPR?
When you give rescue breaths look for an easily removable object, If present then remove.
Do NOT perform a blind finger sweep as this can push the object farther in the airway if present.
Review the procedure for relieving choking in a responsive infant.
- Position the infant on one of your forearms, face down with head lower than the chest.
- Use the heel of your other hand to strike the child in the back five times.
- Flip the child into your other forearm and perform five c˙hest compressions.
What is the pediatric assessment triangle?
It’s a tool to help initially assess a patient.
- Appearance
- WOB
- Circulation
Review the steps of the pediatric primary survey.
- Airway: is the child breathing with a clear-sounding airway? Is there any airway trauma that may compromise breathing? If any of these things are not reassuring, try to reposition the child and if that fails then move to an advanced airway.
- Breathing: is the chest rising equally on both sides? Is air movement clear and equal? If not then consider interventions such as supplemental oxygen, a chest tube, or nebulizer meds.
A BP cuff that is too small will give values that are _________.
falsely high
The inverse is true too.
What is the formula for hypotension in a child 1-10?
Less than 70 plus 2x the age in years.
What is the AVPU scale?
It is a scale for assessing the mental status (the D in the ABCDE of the primary assessment). Is the patient’s status
- Alert
- Voice responsive
- Pain responsive
- Unresponsive
What is the lower threshold for infantile and pediatric hypoglycemia?
60
How are adult and pediatric airways different?
Adult airways are cylindrical with the narrowest point being the vocal cords, while pediatric airways are conical and have the narrowest point at the cricoid cartilage.
True or false: the cricoid ring is superior to the vocal cords.
False
What are the O2 flow rates of simple masks vs nonrebreather?
Simple mask: 6-10 L/min
Nonrebreather: 10-15 L/min
Simple masks are also not pure oxygen because they are mixed with ambient air.
What is the proper way to size an oropharyngeal airway?
Tip of the mouth to angle of the mandible
Importantly, oropharyngeal airways should only be used in _____________.
unconscious people (the gag reflex needs to be fully off)
Define obstructive shock.
Obstructive shock is shock that is caused by a physical obstruction to the heart’s function (such as PE, tamponade, PTX, or congenital heart disease).
What are the main causes of cardiac arrest in children and adults?
- Children: respiratory failure and hypotension
- Adults: ventricular arrhythmias
What is the post-ROSC SpO2 goal?
94-99%
This is because you want them to not be hypoxic but you also don’t want to hyper-oxygenate them, which could lead to cell injury from free radicals.
According to PALS, if a child remains comatose after ROSC, then maintain temp _____________.
32 - 34
Pre-RSI atropine is indicated for which age groups?
Less than 1 year of age for all
Less than 5 years receiving succhinylcholine
All bradycardic children.
Dose is 0.02 mg/kg (so for a 15 kg child 0.3 mg)
