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A1 > Pals Ch 7.5 + > Flashcards

Pals Ch 7.5 + Flashcards

1
Q

What is the role of pop-off valves with a bag mask, and when does this need to be closed?

A

-Used so that excessive airway pressures are not used
-Need to be closed if performing CPR, since compressions will open it

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2
Q

What is a self inflating bag, and a flow inflating bag?

A

Self inflating are the ones used by EMS that will inflate by themselves

Flow inflating bags are the ones used by anesthesiologists, and inflate only with a flow of oxygen AND a good seal

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3
Q

What size (in mL) self inflating bags should be used with infants/children and adults?

A

500 mL for children
1000 mL for adults

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4
Q

When does the rest of the body catch up to occiput size, and a child no longer needs padding underneath their back for ventilation?

A

2 years

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5
Q

True or false: Bag mask ventilation can be used to assist a spontaneously breathing child

A

True

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6
Q

If a pt gets harder to bag, what three major etiologies should come to mind?

A

-PTX
-Airway obstruction
-Air stacking

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7
Q

Why might suctioning cause bradycardia?

A

Vagal stimulation

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8
Q

How do you measure an OPA?

A

Corner of the mouth to the angle of the jaw

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9
Q

What must be considered in children when applying an oxygen mask?

A

Increased agitation may worsen hypoxemia

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10
Q

What are the two major low flow oxygen delivery devices? High flow?

A

Low flow = nasal cannula, simple oxygen mask
High flow = Non-rebreather, high flow NC

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11
Q

What is the appropriate level of O2 flow rate for a NC?

A

4 L/min

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12
Q

What is the appropriate level of O2 flow rate for a simple face mask?

A

6-10 L/min

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13
Q

What is the appropriate level of O2 flow rate for a Non-rebreather?

A

10-15 L/min

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14
Q

What is the appropriate level of O2 flow rate for a high-flow NC?

A

4-40 L/min

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15
Q

What is the appropriate level of medication flow rate for a nebulizer? How long should they use the neb for?

A

-5-6 L/min
-8-10 minutes

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16
Q

What should be done if there are no infant sized pulse ox probes?

A

Attach adult sized one to hand of infant

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17
Q

What are the components of the DOPE mnemonic for sudden deterioration in the intubated patient?

A

Displacement of tube
Obstruction of tube
PTX
Equipment failure

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18
Q

What are the components of the SOAPME mnemonic for checklist prior to intubation?

A

Suction
Oxygen
Airway equipment
Pharmacologic agents
Monitoring equipment

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19
Q

What are the 4 monitoring devices needed prior to RSI?

A

-Monitor
-Pulse ox
-BP
-ETCO2

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20
Q

True or false: shock can be present with a normal BP

A

True

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21
Q

What is ScvO2? What are the two causes of a decrease in this number?

A

Venous oxygen content
-Decreased cardiac output
-Increased metabolic demand

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22
Q

Why can arrhythmias like heart blocks and junctional rhythms lead to decreased cardiac output?

A

Loss of appropriately timed atrial kick

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23
Q

Why are infants more dependent on HR to increased CO?

A

Because SV is fixed more so than in an adult

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24
Q

What are the three factors that determine SV?

A

Preload
Contractility
Afterload

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25
Q

Why does CVP not perfectly correlate to preload?

A

If right atrium has increased pressure (e.g. tPTX), then pressure will increased, but there will be no increase or even a decrease in preload

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26
Q

What does the body do when tissue perfusion is inadequate? How does this impair cardiogenic shock caused by increased afterload?

A

Constricts vessels, which will increase afterload, and worsen problem

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27
Q

What are two major causes of increased afterload in the child?

A

pHTN/HTN
Aortic stenosis

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28
Q

What happens to pulse pressure with hypovolemic shock?

A

Decreases

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29
Q

What defines compensated shock?

A

Decreased perfusion, but normal BP

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30
Q

What can you do to assess if an automated BP cuff is getting an accurate measurement, besides doing a manual check?

A

See if extremity is well perfused

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31
Q

What is the definition of hypotension in children 1-10- years of age (formula)?

A

Less than: 70+ (age *2)

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32
Q

What are the four major types of shock?

A

Obstructive
Cardiogenic
Distributive
Hypovolemic

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33
Q

Why is tachypnea a compensatory mechanism for blood loss?

A

Respiratory alkalosis to combat lactic acidosis from hypoxia

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34
Q

Why might SvO2 be decreased in septic shock?

A

-Maldistribution of blood flow
-Sepsis may cause inability to utilize O2 at cellular level

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35
Q

What happens to preload, contractility, and afterload with distributive shock?

A

-Preload = decreased
-Contractility = normal or decreased
-Afterload = variable

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36
Q

What happens to pulse pressure in distributive shock?

A

-If warm extremities = widened
-If cold extremities = narrow

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37
Q

What is the role of the adrenal glands in septic shock?

A

If infarcted or ischemic, will not produce the necessary catecholamines to maintain BP, worsening shock

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38
Q

What causes the decreased cardiac output with anaphylactic shock?

A

Increased pulmonary resistance

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39
Q

Neurogenic shock is caused by a loss of SNS activity at and above what spinal level?

A

T6

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40
Q

What happens with pulse pressure in neurogenic shock?

A

Increased

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41
Q

What happens to HR, afterload, and SVR with cardiogenic shock?

A

Tachycardia with high SVR and high afterload

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42
Q

How is tachypnea different in cardiogenic shock from other forms of shock?

A

Pulmonary edema in cardiogenic causes marked respiratory distress, while other forms/causes of shock have a “quiet” tachypnea

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43
Q

How can you differentiate cardiogenic shock from other forms of shock?

A

-S/sx of CHF
-Cyanosis
-Cool extremities

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44
Q

What is the role of volume resuscitation in cardiogenic shock?

A

Detrimental–give in small boluses of 5-10 mL/kg (about half normal amount)

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45
Q

What are the four major causes of obstructive shock?

A

-PE
-tPTX
-Cardiac tamponade
-Ductal dependent lesions

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46
Q

What happens to preload, contractility, and afterload with obstructive shock?

A

Preload = variable
Contractility = normal
Afterload = increased

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47
Q

What will be heard on auscultation of the heart with cardiac tamponade?

A

Muffled heart sounds

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48
Q

What is pulsus paradoxus? How do you determine this clinically?

A

-Decrease in SBP by more than 10 mmHg during inspiration
-Using a manual cuff, inflate the cuff. Deflate slowly, and listen for the first K sounds when child is exhaling. Note the second time when it is heard throughout the respiratory cycle. If this difference is greater than 10 mmHg, then you have it.

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49
Q

When do ductal dependent lesions typically present?

A

Within the first days to weeks of life

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50
Q

What are the ductal dependent heart syndromes that cause cardiogenic shock?

A

-Coarctation of the aorta
-Critical aortic stenosis
-Hypoplastic left heart
-Interrupted aortic arch

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51
Q

What are the distinguishing clinical features of cardiogenic shock from ductal dependent lesions?

A

-Difference in central vs peripheral pulses/BP
-3-4% higher O2 sat on right side

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52
Q

How can you distinguish cardiogenic shock from a PE clinically?

A

S/sx of right heart failure will be present

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53
Q

Which types of shock have labored breathing?

A

Cardiogenic and obstructive

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54
Q

Increasing tachycardia in a child = ?

A

Shock

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55
Q

What are the four main components of treating shock in a child?

A

-Maximize O2
-Improve cardiac output
-Reduce O2 demand
-Correct metabolic derangements

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56
Q

What are the three main drivers of increased O2 demand in children?

A

-Pain and anxiety
-Increased work of breathing
-Fever

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57
Q

Why should sedative agents be used cautiously in children in shock?

A

Will decrease endogenous stress response

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58
Q

What are the four major metabolic derangements in children in shock?

A

-Hypoglycemia
-Hypocalcemia
-Hyperkalemia
-Lactic acidosis

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59
Q

How does serum ionized Ca relate to pH?

A

Inversely

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60
Q

What is the relationship between K and H+ ions?

A

Cell will try to take up more H+, exchanging it with K+, meaning acidosis is often accompanied by hyperkalemia

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61
Q

What cause of acidosis is caused by HCO3 loss?

A

Diarrhea

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62
Q

When is IO access useful in shock?

A

Flat veins and quick need for fluids

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63
Q

What is the bolus amount in children, and how fast should it be given? What if cardiogenic shock?

A

20 mL/kg over 10-20 minutes
10 mL/kg if cardiogenic shock

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64
Q

What is the goal urinary output in infants, children, and adults?

A

Infants = 2 mL/kg/hr
Children = 1 mL/kg/hr
Adults = 0.5 mL/kg/hr

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65
Q

How many boluses of fluid do you give?

A

Reassess after each one, and titrate to response

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66
Q

Why get CBC with shock? (3 lab values and their significance)

A

-Hb = hemorrhage/hemolysis
-WBCs = sepsis
-Platelets = DIC

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67
Q

Why get glucose with shock? (3)

A

Sepsis
Adrenal insufficiency
Decreased production (liver)

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68
Q

Why get potassium with shock? (4)

A

-Renal dysfunction
-Acidosis
-Diuresis
-Adrenal insufficiency

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69
Q

Why get Ca with shock? (3)

A

-Sepsis
-transfusion/colloid hypocalcemia
-NaHCO3 use

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70
Q

Why get lactate with shock?

A

Measure and trend acidosis and treat it

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71
Q

Why get ABG with shock?

A

Determine etiology of shock (lactic acidosis, poisoning, anion gap)

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72
Q

Why get SvO2 with shock?

A

-If low, need to maximize O2 delivery
-If high, maldistribution

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73
Q

When should vasopressor be used in shock?

A

Only after several fluid boluses

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74
Q

Why are vasodilators helpful in cardiogenic shock?

A

Reduces SVR and afterload

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75
Q

What is Milrinone, and what is its effects?

A

Phosphodiesterase inhibitor
-Decreases SVR
-Improves coronary blood flow
-Improves contractility

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76
Q

What are the three major inotropes?

A

-Epi
-Dopamine
-Dobutamine

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77
Q

What vasodilator does not increased cardiac contractility?

A

Vasopressin

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78
Q

What may happen to a sick child with a bolus of fluids that is too much or too fast?

A

Pulmonary and/or peripheral edema

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79
Q

What can colloids cause that crystalloids cannot?

A

-Hypersensitivity rxns
-Coagulopathies
-Hypocalcemia (?)

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80
Q

What is the risk of giving fluids too fast with DKA?

A

Cerebral edema due to high osmolarity of blood

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81
Q

What is the rate of fluid bolus for kids in DKA? What is the exception to this?

A

10-20 mL/kg over 1-2 hours instead of 10-20 minutes

If crashing in hypotensive shock, then give the usual amount

82
Q

OD of what medications may lead to fluid boluses causing pulmonary edema?

A

CCBs or BBs

83
Q

What is the rate of IVF boluses in poisonings? Why?

A

5-10 mL/kg over 10-20 minutes, since some meds (e.g. CCBs, BB) will lead to pulmonary edema

84
Q

Do standard infusion pumps have a high enough rate for bolus infusion?

A

No

85
Q

What needs to be done after each fluid bolus in a shock child?

A

Reassess and look/listen for pulmonary edema or other untoward effects

86
Q

Deterioration after fluid boluses = ?

A

Cardiogenic shock

87
Q

Persistently delayed cap refill in a shock child with several boluses = ?

A

Ongoing hemorrhage

88
Q

What is the dose of pRBCs for children with hemorrhagic shock?

A

10 mL/kg

89
Q

What is the difference between crossmatch and type specific blood?

A

Crossmatched has been ensured that no antibodies that will cause side effects are present, while type specific is Rh and ABO compatible, but may have these

90
Q

When should Ca be administered to children receiving blood?

A

If hypotensive or has hypocalcemia

91
Q

What three major side effects can occur if administering cold blood?

A

-Hypothermia
-Myocardial dysfunction
-Ionized hypocalcemia

92
Q

True or false: you should treat hypoglycemia in shock

A

True

93
Q

Why might hyperglycemia happen with shock, and should you treat it?

A

-Cortisol increases and decreased perfusion
-Can treat with maybe better outcomes, but risk hypoglycemia, which is worse

94
Q

What is the definition of hypoglycemia in a preterm or term neonate? Infants? Children? Adults?

A

Preterm/term neonates = 45 or less
Everyone else = 60 or less

95
Q

What is the treatment for asymptomatic and symptomatic hypoglycemia? Dose?

A

-Asymptomatic = oral glucose (e.g. OJ)
-Symptomatic = 5-10 mL/kg of D10

96
Q

What percent and mL/kg represent mild, moderate, and severe dehydration in children?

A

Mild = 5% or 50 mL/kg
Moderate = 10% or 100 mL/kg
Severe = 15% or 150 mL/kg

97
Q

What is the amount of blood in a child (in mL/kg)?

A

80 mL/kg

98
Q

At what level of volume loss do infants and children become lethargic and altered (mild, mod, or severe)?

A

Moderate

99
Q

What is the IVF to blood ratio given in hemorrhagic shock in children?

A

3:1

100
Q

What is the dose (in mL/kg) of pRBCs and whole blood for children?

A

pRBCs = 10 mL/kg
Whole blood = 20 mL/kg

101
Q

When is bicarb indicated for the treatment of acidosis 2/2 hypovolemia?

A

Moribund patients or slightly earlier if due to GI losses

102
Q

What two things does a persistent metabolic acidosis signify in hypovolemic shock?

A

-Ongoing losses
-Inadequate resuscitation

103
Q

What are the three main goals of treating sepsis?

A

-Restore hemodynamic stability
-Support organ function
-Identify and control infection

104
Q

What is the goal time to identify and treat shock respectively?

A

Recognize within 15 minutes, and have several boluses in before 1 hour

105
Q

What is the dose of IVFs for neonates with shock?

A

10 mL/kg

106
Q

What are the five major identifier of shock listed on the septic shock algorithm for peds?

A

-AMS
-HR changes
-Hypotension
-Perfusion (cap refill)
-Temperature

107
Q

What will cap refill time be with septic shock?

A

normal to increased

108
Q

What should be done if a child in septic shock does not respond to IVFs?

A

Pressors and critical care consultation

109
Q

When should epi/dopamine be used to treat shock? Norepi?

A

Epi/dopamine if cold extremities, poor cap refill
Norepi if warm extremities, flash cap refill

110
Q

When should cortisone administration be considered in the treatment of shock?

A

If not responding to fluids/pressors

111
Q

If a child enters the critical stage of hypovolemic shock, what procedural interventions need to happen?

A

-Central line
-Art line
-Intubation

112
Q

What is the first step in stabilizing a pediatric septic shock patient?

A

ABCs

113
Q

What should be done for the critical patient in septic shock whose SvO2 is less than 70% and extremities still cold despite epi administration? With low BP? Adequate BP?

A

-continue IVFs, blood, epi
-If DBP low, add norepi
-If BP adequate, add milrinone or other vasodilator therapy

114
Q

What should be done for the critical patient in septic shock whose SvO2 is greater than 70% and extremities are warm despite norepi administration?

A

-IVFs, norepi
-Add additional vasopressor/inotropic support

115
Q

What should be done for the critical patient in septic shock whose SvO2 is greater than 70%, with resolution of sign of shock?

A

-transfer to ICU

116
Q

What is the goal time for administering abx in septic shock?

A

1 hour

117
Q

What is the normal range for ScvO2?

A

65-85% (should be 25-30% below arterial)

118
Q

What does a very high ScvO2 indicate? (3)

A

-Cyanide poisoning
-Microcirculatory shunting (e.g. sepsis)
-L to R shunts

119
Q

Why is milrinone given to patients with shock with low SvO2 but adequate BP?

A

Improves cardiac output with inotropic effects and vasodilation

120
Q

Why is norepi given to patients with shock with low SvO2 and low BP?

A

Raise BP

121
Q

Why is norepi given to patients with SvO2 less than 70% with warm extremities?

A

Vasoconstrictive effects to increase BP, without increasing HR

122
Q

What is vasopressin?

A

ADH

123
Q

What sort of patients are at risk for adrenal insufficiency?

A

Chronic steroid use

124
Q

What is the dose of hydrocortisone used in fluid refractory shock?

A

1-2 mg/kg IV bolus

125
Q

What is the low dose infusion of epi for anaphylactic shock in children?

A

0.05 mcg/kg/min

126
Q

When is albuterol indicated for the treatment of anaphylactic shock?

A

If bronchospasm occurs

127
Q

Should H1 and H2 blockers be given in combination for anaphylactic shock?

A

yes–may have synergistic effects

128
Q

How long must a child be watched after development and treatment of anaphylaxis? Is there any correlation between severity of anaphylaxis and the chances of delayed symptoms

A

-several hours
-Yes, more severe, more likely to develop symptoms

129
Q

Why is there a wide pulse pressure with neurogenic shock?

A

Low DBP due to loss of SNS

130
Q

What are the mainstays of treatment for neurogenic shock (2)?

A

-Vasopressors
-Warm blankets (due to dysautonomia)

131
Q

What is the most effective way to increase cardiac output in patients with cardiogenic shock?

A

Vasodilators to reduce afterload

132
Q

What is the problem with inotropes in cardiogenic shock? Do you still give them?

A

Will increase cardiac oxygen demand, but still give cautiously and judiciously because increased CO is needed

133
Q

What are the clinical features of cardiogenic shock?

A

-Pulmonary edema
-JVD
-Hepatomegaly

134
Q

What is the role of the ER provider in the treatment of cardiogenic shock?

A

-Stabilize as much as possible, but cardiothoracic surgeon/cardiologist will be needed to diagnose and fix problem

135
Q

What is the hallmark way to diagnose cardiogenic shock?

A

CXR showing cardiomegaly in a shock pt but Echo best

136
Q

What is the amount of fluid boluses (in mL/kg) and over how long (minutes) should fluid be given in cardiogenic shock peds?

A

5-10 mL/kg over 10-20 minutes

137
Q

What intervention should be undertaken if a child develops pulmonary edema?

A

PPV (noninvasive or invasively)

138
Q

What are the 5 major tests that help to diagnose cardiogenic shock?

A

-Hb
-ABG
-Troponin
-lactate
-Thyroid

139
Q

What three studies (not labs) can help diagnose cardiogenic shock?

A

-ECG
-CXR
-Echo

140
Q

What is the preferred drug for the treatment of cardiogenic shock?

A

Milrinone

141
Q

What treatment will maintain a patent ductus?

A

Prostaglandin E1

142
Q

What are the four general locations for IO devices in children?

A

-Below tibial plateau
-Above the medial malleolus
-Distal femur
-ASIS

143
Q

Where is the tibial location site for IO access?

A

Finger breadth below and medial to the tibial plateau

144
Q

What is the first test of the IO to ensure it did not go through bone or into SQ tissue?

A

IVFs–no swelling should occur

145
Q

What are the 4 major causes of primary bradycardia in children?

A

-CHD
-Surgical injury
-Myocarditis
-cardiomyopathy

146
Q

What are the 5 major causes of secondary bradycardia in children?

A

-Hypoxia
-Drugs
-Hypotension
-Acidosis
-Hypothermia

147
Q

What two major classes of drugs can cause 2nd degree type I AV block?

A

BBs and CCBs

148
Q

What are the etiologies of second degree type II AV block?

A

Intrinsic conduction abnormalities from drugs or MI

149
Q

What are the etiologies of third degree AV block? (3)

A

-Extensive injury to the heart
-MI
-Congenital lesions

150
Q

The HR is usually under what value for sinus tachycardia in infants and children respectively?

A

220 bpm for infants
180 for children

151
Q

When is SVT usually diagnosed in a child? Why?

A

Not until pulmonary edema occurs (weeks) since no other symptoms (that an infant can vocalize anyway)

152
Q

What are the s/sx of SVT in infants? (4)

A

-Irritability/sleepiness
-Poor feedings
-Gray or mottled skin
-Tachypnea

153
Q

What are ways to differentiate SVT from ST?

A

ST is gradual in onset, and will vary with activity
SVT is sudden and invariant.

154
Q

When is CPR indicated for a bradycardia in peds?

A

If less than 60 bpm and have cardiopulmonary compromise despite interventions

155
Q

What should be done if CPR alone does not improve pediatric bradycardia?

A

Give epi and/or atropine. Consider pacing.

156
Q

What is the dose of epi for pediatric bradycardia?

A

0.01 mg/kg or 0.1 mL/kg of the 0.1 mg/mL concentration

157
Q

What is the dose of atropine for pediatric bradycardia? What is the minimum and max dose? How often can this be repeated?

A

0.02 mg/kg
Min dose = 0.1 mg
Max dose = 0.5 mg
May repeat once

158
Q

What is the epi dose given via ET tube for pediatrics?

A

0.1 mg/kg (0.1 mL/kg)

159
Q

What is the infusion rate of epi for bradycardia?

A

0.1 -0.3 mcg/kg/min

160
Q

When is atropine the first line drug for peds bradycardia When is it not?

A

Is with primary bradycardia (e.g. AV block)
Is not if secondary (e.g. hypoxia)

161
Q

What changes in the brady/tachy algorithms in heart transplant patients?

A

Since nerves are not reattached completely, atropine/epi may be ineffective. Thus pacing should be considered early

162
Q

What are the 5 Hs and 2 Ts of peds bradycardia?

A

-Hypoxia
-H+ ions
-Hyperkalemia
-Hypothermia
-Heart block
-Toxins
-Trauma

163
Q

Bradycardia in a head trauma = ?

A

Cushings from increased ICP

164
Q

If a monitor is unable to identify R waves for synchronized cardioversion, what can be done?

A

Increase amplitude of EKG

165
Q

What is the dose in J/kg for synchronized cardioversion in children with SVT? What is the first dose is ineffective?

A

0.5 to 1 j/kg, increasing to 2 j/kg if ineffective

166
Q

Why must paddles/pads never touch each other?

A

Arc of electricity

167
Q

What is the role of cardioversion with a-flutter?

A

No effect because does not go through the AV node

168
Q

What are the acute side effects of amiodarone?

A

Hypotension and bradycardia

169
Q

Where is amiodarone eliminated (liver or kidneys)? What is the significance of this?

A

Liver
Cautious use if hepatic failure

170
Q

What is the dose of amiodarone in pediatric tachycardia with poor perfusion, and over how long should this be given?

A

5 mg/kg infused over 20-60 minutes

171
Q

What is the max dose of amiodarone in a child?

A

15 mg/kg

172
Q

What is the dose of procainamide in children, and over how long should this be given?

A

15 mg/kg over 30-60 minutes

173
Q

What must be done when giving procainamide?

A

Constant monitoring of ECG and BP

174
Q

What are the acute side effects of procainamide?

A

Hypotension
Heart block
QT prolongation

175
Q

Why should verapamil NEVER be used in infants?

A

Refractory hypotension and cardiac arrest have been documented

176
Q

What is the first and second dose of adenosine in mg/kg for SVT in peds?

A

0.1 mg/kg
0.2 mg/kg

177
Q

True or false: adenosine will not cause harm if given to patients with wide, monomorphic VT, if you mistakenly think it is SVT with aberrancy

A

True

178
Q

What are the two second line drugs and their dosages for the treatment of SVT?

A

Amiodarone 5 mg/kg over 20-60 minutes
Procainamide 15 mg/kg over 30-60 minutes

179
Q

When should you consult a cardiologist when a child presents with hemodynamically stable SVT?

A

If adenosine doesn’t work (before amiodarone, procainamide, or cardioversion)

180
Q

What is the dose of electricity for cardioversion in kids with SVT?

A

0.5-1 j/kg for first dose, 2 j/kg for each additional dose

181
Q

What is the treatment for a wide complex tachycardia if the patient is hemodynamically UNstable?

A

Synchronized cardioversion

182
Q

What is the treatment for a wide complex tachycardia if the patient is hemodynamically stable?

A

Consider adenosine
Call cardiologist before giving antiarrhythmics

183
Q

What is a normal QRS duration?

A

less than 0.09 seconds

184
Q

What is the treatment for sinus tach in peds?

A

Search for and treat underlying cause

185
Q

What is the treatment for a wide complex tachycardia resistant to cardioversion?

A

COnsult cardiologist before giving antiarrhythmics

186
Q

Why should amiodarone and procainamide never be administered together?

A

QT prolongation

187
Q

What is the first phase of post cardiac arrest care in children?

A

Stabilizing the ABCs

188
Q

What is the second phase of post cardiac arrest care?

A

-Support general organ function
-correct electrolyte and acid/base abnormalities
-Target temp management

189
Q

What three major organ systems are targeted with post cardiac arrest care?

A

-Cardiovascular
-Pulmonary
-Neuro

190
Q

What is the goal O2 sat for post cardiac arrest care?

A

Over 94%, but the least amount O2 necessary to get there

191
Q

What should be used to target adequate oxygenation in a child: O2 sat or PaO2? (2)

A

O2 sat if not anemic
PaO2 if anemic

192
Q

True or false: in children with asthma and respiratory failure, rapid correcting of hypercarbia is unnecessary post arrest

A

True

193
Q

In what patients does hypercapnia need urgent recorrecting post arrest? (2)

A

If they have CHD or pHTN

194
Q

How soon after initial vent settings are placed should you get an ABG?

A

Within 15 minutes

195
Q

What is the goal SpO2 in kids with CHD post arrest?

A

Back to their baseline

196
Q

When is an art line generally needed? Why?

A

When shock occurs, because cuffs are not accurate in these situations

197
Q

What should the BP be in children post ROSC? What is the role of vasopressors in this?

A

-Above the 5th percentile (use the 70+2*age formula)
-Use pressors as needed

198
Q

Why is intubation a double edged sword with cards problems in kids?

A

Meds and the procedure can cause cardiovascular collapse

199
Q

When trying to optimize the following parameters, what drugs or intervention should be given:
-Preload
-Contractility
-Afterload
-HR

A

-Preload = IVFs
-Contractility = inotropic
-Afterload = vasopressors or vasodilators
-HR = Chronotropes or pacing

200
Q

What are the three major drugs for hypotensive shock?

A

Epi
Dopamine
Norepi

201
Q

What are the four major drugs used for normotensive shock?

A

Dobutamine
Dopamine
Epi
Milrinone

202
Q

What is the predominant effect of epi (alpha or beta) with low and high doses respectively?

A

Low = beta (1 and 2) effect
High = alpha effect

A1 (32 decks)

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