PALS Concepts Flashcards
1
Q
EWL
A
estimated weight loss
2
Q
FBAO
A
foreign body airway obstruction
3
Q
LVOT
A
left ventricular outflow tract obstruction
4
Q
PEFR
A
peak expiratory flow rate
5
Q
ROSC
A
return of spontaneous circulation
6
Q
what is a prominent sign of ROSC?
A
sudden increase in EtCO2
7
Q
RVOT
A
right ventricular outflow tract obstruction
8
Q
agonal breathing
A
half of pts in cardiac arrest will gasp
“snoring, gurgling, moaning, labored breathing”
9
Q
agonal rhythm
A
slow complex rhythms that precede asystole
10
Q
acryocyanosis
A
blue discoloration of hands and feet and around the mouth and lips
11
Q
apnea
A
cessation of breathing for 20 seconds
12
Q
apnea definition when accompanied by bradycardia, cyanosis, or pallor
A
<20 seconds
13
Q
central apnea
A
no respiratory effort
14
Q
obstructive apnea
A
ventilation is impeded by an obstructed airway
15
Q
mixed apnea
A
combination of both central and obstructive apnea
16
Q
what is the most common cause of bradycardia in kids?
A
apnea/hypoxia
17
Q
bradycardia definition in children
A
ranges based on source and age from <60bpm- <100bpm
18
Q
broselow tape
A
approximates weight and drug doses
19
Q
channelopathy
A
genetic mutation and disorder of the ion channels in myocardial cells that predisposes the heart to arrhythmias
20
Q
neonate
A
1-28 days
21
Q
infant
A
1month-1yr
22
Q
child
A
1 year to puberty
23
Q
adult
A
puberty and older
24
Q
chest compression fraction
A
proportion of time spent performing chest compressions for pts in cardiac arrest
25
what should CCF be?
at least 60%
| ideally 80%
26
croup
inflammation of the larynx/vocal cords
27
mild croup sound
barking cough
28
moderate croup sound
stridor and retractions at rest
29
severe croup sound
significant agitation with decreased air entry
30
cyanosis
bluish discoloration of skin resulting from poor circulation or inadequate oxygen of the blood
31
when is cyanosis apparent?
at least 5g/dL of Hgb are desaturated
this means that the O2 saturation at cyanosis appearance depends upon Hgb concentration
32
febrile
temp >38 degrees C
33
in pals what should you administer when a fever is present?
Abx
common in sepsis and lung tissue disease
34
in pals when is a patient considered to have hypoxemia?
spO2 is less than OR equal to 94% on room air
35
when should you consider administering supplemental oxygen in PALs?
spo2 <94
| poor signs of perfusion
36
what can present hypoxemia from turning into tissue hypoxia?
increase in CO
37
hypoglycemia neonate
blood sugars <45mg/dL
38
hypoglycemia infant/child/adolescent
<60mg/dL
39
treatment for hypoglycemia
0.5-1g/kg bolus of glucose
| recommended D25W so (4mL)
40
hypotension systolic neonate
<60
41
hypotension systolic infants
<70
42
hypotension systolic children (1-10yr)
<70 + (age in yrs x2)
43
hypotension systolic children >10yrs
<90
44
heliox
breathing gas composed of a mixture of helium and oxygen
45
why does heliox help breathing?
helium gives lower density than air and oxygen alone and produces a higher probability of laminar flow
46
what does laminar flow in the airways do?
less airway resistance
less mechanical energy to ventilate
decreases work of breathing
47
what does heliox relieve symptoms of?
upper airway obstruction
| middle and upper airway
48
where does heliox have little effect?
small airways since flow is already laminar
49
mottling
patchy discolorations of skin caused by vasoconstriction (pallor) mixed with areads of vasodilation (cyanosis or erythema)
50
what is mottling a sign of?
imminent death
51
pallor
pale color due to lack of oxygen in the skin
52
central pallor
pallor seen in the lips and mucous membrane
53
signs of good peripheral perfusion 5
```
good pulse (BP adequate)
flushed skin
brisk capillary refill (<2 sec)
warm skin
awake and alert
```
54
signs of poor peripheral perfusion 5
```
weak pulse
pale or cyanotic skin color
delayed capillary refill
cool extremities
decreased responsiveness or consciousness
```
55
permissive hypoxemia
spO2 reading of <94% that may be appropriate in certain circumstances
56
examples of permissive hypoxemia
pt at high altitude
| pt with congenital heart disease
57
petechiae and purpura
purple discolorations caused by small vessel bleeding
58
petechiae
small dots
| suggest low platelet count
59
purpura
appear as larger areas
60
what are petechiae and purpura a sign of in PALS?
septic shock
| could be said as bruises or discolorations of skin
61
poikilothermia
unable to regulate body temperature
62
refractory
a child is refractory to a treatment if they do NOT improve or respond to therapy
63
fluid refractory hypotension
child remains hypotensive despite fluid admin
64
hypoxic refractory to supplemental oxygen
may mean they need a breathing treatment or need mask vent or intubation
65
norepinephrine refractory shock
child in shock is unresponsive to norepinephrine therapy
66
normal capillary refill time
<2sec in neutral thermal environment with extremity slightly above heart level
67
prolonged capillary refill time
>5 seconds
68
what are the common causes of prolonged capillary refill time
dehydration
shock
hypothermia
69
SVT rate infants
>220
70
SVT rate children
>180
71
oxygen consumption adults
3-4mL/kg/min
72
oxygen consumption infants
6-8mL/kg/min
73
SpO2 PALS
>94% on room air
| <90% on 100% oxygen requires intervention
74
ScvO2 PALS
25-30% below SaO2
| 70-75% is SaO2 is normal
75
urine output infants/young children
1.5-2mL/kg/hr
76
urine output older children and adolescents
1mL/kg/hr
77
what is reduced urine output a sign of
poor perfusion
78
large (upper) airways have what kind of air flow
more turbulent air flow
| more resistance
79
lower gas density does what to air flow
higher % of laminar flow
| less resistance
80
why are peds pts more prone to upper airway obstruction?
large tongue
| large occiput that causes neck flexion and takes the pt out of sniff position
81
how should the infant be positioned to open and clear the airway
pts head neutral
| shoulder roll
82
severe choking in responsive children
providers can do heimlich or abdominal thrusts below xyphoid
83
severe choking in responsive infant
place the pt prone in one arm 5 back slaps
| flip and deliver 5 downward chest thrust with two fingers
84
severe choking in unresponsive patients
immediately start CPR (even if pulses are palpable)
| each time you open mouth look for opject
85
after obstruction is relieved what should you do?
place pt in recovery position
86
high flow nasal cannula how much can it deliver and what is the fio2?
>50L/min it can deliver close to 100% FiO2 similar to nonrebreather mask
87
what is different about high flow nasal cannula that makes the pt tolerate higher flows without discomfort?
humidified and warmed
| doesnt interrupt ability to communicate, eat or drink
88
does high flow nasal cannula produce positive airway pressure
yes 3cmH2O
89
low flow oxygen deliver devices and fio2
simple face mask (35-60%) requires at least 6L
| nasal cannula 22-60%
90
high flow >10L oxygen deliver devices and fio2
```
high flow nasal cannula (up to 4L in infants, up to 40L in adolescents) (up to 95%)
nonrebreathing mask (up to 95%)
```
91
breathing treatments
```
nebulizer
metered dose inhaler (MDI)
MDI with spacer
heliox
humidified oxygen
```
92
clinical uses for heliox
conditions of large airway narrowing (croup, upper airway swelling)
conditions involving the medium airways (asthma, COPD)
93
2 advantages to humidified oxygen
decreases chance of coughing
| loosen mucus and provide easier breathing
94
what should be avoided in patients with respiratory distress
coughing bc it can exacerbate the symptoms of croup
95
what conditions is humidified oxygen used for?
moderate to severe croup
| asthma
96
racemic epinephrine
decreases swelling and edema in airway via vasoconstriction
97
self inflating ambu bag components
does not require oxygen and inflates on own with room air
has ability to hook up to oxygen to increase fio2
may come with reservoir bag
98
if an ambu bag is connected to oxygen and NOT reservoir bag
ambu bag fill with mixture of oxygen and air during exhalation
99
if an ambu bag is connected to oxygen AND reservoir bag
the bag will fill with mostly oxygen during exhalation
100
is the fio2 higher with or without the reservoir bag (assuming oxygen is always attached)
with reservoir bag fio2 will be higher
101
flow inflating anesthesia bag
requires oxygen to operate
| pressure controlled with apl valve
102
infant and young children flow inflating bag size
450-500mL
103
older children and adolescent flow inflating bag size
1000mL
104
when are uncuffed tracheal tubes recommended?
children <8yrs old
105
formula for choosing the correct uncuffed endotracheal tube
age/4
106
formula for choosing the correct cuffed ETT
age/4 +3
107
formula for choosing the correct depth of insertion <2 yrs old
internal diameter (mm)x3
108
formula for choosing the correct depth of insertion >2yrs old
age/2 +12
109
confirming correct endotracheal tube placement PALS
six ventilations recommended to wash out CO2 that may be in the stomach then etCO2 can be presumed from trachea
110
ETT medications in PALS
```
LEAN
lidocaine
epi
atropine
narcan
```
111
method of ETT drug administration
dilute drug with 5mL of N/S
deliver drug via ETT
follow with 5 positive pressure ventilations
112
rales (crackles, crepitation)
intermittent popping sound
113
possible causes of rales
fluid in distal airways
| atelectasis
114
in PALS scenarios what does rales suggest?
cardiogenic shock
115
what is the key diagnosing difference between hypovolemic shock and cardiogenic shock
rales
116
rhonchi
low pitched noises that have been described as a snoring or bubbling sound
117
what is rhonchi caused by
secretions
mucus
blood
IN LARGE AIRWAYS
118
wheezing
high pitched noise during expirationthat is caused by bronchoconstriction
119
percussion examination
provider lays their left middle finer over body surface and taps on it with right middle finger
120
what sounds can be heard on percussion?
resonant
hyperresonant
dull
121
what sounds are normal with percussion?
resonant
122
when are hyperresonant sounds heard?
```
hyperinflated lung (COPD, asthma attack)
hyperinflated chest cavity (tension pneumo)
```
123
airway scenarios in PALS 4
1 lower airway obstruction (asthma) wheeze during exhale
2 upper airway obstruction stridor during inhale
3 lung tissue disease (pneumonia, aspiration)
4 disordered control of breathing
124
DOPE pneumonic use
used in PALS when intubated pt deteriorates
125
what does DOPE stand for
displacement? (ETT in place?)
obstruction? (ETT kinked?)
pneumothorax? (bilateral breath sounds?)
equiptment failure?
126
possible interventions for respiratory distress or failure
airway
breathing
circulation
127
reasons to avoid excessive ventilation
1 it causes air trapping (barotrauma)
2 it increases intrathoracic pressure and impedes venous return
increases risk of regurg and aspiration
128
what can you do to avoid air trapping in kids?
ventilate at slower rates for longer expiration time
129
how can you minimize gastric inflation in kids? 3
1 ventilate slowly (1 breath every 3-5 sec or 12-20 breaths per min)
2 deliver each breath over 1 sec until chest rise
3 consider cricoid pressure
130
inspiratory muscles
```
Dont Ever Stop Praying
Diaphragm
External intercostals
Sternocleidomastoid
Pectoralis Minor
```
131
breathing protocol 5
1 check responsiveness
2 check pulse and breathing simultaneously
3 if there is no pulse or <60bpm begin compressions
4 if there is a pulse and no breathing give rescue breaths
5 after rose begin evaluate identify intervene sequence and post cardiac arrest care
132
disordered control of breathing
abnormal respiratory pattern
133
what is disordered control of breathing caused by? 3
1 muscle weakness (inadequate reversal)
2 depressed consciousness
3 elevated ICP
134
what is disordered control of breathing USUALLY triggered by?
medication overdose
135
head bobbing
sign of respiratory failure
chin lift inspiration
chin down expiration
neck muscles assist
136
grunting (low pitch during exhalation)
small airway obstruction/collapse (partially closed glottis)
137
what is grunting a sign of?
lung tissue disease
(pneumonia, pulmonary edema, pulmonary contusion, ARDS)
severe respiratory distress
impending respiratory failure
138
nasal flaring
dilation of nostrils with inhalation
| sign of respiratory distress
139
retractions
manifest as inward movement of chest wall during inspiration
| using chest muscles to breath
140
what are retractions caused by?
increased airway resistance (stiff lungs)
141
seesaw respirations
during inspiration
chest retracts and abdomen expands
during expiration
chest expands and abdomen moves inward
142
what do seesaw respiration usually indicate?
upper airway obstruction
BUT can also be seen in severe lower airway obstruction, lung tissue disease, disordered control of breathing
143
children with what usually have seesaw respirations? (not airway issues)
neuromuscular weakness
144
stridor
high pitched sound on inspiration indicates upper airway obstruction
145
quiet tachypnea
tachypnea with no signs of respiratory distress or increased respiratory effort
146
what is quiet tachypnea caused by?
non pulmonary issues:
| fever, pain, metabolic acidosis
147
retractions + inspiratory snoring/stridor diagnosis
upper airway obstruction
| croup foreign body
148
retractions + expiratory wheezing diagnosis
lower airway obstruction
| asthma bronchiolitis
149
retraction + grunting or labored respirations diagnosis
lung tissue disease
150
severe retractions diagnosis
may be accompanied by head bobbing or seesaw respirations
151
respiratory distress differentiation 4
1 increased respiratory rate and effort but able to move air
2 potential abnormal airway sounds and pallor
3 tachycardia and anxiety
4 improves with initial therapy
152
respiratory failure differentiation 4
1 inadequate oxygenation/ventilation that requires intervention
2 increased OR decreased respiratory effort or apneic
3 bradycardia, cyanosis, lethargy
4 may not respond to initial breathing treatments and interventions
153
what are the most immediate causese of pediatric cardiac arrest?
respiratory failure
| hypotensive shock
154
in hospital cardiac arrest survival % vs out of hospital cardiac arrest %
hospital 43%
| out of hosp 8%
155
survival % cardiac arrest shockable rhythm vs asystole
shockable 25-34%
| asystole 7-24%
156
what is the highest rate for survival cardiac arrest and why?
64%
| bradycardia and CPR and ventilation provided before cardiac arrest
157
what is the leading cause of death in infants <6mo
SIDS
158
where to check pulse >1 yr old
carotid or femoral
159
where to check pulse <1 yr old
brachial pulse
160
effective CPR 8
```
1 push fast (100-120 per min)
2 push hard
3 minimize interuptions
4 press on lower 1/2 breastbone
5 allow complete chest recoil
6 rotate compressors
7 avoid excessive ventilation
8 use monitoring to guide effectiveness
```
161
cpr depth infant
1.5 inches
162
cpr depth child
2 inches
163
cpr depth adolescents and adults
<2.4 inches
164
what etco2 shows effective compressions
>15-20 mmHg
165
when is the two handed CPR technique used in PALS
adults and kids >8yrs
166
when is the one handed CPR technique used in PALS
alternative to two hand in children ages 1-8yrs old
167
when is the two finger CPR technique used in PALS
infants when ONE responder available
| 2 fingers above xyphoid process
168
when is the thumb encircling CPR technique used in PALS?
neonates and infants when TWO responders available
169
what advantages does the thumb encircling technique have over two finger? 3
better coronary blood flow
more consistent depth
may generate higher blood pressures
170
when is compression only CPR recommended?
only when the rescuer is unable or unwilling to deliver breaths
171
CPR summary children 1- puberty 1 provider
30:2
| one or two hand tech
172
CPR summary children 1-puberty 2 providers
15:2
| two handed technique
173
CPR summary children 1-puberty 2 providers AND advanced airway
100-120 comp/min
8-10 breath/min
one vs two hand tech
174
CPR summary neonates 1 provider
3:1 respiratory arrest
15:2 cardiac arrest
two finger tech
175
CPR summary neonates 2 providers
3:1 respiratory arrest
15:2 cardiac arrest
thumb encirc tech
176
CPR summary neonates 2 providers AND advanced airway
100-120 comp/min
age appropriate RR
thumb encirc tech
177
4 methods for evaluating diability
1 glucose
2 pupil response to light
3 AVPU response scale
4 glascow coma scale
178
what is the first thing you should try to do when assessing neurologic function?
check glucose
179
what do you do if the pt is hypoglycemic
bolus dextrose
180
what3 things should be assessed when checking pupils?
pupil size in mm
equality of pupil size
constriction in response to light
181
acronym PERRL
normal pupil responses to light
| Pupils Equal, Round, Reactive to Light
182
what is suspected if pupils dont constrict to light
brainstem injury
183
what may cause unequal pupil size?
increased intracranial pressure
184
AVPU (best out of hospital)
Alert
responsive to Voice
responsive to Pain
Unresponsive
185
Glasgow coma scale (best in hospital)
method of assessing consciousness and neurologic status
186
scoring of glasgow coma scale
eye opening 4 possible points
verbal 5 possible points
motor 6 possible points
187
what GCS is intubation indicated?
<8
188
mild head injury GCS
13-15
189
moderate head injury GCS
9-12
190
severe head injury GCS
3-8
191
TBW % infants
70%
192
TBW % neonates
80%
193
1kg = ___ liter(s) of water
1
194
in PALS how much of body weight is water>
100%
195
two ways that weight loss in PALS can be expressed as volume loss-
expressed as percentage of volume depletion (10% weight loss= 10% volume depletion)
expressed in mL/kg
(10% weight loss= volume loss 10mL/kg)
196
mild dehydration infant
5% volume depletion
197
moderate dehydration infant
10% volume depletion
198
severe dehydration infant
15% volume depletion
199
mild dehydration adolescent
3% volume depletion
200
moderate dehydration adolescent
5-6% volume depletion
201
severe dehydration adolescent
7-9% volume depleteion
202
why can younger children better tolerate volume loss?
younger children have higher circulating blood volumes so water takes up a larger portion of their TBW
203
why cant older children tolerate as much volume loss?
water takes up a lower percentage of their TBW
204
what type of shock can dehydration lead to?
hypotensive shock
205
treatment for dehydration
multiple 20mL/kg boluses of isotonic crystalloid
206
what are rapid bolus?
20mL/kg over 5-10 min
207
what are rapid bolus indicated for? 2
hypovolemic/hypotensive shock
| distributive shock
208
what are smaller OR slower boluses
5-10mL/kg 10-20min
209
what are smaller or slower boluses indicated for? 4
cardiogenic shock
evidence of pulmonary edema
poisonings (BB or CCB)
diabetic ketoacidosis
210
synthetic colloids
considered if hypovolemia/hypotension persists after 3 boluses of crystalloids
211
maxiumum dose of colloid
20-40mL/kg
212
what could a high dose of colloid cause?
coagulopathy
213
total dose of albumin
should not exceed the amount in body
| 2g/kg
214
indications for blood therapy
traumatic volume loss
| children unresponsive to 2-3 boluses of rapid crystalloid
215
initial dose PRBC
10mL/kg
216
goal Hgb for blood therapy PALS
>10g/dL
217
priorities for the type of blood
```
crossmatched
type specific (within 10 min)
type O blood
```
218
why should female patients only receive O- blood?
they will have the Rh antibody, and if pregnant with postitive blood type baby the antibodies cross placenta
219
what should you always check prior to a fluid bolus?
breath sounds in lower lobes
220
fluid therapy for DKA
isotonic 10 to 20mL/kg over 1 to 2 hours UNLESS they are hypotensive shock then be more aggressive
221
fluid therapy with febrile illnesses
restrictive volumes of isotonic crystalloid
222
at what age are pediatric manual defib pads used?
<1yr
| bc they can use lower energy dose than AED
223
at what age are pediatric AED pads used?
1-8yrs
| automatically recognized by aed
224
pediatric dose attenuator
the aed has a key or switch that can deliver child shock dose
225
when are adult aed pads used in PALS
kids >8yr
| acceptable use on infants in cardiac arrest if peds pads arent there
226
can you cut adult pads to fit a child?
no
227
paddle choice and placement >1yr
large paddles
| anterior posterior
228
paddle choice and placement <1yr
small infant paddles
| anterior anterior
229
synch cardioversion 1st and 2nd shock doses
0.5-1 J/kg
| 2 J/kg
230
defib 1st,2nd, subsequent and max shocks
2 J/kg
4 J/kg
>4 J/kg
10 J/kg
231
what is the set of ABCs in PALS thats (not ABCDE)
appearance (crying? unresponsive?)
breathing (are they breathing? difficult?)
circulation/color (cyanosis? poor perfusion?)
(assessment triangle)
232
5 steps to the primary assessment in PALS
```
1 check responsiveness
2 perform CAB
3 do initial intervention based on CAB (compressions, oxygen, IV etc)
4 perform diability step (check glucose)
5 perform exposure step (physical exam)
```
233
how to perform CAB
1. check pulse cap refill/perfusion
2 place monitors, IV, o2 if needed
3 see if airway is open and able to breath
4 ASCULTATE
234
(secondary assessment) SAMPLE
```
signs/symptoms
allergies
medications
past medical history
last meal
events
```
235
what is the diagnostic assessment?
continuation of secondary assessment
diagnostic tests (chest xray, ultrasound)
Hs Ts
236
what is EII?
evaluate, identify, intervene
| pattern when looking at scenarios
237
what does it mean to identify?
diagnose the type and severity of problem
238
possible causes of low CO
bradycardia
hypovolemia
decreased contractility
239
general symptoms of low CO (Low ScvO2) 5
```
hypotension
vasoconstriction and weak pulse
signs of poor perfusion
oliguria
narrow pulse pressure
```
240
additional symptoms of low CO (low ScvO2) if pt has decreased contractility 3
pulmonary edema
rales on auscultation
jugular venous distention
241
symptoms of low afterload (vasodilation) 7
```
high CO
good pulse
decreased preload
wide pulse pressure
brisk capillary refill (if BP is adequate)
delayed capillary refill (if BP is too low)
flushed skin
if severe angioedema
```
242
symptoms of high afterload (vasoconstriction)
weak pulse
pale skin
delayed capillary refill
243
what is the most common cause of vasoconstriction in PALS?
decreased CO
244
ScvO2
oxygen saturation of blood in the superior vena cava
245
causes of low ScvO2 4
low CO
hypoxia
increased metabolism
anemia
246
how does anemia cause low ScvO2
less RBC then higher portion of O2 taken off of each RBC leads to lower ScvO2
247
causes of high ScvO2 3
high CO
reduced metabolism (hypothermia)
sepsis
248
how does sepsis cause high ScvO2?
mitocondrial dysfunction impairs oxygen uptake and consumption at cellular level
249
if CO is low will ScvO2 always be low?
usually but if pt is in sepsis in addition to low CO then it may be elevated
250
If ScvO2 is low will CO always be low?
no, other things can cause low ScvO2
251
what are the 3 possible ScvO2 scenarios
low ScvO2 low BP
low ScvO2 normal BP
high ScvO2 low BP
252
low ScvO2 and low BP
hypotensive shock
| hypovolemia or decreased contractility
253
is someone is hypotensive shock vasocontricted or vasodilated?
constricted to compensate
254
treatment for hypotensive shock 2
```
1 fluid resusitation/transfuse to Hb >10g/dL
2 after (1) consider vasoactive drugs
```
255
drug for hypotensive cold shock
epi
256
drug for hypotensive warm shock
norepi
257
low ScvO2 with normal BP
normotensive shock
| or compensative shock
258
is someone is normotensive shock vasoconstricted or vasodilated?
vasoconstricted but is able to compensate the low CO
259
treatment for normotensive 3
1 fluid bolus
2 administer epi (cold shock)
3 if symptoms continue after 1 and 2 then consider vasodilator Milrinone or nipride
260
high ScvO2, warm extremities, low BP
warm shock
261
what are two types of warm shock?
anaphylaxis
| sepsis
262
treatment for warm shock
fluid boluses
| consider vasopressors
263
shock definition
a physiologic state characterized by inadequate tissue perfusion
264
4 common shock symptoms
hypotension
decreased CO
poor signs of perfusion
vasodilation
265
compensated shock
maintains normal BP and CO
266
what are the two wats the body can compensate during shock
increase SVR
| increase HR
267
decompensated shock
BP remains low despite any compensatory efforts by body
268
warm shock is caused by what
vasodilation
269
4 symptoms of warm shock
good peripheral pulses
increased CO
wider pulse pressure
warm flushed skin
270
cold shock
caused by low CO (bc hypovolemia or decreased contractility) and vasoconstriction
271
3 symptoms of cold shock
pale mottled skin
peripheral tissues are cold
hypotension with narrow pulse pressure
272
what other times can normotensive shock occur other than compensated shock?
hypoxia
| anemia
273
hypovolemic shock 2 types
```
hemorrhagic (loss of 30%blood volume)
non hemorrhagic (GI losses)
```
274
what shock is most common in kids?
hypovolemic shock
275
how is hypovolemic shock treated?
fluids and or blood products
276
cardiogenic shock
caused by decrease in cardiac contractility
277
how do you treat cardiogenic shock
smaller fluid bolus (5-10mL/kg)
inotropes
vasodilators (only if BP is normal)
278
dissociative shock
adnormalities in hemoglobin affinity
| carbon monoxide poisoning and methemoglobinemia
279
obstructive shock
shock caused by an obstruction to blood flow somewhere
280
4 types of obstructive shock
pulmonary embolism
cardiac tamponade
tension pneumothorax
ductal dependent lesions
281
signs/symptoms of obstructive shock 2
same as with impaired contractility
| additional signs for each type
282
signs and symptoms of pulmonary embolism 4
signs of impaired cardiac contractility
respiratory distress
chest pain
right heart failure
283
treatment for PE 3
20mL/kg fluid bolus
consider thrombolytics and anticoagulants
expert consult
284
signs and symptoms of cardiac tamponade 3
signs of impaired cardiac contractility
muffled heart sounds
pulsus paradoxus
285
treatment of cardiac tamponade 2
pericardiocentesis
| 20mL/kg fluid bolus
286
signs and symptoms of tension pneumothorax 5
deflated lung and respiratory distress (unilateral sounds)
tracheal deviation towards contralateral side
poor signs perfusion
distended neck veins
pulsus paradoxus
287
treatment tension pneumo 3
needle decompression
| chest tube placement
288
needle decompression
2nd-3rd intercostal space
| mid clavicular
289
chest tube
6th-7th intercostal space
| mid axillary line
290
unique symptom of ductal dependent lesion
rapid deterioration in consciousness
291
treatment of ductal dependent lesion
prostaglandin e1
| expert consult
292
distributive shock
caused by vasodilation and "relative hypovolemia"
293
3 types of distributive shock
anaphylactic shock
neurogenic shock
septic shock **most common**
294
anaphylactic shock
severe allergic reaction
massive histamine release
1 systemic vasodilatino
2 pulmonary vasoconstriction
295
7 treatment for anaphylactic shock
```
1 subQ/IM epi
2 bronchodilator
3 20mL/kg fluid bolus
4 corticosteriods
5 H1 and H2 blockers
6 magnesium
7 consider humidified oxygen, bipap and intubation
```
296
neurogenic shock
loss of sympathetic tone following spinal cord injury
| leads to: vasodilation, bradycardia, hypothermia
297
treatment of neurogenic shock
fluid boluses and vasopressors
298
spinal shock
acute loss of sensation and motor function with gradual recovery
299
what may occur in spinal injuries above T6?
autonomic dysreflexia
300
distributive shock (septic)
infection usually associated with:
potentially fatal inflammatory reaction of whole body (SIRS)
an immune response that can lead to multiple organ dysfunction syndrome
301
what are the 4 examples of an immune response the body can have in septic shock?
extreme vasodilation
hypoxia (leads to elevated serum lactate conc)
lung failure (pulm edema)
potential renal failure
302
mechanism of sepsis
endotoxins induce nitric oxide synthase
produces relaxation of vascular smooth muscle tone
results in hypotension and reduced contractility
303
treatment for sepsis 3
early ABX
fluid resuscitation
vasopressor to maintain MAP >65
304
unique septic shock symptoms
```
petechiae purpura
infection
high or low WBC count
acid base abnormalities
adrenal insufficiency
hypocalcemia, hypoglycemia, hyperglycemia
```
305
3 additional treatments for septic shock-
laboratory work (WBC, plasma calc, plasma glucose)
steroids
possible calc and glucose replacement
306
mechanism of steroids in sepsis
prevent induction of nitric oxide synthase
enhance response to catecholamines
reduce inflammatory response
307
problem with steroids in sepsis
can worsen underlying infection and hyperglycemia
308
septic shock management within first 10-15 min 3
1 identify shock
2 monitors oxygen IV
3 draw blood cultures and labs
309
septic shock management within first hour 3
1 start 20mL/kg fluid boluses (stop if rales)
2 start vasopressors
3 administer broad spectrum Abx
310
septic shock management critical care (after first hor) 4
1 administer stress dose steriods if needed
2 correct hypoglycemia and hypocalcemia
3 start invasive lines (a line and central line)
4 consider intubation
311
calcium dose
20mg/kg
312
dextrose dose
0.5-1g/kg
313
in what situations would you consider prolonging resuscitative efforts?
recurring or refractory vfib/vtach
drug toxicity
hypothermia
314
2 phases of post resuscitation management
1 immediate post arrest management ABCs
| 2 broader multi-organ supportive care
315
8 goals of post resusciation management in PALS
1 SpO2 94-99
2 use fluids/vadopressors to keep systolic within 5th percentile for age
3 avoid hyper or hypocarbia 35-45
4 continually monitor temp/initiate TTM
5 monitor/treat hypoglycemia
6 manage and treat shock after ROSC
7 consider CT scan and avoid increases in ICP if applicable
316
if intubated at what cmH2O should there be a leak
20-25cmH2O
317
what things can you do to prevent increases in ICP?
elevating bed 30 degrees
mannitol
normocapnea
318
TTM in PALS for infant and children remaining comatose after OHCA
avoid fever/maintain normothermia (36-37.5)for 5 days
OR
maintain 2 days of initial continuous hypothermia (32-34) followed by 3 days of continuous normothermia
319
TTM for infants and children remaining comatose after IHCA
fever should be treated/avoided
320
pediatric dose of atropine
20mcg/kg
| can be repeated
321
max single dose of atropine for child
0.5mg
322
max total dose of atropine for child
1mg
323
max total dose of atropine for adolescent
3mg
324
IV dose epi in PALS bradycardia
10mcg/kg (0.01mg/kg)
| repeat every 3-5 min as needed
325
ETT dose of epi in PALS bradycardia
100mcg/kg
326
adenosine in PALS SVT
dose 1 100mcg/kg (max 6mg)
| dose 2 200mcg/kg (max 12mg)
327
how should adenosine be administered
rapidly followed by 5-10mL bolus of N/S
328
Amiodarone dose (SVT/Stable Vtach)
5mg/kg over 20-60min
329
procainamide dose (SVT/Stable Vtach)
15mg/kg over 30-60min
330
Epi (Vfib/Pulseless Vtach)
10mcg/kg every 3-5min
331
lidocaine PALS vfib/pulseless vtach
1mg/kg
332
amiodarone PALS vfib/pulseless vtach
5mg/kg rapid bolus
| may repeat up to total dose of 15mg/kg OR 300mg total
333
when is amiodarone contraindicated?
torsades
334
magnesium indication and dose
torsades
| 25-50mg/kg
