PALS Concepts Flashcards
Lance Carter, CAA
EWL
Estimated Weight Loss
FBAO
Foreign Body Airway Obstruction
LVOT
Left Ventricular Outflow Tract
PEFR
Peak Expiratory Flow Rate
ROSC
Return Of Spontaneous Circulation -A prominent sign of ROSC is a sudden increase in EtCO2
RVOT
Right Ventricular Outflow Tract
Agonal Rhythm
Acryocyanosis
Apnea
Central vs. Obstructive Apnea
Most Common Cause of Bradycardia In Kids
Bradycardia Definition
Broselow Tape
Channelopathy
Child Definitions (According to the AHA)
Chest Compression Fraction (CCF)
Croup
Cyanosis
Febrile
Hypoxemia
Hypoglycemia
Treatment for Hypoglycemia
Hypotension (Systolic BP Readings)
Heliox
Mottling
Pallor
Signs of Bad Peripheral Perfusion
Signs of Good Peripheral Perfusion
Permissive Hypoxemia
Petechiae & Purpura
Petechiae & Purpura, Poikilothermia
Factors that Affect Pulse Pressure (3)
- *1. Stroke volume**
- Stroke volume PRIMARILY affects (and is proportional to) systolic blood pressure
- Increased stroke volume = increased systolic pressure
- Decreased stroke volume = decreased systolic pressure
- *2. Systemic vascular resistance (SVR)**
- SVR PRIMARILY affects (and is proportional to) diastolic blood pressure
- Increased SVR (vasoconstriction) = increased diastolic BP
- Decreased SVR (vasodilation) = decreased diastolic BP
- *3. Aortic compliance**
- If the aorta has good vascular compliance (like in younger, healthy patients), the systolic pressure will be lower during systole
- If the aorta is noncompliant/“stiff” (like in older patients), systolic pressure will be much higher during systole
- In other words, systolic pressure (and thus pulse pressure) is inversely proportional to aortic compliance
Capillary Refill Time
Normal Heart Rate
Oxygen Consumption
Sp02
ScvO2
Urine Output
Normal Respiratory Rate (RR)
PALS ABCDEs
Airway, Breathing, Circulation, Disability, Exposure
Laminar & Turbulent Airflow
Opening & Clearing the Airway
Proper Positioning
Severe Choking In Responsive Children
Severe Choking In A Responsive Infant
Severe Choking In Unresponsive Patients
After the Obstruction is Relieved
Possible Treatments in the Airway Scenarios
High Flow Nasal Cannula
Possible Treatments in the Airway Scenarios
Low Flow vs. High Flow Oxygen Delivery Systems
Possible Treatments in the Airway Scenarios
Breathing Treatments (3)
Possible Treatments in the Airway Scenarios
Heliox
Clinical Uses For Heliox (2)
Possible Treatments in the Airway Scenarios
Humidified Oxygen Advantages (2) and Indications (1)
Possible Treatments in the Airway Scenarios
Racemic Epinephrine
Airway Equipment in PALS
Self Inflating Ambu Bag
Self Inflating Ambu Bag (Without A Reservoir Bag)
Self Inflating Ambu Bag (With A Reservoir Bag)
Airway Equipment in PALS
Flow Inflating (Anesthesia) Bag
Formula To Determine Correct ETT Size, Based On Age
Uncuffed Tracheal Tubes
Formula To Determine Correct ETT Size, Based On Age
Depth of Insertion Formula
Confirming Correct Endotracheal Tube Placement
Endotracheal Tube Medications in PALS
Medications and Methods of Administration
Rales (Crackles, Crepitation)
Rhonchi
Wheezing
Lung Percussion Examination
Resonant & Dull Sounds on Percussion
Airway Scenarios in PALS (4)
DOPE Pneumonic
Notes on Breathing
Reasons To Avoid Excessive Ventilation (3)
Inspiratory Muscles
Breathing Protocol
(C-A-B, not A-B-C)
Signs of Labored Breathing/Respiratory Distress
Disorded Control of Breathing
Signs of Labored Breathing/Respiratory Distress
Causes of Disordered Control of Breathing (3)
Signs of Labored Breathing/Respiratory Distress
Head Bobbing, Grunting
https://www.youtube.com/watch?v=vvgTCG18oZo (Head Bobbing)
Signs of Labored Breathing/Respiratory Distress
Nasal Flaring
Signs of Labored Breathing/Respiratory Distress
Retractions
http://ttps://www.youtube.com/watch?v=bYso_Oz-35k
“–It’s caused by increased airway resistance (or “stiff” lungs) impairing air movement”
Signs of Labored Breathing/Respiratory Distress
Seesaw Respirations
Indications of seesaw respirations
Signs of Labored Breathing/Respiratory Distress
Stridor, Quiet Tachypnea
Retractions With Other Signs of Airway Obstruction
Respiratory Distress vs. Respiratory Failure
The most immediate causes of pediatric cardiac arrest are: (2)
25%
Cardiac Arrest Stats
Checking For A Pulse
Effective CPR
Two Hand CPR Technique
One Hand CPR Technique
One Hand CPR Technique
“Thumb Encircling” CPR Technique
“Compression Only” CPR?
CPR Summary
BLS Cardiac Arrest Algorithm for the Single Rescuer
Methods for Evaluating “Disability”
Disability
(Quick Evaluation of Neurologic Function)
Glucose
Disability
(Quick Evaluation of Neurologic Function)
Pupil Response to Light
Disability
(Quick Evaluation of Neurologic Function)
AVPU
Disability
(Quick Evaluation of Neurologic Function)
Glasgow Coma Scale
Exposure
Fluid Estimations
Estimated Weight Loss (EWL)
Estimated Weight Loss And Dehydration
- Notice how younger children can better tolerate volume loss (i.e., they it takes a higher overall volume loss before they are considered “dehydrated”
- This is due to the fact that younger have higher circulating blood volumes (per kg), so water takes up a larger portion of their total body weight (i.e., they have more water to lose) - Older children can’t tolerate as much volume loss (in mL/kg), because water takes up a lower percentage of their total body weight (i.e., they don’t have as much water to lose)
- Dehydration can lead to hypotensive (non-hemorrhagic) shock
Clinical Management Of Dehydration
Hypotensive (non-hemorrhagic) Shock
Crystalloid Therapy
Colloid Therapy
Blood Therapy
Why Only O- Blood For Females?
Fluid Boluses in the Scenarios
Fluid Therapy in Diabetic Ketoacidosis (DKA)
Fluid Therapy With Febrile Illnesses
Fluid Administration Summary
Pediatric Manual Defibrillator Pads
Pediatric AED Pads & Pediatric Dose Attenuator
Adult AED Pads
Using Paddles
The Choice Of Defibrillator & Pads In PALS
Defibrillator Dosing In PALS
Epinephrine and Defibrillation
There Are 2 Sets of “ABCs” in PALS
Pediatric Assessment Triangle (First Set of ABCs)
Steps To The Pediatric Assessment Triangle (PAT)
“Primary Assessment” (Second Set of ABCs)
Steps to the Primary Assessment (ABCDE’s)
The Pediatric Assessment Triangle And Primary Assessment
(Both Sets Of ABCs)
Recap of Initially Approaching a Pediatric Patient
Secondary Assessment (SAMPLE)
Diagnostic Assessment
Evaluate, Identify, Intervene (“EII”) Cycle
Evaluate, Identify, Intervene (“EII”) Cycle
Back to “Evaluate, Identify, Intervene” (EII)
Steps to Diagnose and Follow in Each Scenario
- Start out with the initial ABCs (Appearance, Breathing, Circulation)
- Check responsiveness
- If unresponsive, check pulse, activate EMS, & start resuscitation - Start the primary assessment (ABCDEs) with C-A-B
- Check signs of perfusion (color, capillary refill, strength of pulse, temperature, etc)
- Verbalize “monitors, IV, oxygen (if needed)”
- Also remember to auscultate and check for breathing difficulty - Finish the primary assessment by completing the “D & E” steps
- Get a glucose/check pupils/AVPU
- Look over the child for any bodily abnormalities (i.e., signs of trauma) - Intervene (start therapy) at the earliest appropriate time during the primary assessment
- For instance, the “monitors, IV, oxygen” count as an intervention - Reevaluate by performing the secondary and diagnostic assessments while your initial intervention is going on
- In other words, “what happened?” How did the child get to this state?”
- Verbalize “SAMPLE” the H’s & T’s (more for cardiac arrest patients)
- Get labs and diagnostic tests (CXR, ultrasound, etc) - Intervene again, based on the additional information
- Fluids, breathing treatments, etc - Frequently reassess the patient to determine the next step
- Determine if the child’s condition is improving based on the initial interventions
- Determine whether or not additional interventions are necessary - Intervene again and continually reassess after every intervention
Possible Causes of Low Cardiac Output
Symptoms Of Low Cardiac Output (Low ScvO2)
Symptoms Of Low Afterload (Vasodilation) (7)
High Afterload (Vasoconstriction)
Central Venous O2 Saturation (ScvO2)
Possible Causes Of Low ScvO2
Possible Causes Of High ScvO2
If cardiac output is low, will ScvO2 always be low?
If ScvO2 is low, will cardiac output always be low?
ScvO2 Scenarios In PALS (3)
Low ScvO2 & Low Blood Pressure Scenario
(Hypotensive Shock Scenario)
Treatment For Hypotensive Shock
(Low ScvO2 & Low Blood Pressure)
Low ScvO2 With Normal BP
(“Normotensive Shock” Scenario)
Treatment For “Normotensive/Compensated Shock”
(Low Cardiac Output With Vasoconstriction)
High ScvO2, Warm Extremities, and Low BP Scenario
Examples Of Warm Shock
(High Cardiac Output & Low Blood Pressure)
Treatment For Warm Shock
(High Cardiac Output & Low Blood Pressure)
Summary of Therapy Based on ScvO2
Shock Definition
Common Shock Symptoms (4)
Compensated (Normotensive) Shock
Decompensated (Hypotensive) Shock
Warm Shock
Cold Shock
Normotensive Shock
Treatments For The Shock States
Hypovolemic Shock
Cardiogenic Shock
Dissociative Shock
Obstructive Shock
Obstructive Shock (Pulmonary Embolism)
Obstructive Shock (Cardiac Tamponade)
Obstructive Shock (Tension Pneumothorax)
Treatment of Tension Pneumothorax
Obstructive Shock (Ductal Dependent Lesions)
Distributive Shock
Distributive Shock (Anaphylactic Shock)
Treatment For Anaphylactic Shock
Distributive Shock (Neurogenic Shock)
Spinal Shock
Distributive Shock (Septic Shock)
Cardiac Output in Septic Shock
Symptoms Unique To Septic Shock
Treatment Unique To Septic Shock
Steroid Therapy In Septic Shock
Septic Shock Management
ABCDE’s Of Shock
Summary of Shock Therapy
Overall Resuscitation Notes
Goals of Post Resuscitation Management
Targeted Temperature Management (TTM) in PALS
Atropine In PALS Bradycardia
Is There A Minimum Dose Of Atropine?
Epinephrine In PALS Bradycardia
Amiodarone And Procainamide In PALS SVT/Stable Vtach
Drug Dosing In PALS Vfib/Pulseless Vtach
BLS, ACLS, PALS Changes (2015)
Web Based Integrated Guidelines
Supplementary Reading
https://www.medschool.lsuhsc.edu/emergency_medicine/docs/PALS%20Cases.pdf (PALS Cases)
https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-12-pediatric-advanced-life-support/ (Web based integrated guidelines)
