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A1 > PALS ch 1 > Flashcards

PALS ch 1 Flashcards

1
Q

What is the rate of ventilation for a child?

A

1 breath ever 3-5 seconds

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2
Q

Under what pulse rate is CPR indicated for a child?

A

60 bpm

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3
Q

When a child goes down, do you call 911 first, or start compressions first (for a single rescuer)?

A

If witnessed, call 911

If not, then start CPR

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4
Q

What is the ventilation to compression ratio in children for 1 and 2 rescuer provider(s)?

A 
1 = 30:2
2 = 15:2
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5
Q

When should you use an AED?

A

ASAP

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6
Q

Where should you palpate a pulse in an infant? Child?

A 
INfant = brachial pulses
Child = carotid or femoral
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7
Q

What is the first step in the BLS primary survey?

A

Ensure scene safety

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8
Q

Checking for a pulse and breathing should take no longer than how many seconds?

A

10

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9
Q

If you find an infant with a pulse and breathing, what should be done?

A

Monitor until help arrives

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10
Q

If you find an infant with a pulse, but not breathing what should be done?

A

ventilate them at 1 breath every 5 seconds

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11
Q

What is the technique for compressions in an infant?

A

two fingers

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12
Q

What is the rate of compressions for an infant or child?

A

Same as adult: 100-120 bpm

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13
Q

What is the chest compression depth for a child?

A

2 in or 5 cm

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14
Q

What is the chest compression depth for an infant?

A

1.5 inches, 4 cm or about 1/3 of the AP chest diameter

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15
Q

True or false: adult pads for a kid is better than no pads

A

True

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16
Q

What age is adult pads preferred over child pads?

A

8 years

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17
Q

What are the components of the TICLS mnemonic for appearance of a child?

A 
Tone
Interactiveness
Consolability
Look/grimace
Speech
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18
Q

What are the components of the primary and secondary survey?

A 
Primary = ABCDEs
Secondary = Focused H and P
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19
Q

At what age do back slaps become abdominal thrusts for choking children?

A

1 year

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20
Q

When should you begin CPR for a choking child?

A

When they become unresponsive

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21
Q

What is the respiratory rate for:

  • Infants =
  • Toddler =
  • Preschooler =
  • School-aged =
  • Adolescent =
A
  • Infants = 30-53
  • Toddler = 22-37
  • Preschooler = 20-28
  • School-aged = 18-25
  • Adolescent = 12-20
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22
Q

A consistent RR of over (__) or under (__) is abnormal at any age?

A

Under 10 or over 60

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23
Q

How long can the pause be in an infant periodic breathing be before it is considered abnormal?

A

15 seconds

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24
Q

What are the common causes of tachypnea without increased signs of respiratory effort?

A
  • Dehydration
  • Fever
  • Sepsis
  • CHD
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25
Q

What are the three categories of apnea?

A
  • Central
  • Obstructive
  • Mixed
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26
Q

What are three major signs of increased work of breathing for infants?

A
  • Nasal flaring
  • Head bobbing
  • Retraction
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27
Q

Where in the chest wall will mild to moderate retractions occur? Severe?

A
  • Mild-moderate = subcostal, substernal, intercostal

- Severe = Supraclavicular, suprasternal, sternal

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28
Q

What are seesaw respirations? What does this type of breathing usually indicated?

A
  • When the chest retracts and the abdomen expands during inspiration
  • Usually indicated upper airway obstruction
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29
Q

Why is seesaw breathing an emergency?

A

Cause is usually emergent, but also fatigue will set in soon

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30
Q

What is the normal tidal volume (in mL/kg) that is true throughout life?

A

5-7 mL/kg

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31
Q

Where are the anterior, lateral, and posterior listening posts for assessing an infant’s breathing?

A
  • Anterior = Just lateral to the sternum
  • Lateral = axillae
  • Posterior = Both sides of the back
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32
Q

Where is the best place to listen to the lower part of an infant’s lungs? Why?

A

-Axillae, because chest wall is thin, and this is least likely place breath sounds from other lung or upper airway will be transmitted

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33
Q

What is the purpose of grunting in infants?

A

Keep lower airways open

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34
Q

What Does grunting in an infant usually indicate?

A

Sign of lung tissue disease resulting from small airway compromise (e.g. pneumonia, ARDS, pain)

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35
Q

Is wheezing usually present during inspiration or expiration?

A

Expiration

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36
Q

What is a normal pulse ox reading?

A

94%+

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37
Q

What is a normal awake heart rate for the following:

  • Neonate =
  • Infant =
  • Toddler =
  • Preschooler =
  • School aged child =
  • Adolescent =
A
  • Neonate = 100-205
  • Infant = 100-180
  • Toddler = 100-140
  • Preschooler = 80-120
  • School aged child = 75-120
  • Adolescent = 60-100
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38
Q

True or false: weak central pulses are always abnormal

A

True

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39
Q

How much hemoglobin needs to be desaturated to produce cyanosis? What is the significance of this?

A

5 g/dL of Hb need to be desaturated

Children may have significant hypoxemia if they’re anemia, but will not be cyanotic

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40
Q

What percent of the arm should a BP cuff cover in a child?

A

should cover 50-75% of the length of the upper arm (from axilla to antecubital fossa)

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41
Q

What is the definition of hypotension in terms of SBP for:

  • Term neonates
  • Infants (1-12 months)
  • 1-10 years
  • Children over 10
A
  • Term neonates = 60
  • Infants (1-12 months) = 70
  • 1-10 years = 70 +2*(age in years)
  • Children over 10 = 90
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42
Q

What is the normal urinary output for infants? Young children? Adults?

A 
Infants = 2 mL/kg/hr
Children = 1 mL/kg/hr
Adults = 0.5 mL/kg/hr
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43
Q

What are the components of the verbal parts of the GCS score?

A 
5 = Oriented
4 = Confused
3 = Incoherent words
2 = incomprehensible sounds
1 = none
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44
Q

What are the components of the visual parts of the GCS score?

A 
4 = spontaneously
3 = to voice
2 = to pain
1 = none
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45
Q

What are the components of the motor parts of the GCS score?

A 
6 = obeys commands
5 = localizes pain
4 = withdraws from pain
3 = decorticate
2 = decerebrate
1 = none
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46
Q

How is the severity of TBIs rated by GCS score?

A

15-13 mild
9-12 moderate
9 or less = severe

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47
Q

What is the verbal scoring system in GCS for small children?

A 
5 = smiles, coos, and babbles
4 = cries, but consolable
3 = inconsolable 
2 = Moans, grunts to pain
1 = No response
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48
Q

What is the definition of hypoglycemia in a newborn and a child?

A 
Newborn = less than 45 mg/dL
Child = less than 60 mg/dL
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49
Q

Do petechiae and/or purpura blanch with pressure?

A

No

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50
Q

What is the limitations of using PaO2 in determining the oxygenation status of a patient?

A

Only measures O2 content in blood. Thus if anemic, the patient may still be hypoxic with normal PaO2

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51
Q

What other variable is needed to determine the oxygen saturation from a PaO2 measurement?

A

pH

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52
Q

When is a VBG useful?

A

When the patient is not well perfused

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53
Q

What is the role of PaO2 in a VBG?

A

Not useful

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54
Q

What is the normal range for SvO2? What about if the arterial concentration is lower?

A
  • 70-75%, assuming arterial is 100%

- Otherwise 25-30% lower than arterial

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55
Q

If a patient has an elevated lactate, what other lab abnormality must be present to correctly diagnose ischemia?

A

A metabolic acidosis needs to be present

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56
Q

What are the top three causes of cardiac arrest in children?

A
  • Respiratory arrest
  • Shock
  • Arrhythmia
57
Q

What are some cardiogenic causes of cardiac arrest in children?

A
  • HOCM
  • Long QT syndrome
  • Anomalous coronary artery
  • Myocarditis
  • Channelopathies
58
Q

What is commotio cordis?

A

Sharp blow to the chest, causing cardiac arrest

59
Q

What are the 6 H’s?

A
  • Hypoxia
  • Hyper/hypokalemia
  • Hypothermia
  • Hydrogen Ions
  • Hypovolemia
  • Hypoglycemia
60
Q

What are the 5 T’s?

A
  • Tamponade
  • Tension PTX
  • Toxins
  • Thrombosis coronary
  • Thrombosis pulmonary
61
Q

How long should it take to deliver a breath?

A

About 1 second

62
Q

What is the relative dose amount for epi given via the ET route as compared to the IV/IO route?

A

10x

63
Q

True or false: there is no evidence that performing chest compressions in a child with normal heart activity is harmful

A

True

64
Q

What is the dose of epinephrine in PALS?

A

0.01 mg/kg (0.1 mL/kg of the 0.1 mg/mL concentration)

65
Q

What is the dose of amiodarone in PALS?

A

5 mg/kg bolus, repeated up to 2x

66
Q

What is the dose of lidocaine in PALS?

A

1 mg/kg bolus, 20-50 mcg/kg/min maintenance

67
Q

What is the amount of electricity in Joules for the first and second shock for pediatric arrest?

A

2 j/kg first shock

4 j/kg for each additional shock

68
Q

What is the max shock dose for children in Vfib/vtach?

A

10 J/kg

69
Q

What is the dose of Mg for PALS?

A

25-50 mg/kg bolus

70
Q

What are the only two modifications to the BLS algorithm in pediatric drowning cases?

A
  • C-spine precautions

- Hypothermia precaustions

71
Q

What is the role of monitoring PETCO2 in patients with a single ventricle?

A

Not as useful, since it may not reflect CO

72
Q

What is the treatment for hypoxia due to a diffusion defect?

A

Application of non-invasive PPV

73
Q

What are some causes of V/Q mismatch?

A
  • PE
  • Pneumonia
  • Atelectasis
  • Asthma
  • Bronchiolitis
  • FB
  • ARDS
74
Q

What is the treatment for a V/q mismatch?

A

PPV

75
Q

What are causes of alveolar hypoventilation?

A
  • CNS problem
  • TBI
  • Drug overdose
  • Neuromuscular weakness
  • Apnea
76
Q

What are the two major extrapulmonary diseases that decrease lung compliance?

A

Pleural effusion

PTX

77
Q

What are the four major categories of etiologies of respiratory distress?

A
  • Upper airway obstruction
  • lower airway obstruction
  • Lung tissue disease
  • Disordered control of breathing
78
Q

Which generally denotes an upper and lower airway obstruction: inspiratory noise vs expiratory

A 
Inspiratory = upper
Expiratory = lower
79
Q

What causes the air trapping with asthma?

A

Proximal bronchioles collapse, trapping air distally

80
Q

What is the typical response of an infant to asthma?

A

Tachypnea more so than deep breathes

81
Q

What is the typical response of infants to lower airway disease? Why?

A
  • Grunting respirations

- This maintains end expiratory pressure to attempt to maintain lower airways open

82
Q

Most children with respiratory compromise can maintain ventilation (elimination of CO2), but cannot maintain oxygenation. what is the significance of this

A

hypercarbia is a late manifestation of lung disease

83
Q

Disordered breathing is typically due to effects in what major organ system?

A

Neurologic function

84
Q

How often are breaths delivered for infants and children with respiratory arrest?

A

1 breath every 3-5 seconds (12-20 breaths per minute)

85
Q

What are the downsides of suctioning?

A

May increase respiratory distress and/or agitate the child

86
Q

What are the characteristics of mild, moderate, and severe croup?

A
  • Mild = Occasional barking cough, no stridor
  • Moderate = Frequent barking cough, stridor at rest, but good air entry
  • Severe = Barking cough, prominent stridor and poor air entry
87
Q

What is the treatment for mild croup?

A

Dexamethasone, supportive

88
Q

What is the treatment for moderate croup?

A
  • Supplemental O2
  • Nebulized epi
  • Dexamethasone
  • Heliox
89
Q

What is heliox?

A

Helium-oxygen mixture used for severe respiatory distress

90
Q

How long should you observe a child after giving racemic epi? Why?

A

2 hours to ensure no recurrence of stridor

91
Q

What is the treatment for severe croup?

A
  • IV/IM dexamethasone
  • Assist ventilation
  • ET or surgical airway if needed
92
Q

How often should epi be administered for anaphylaxis in children?

A

q10-15 minutes as needed

93
Q

What are the treatments, besides epi, for anaphylaxis? (4)

A
  • Methylprednisolone or = IV
  • Albuterol
  • Antihistamine
  • IVFs, intubation, etc
94
Q

Over what age is the heimlich maneuver indicated?

A

Over 1

95
Q

When is CPR administered with a choking child? What should be done while performing CPR?

A
  • As soon as they become unresponsive

- Between sets of compressions, look in the airway for obstruction

96
Q

True or false: performing a blind finger sweep is recommended in a unresponsive choking infant

A

False–this may push the FB further in

97
Q

What is the first priority in children with lower airway compromise: oxygenation or ventilation (removal of CO2)? Why?

A

Oxygenation, because children can tolerate hypercarbia without adverse effects

98
Q

How is bagging a child with a lower airway obstruction different than other bagging?

A

Slower rate to allow more time to exhale trapped air

99
Q

What are the risks of bagging a patient?

A
  • Air trapping
  • PTX
  • Gastric distention
100
Q

What is the only way to truly distinguish asthma vs bronchiolitis in an infant?

A

History of reversible wheezing

101
Q

What is the treatment for bronchiolitis?

A

Supportive care

102
Q

What is the role of nebulized epi or albuterol in the treatment of bronchiolitis?

A

Some infants benefit, can harm others. If using, discontinue if there is no benefit

103
Q

Breathlessness with what activities characterize mild, moderate, and severe asthma?

A 
Mild = with walking
MOderate = with talking
Severe = At rest
104
Q

Is there typically tachycardia with mild, moderate, and/or severe asthma?

A

Mild no, moderate and severe yes

105
Q

What PEF value after neb treatment (in %) characterizes mild, moderate, and severe asthma?

A 
Mild = over 80%
Moderate = 60-80%
Severe = Less than 60%
106
Q

When does pulsus paradoxus present with asthma (mild, moderate, or severe)?

A

Moderate and up

107
Q

What SaO2 levels characterize mild, moderate, and severe asthma?

A 
Mild = 95%+
Moderate = 91-9%
Severe = 90% or below
108
Q

What medications are used at the mild, moderate, and severe level of asthma?

A
  • Mild = O2,albuterol, oral steroids
  • Moderate = O2, Continuous albuterol, IV steroids, ipratropium, IV mag
  • Severe = above +terbutaline IV, bipap or ET tube
109
Q

What is the goal time to administer Abx to children with pneumonia?

A

Within 1 hour of ED arrival

110
Q

What are the two general measures to reduce metabolic demand in children with pneumonia?

A
  • Antipyretics

- Reduce work of breathing

111
Q

What, generally, is chemical pneumonitis?

A

Inhalation of a chemical that causes inflammation and noncardiogenic pulmonary edema

112
Q

What are the interventions, besides O2, for chemical pneumonitis? Last resort?

A
  • Nebs, CPAP, intubation

- ECMO

113
Q

What, generally, is aspiration pneumonitis?

A

Aspiration of gastric contents, causing inflammation and noncardiogenic pulmonary edema

114
Q

When should abx be used in the treatment of aspiration pneumonitis?

A

If fever and infiltrates on CXR are present

115
Q

True or false: abx prophylaxis is indicated in cases of aspiration pneumonitis

A

False

116
Q

What are the causes of cardiogenic pulmonary edema in children?

A
  • LV dysfunction
  • Myocarditis
  • Cardiomyopathy
  • CHD
  • drugs
  • hypoxia
117
Q

What are the components of treatment for cardiogenic pulmonary edema?

A
  • Ventilator (non/invasive) support with PEEP
  • Diuretics
  • Reduce fever and work of breathing
118
Q

What are the three major indications for ET intubation in children with cardiogenic pulmonary edema?

A
  • Hemodynamic instability
  • Persistent hypoxia despite noninvasive measures
  • Impending respiratory failure
119
Q

How is PEEP dosed?

A

Start at 5 mm H2O, and work up until oxygenation improves

120
Q

What are the usual causes of ARDS?

A
  • Systemic inflammation (e.g. pancreatitis, sepsis)

- Pneumonia (aspiration)

121
Q

What is the defining clinical value for ARDS?

A

PaO2/FiO2 less than 300 (with ventilation)

122
Q

What will CXR show in ARDS?

A

Will show parenchymal disease

123
Q

What disease process must be excluded to diagnose ARDS?

A

Cardiogenic pulmonary edema

124
Q

What is the equation for oxygenation index, and a value of what or greater indicates ARDS?

A

(FiO2 x mean airway pressure x100) / PaO2

Value 4 or greater

125
Q

What measures besides vitals should a patient with ARDS have monitored?

A

ETCO2, cardiac monitor

126
Q

What are the lab studies that should be obtained in ARDS?

A
  • ABG
  • Central venous blood gas
  • CBC
127
Q

Should tidal volumes and PEEP be low or high with ARDS?

A 
TV= low
PEEP = higher
128
Q

What is permissive hypercarbia in the setting of ARDS?

A

Allowing increased levels of CO2 in the blood because O2 is the more important determinant of outcomes

129
Q

Maintaining peak inspiratory pressure below what values is important for ARDS?

A

Below 35 cm H2O

130
Q

What is the tidal volume (in mL/kg) for treating ARDS in children?

A

5-8 Ml/kg

131
Q

Ddx for disordered control of breathing? (7)

A
  • Drugs
  • Increased ICP
  • CNS infx
  • Metabolic /Hyperammonemia
  • Hydrocephalus
  • Neuromuscular disease
  • Seizures
132
Q

What are the components of Cushing’s triad?

A
  • Irregular breathing
  • Increased mean arterial pressure
  • Bradycardia
133
Q

What is the role of IVFs in the treatment of increased ICP?

A

Give 20 mL/kg in children if s/sx of poor end organ perfusion develop

134
Q

What is the role of antipyretics in the treatment of increased ICP?

A

used to avoid or aggressively treat fevers

135
Q

Why is hyperventilation not longer a treatment for increased ICP unless there is a brainstem herniation?

A

Reduces cardiac output, and reduces cerebral blood flow

136
Q

What are the tests that should be ordered for a child with central causes of respiratory failure/drug OD?

A
  • EKG
  • ABG
  • CXR
  • CBC/CMP
  • Serum osmols
  • Drugs screen
137
Q

What is the effect of using succinylcholine in patients with neuromuscular diseases?

A

Hyperkalemia, or worsening of respiratory muscle weakness

138
Q

What are the three general things that should be avoided with increased ICP (hyper/hypo things)?

A
  • Hypoxemia
  • Hypercarbia
  • Hyperthermia

A1 (32 decks)

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