PALS feb 20 Part 1-3 Flashcards
what is the push rate for CPR compressions in infants, children, and adolescents?
100 - 120
During compressions, depress the chest __ in or __cm in infants and __ in or __ cm in children.
- 5 in or 4 cm
2. 4 in or 6 cm
Try to limit interruption of compressions to __ seconds, ideally, only for _______.
10 seconds
ventilation
You should provide continuous compressions compressions without pausing for ventilation once ____ _____ is established.
Advanced airway.
Each rescue breath should be given over __ second.
1 second
What is the ratio for compressions to breaths for a single rescuer?
30:2
What is the ratio for compressions to breaths in a 2 or more rescuer scenario?
15:2
After an advanced airway is established, deliver __ breaths per minute or __ breath every __ seconds.
10
1
6
What is the formula used to identify the fifth percentile for systolic BP
70 mmHg + (age in years x 2)
An infant is described as what in years of age.
A child is described as what in years of age.
Less than 1 year in age.
from 1 year to puberty.
If you find an unresponsive pediatric pt with no normal breathing but has pulse, what do you ?
When do you initial compressions?
When do you activate the emergency response system?
Provide 1 rescue breath every 3-5 seconds or about 12-20 breaths per minute.
Initiate compressions if pulse remains less than 60 with signs of poor perfusion.
After 2 minutes of rescue breathing, activate the emergency response system and begin CPR.
To minimize delay in starting CPR, assess breathing and pulse at the same time, this should take no more than __ seconds.
10
Where should you palpate a for a pulse in an infant?
bronchial artery, upper arm
Where should you palpate for a pulse in a child?
carotid or femoral artery, in either the neck or the groin.
If the victim is not breathing normally and has no pulse, what are your priorities?
First 3 steps.
Leave the victim and activate the emergency response system or code team.
Go get or send someone for an AED.
Begin high quality CPR for 2 minutes.
What should you use to deliver compressions in an infant.
Child?
2 finger chest compressions.
One or two hands.
After initiating CPR, if you are still alone and have not activated the emergency response system, what do you do?
Leave the victim to activate the emergency response system and find an AED. Use the AED as soon as possible.
After using the AED, whether shock completed or no shock advised, you begin CPR starting with what?
compressions.
What are 4 signs of poor perfusion?
Cool extremities
altered mental status
pulslessness
skin color; paleness, mottled, patchy, and later cyanotic
True or False
The single rescuer compression to ventilation ratio is the same in adults, children, and infants.
True
The universal rate is 100 to 120 per minute with a ratio of 30:2
What is the compression to ventilation rate for 2 rescuer for a child or infant?
15:2
For infants, the single rescuer should use what technique for compressions.
Multiple rescuers should use what technique?
Two finger technique.
Multiple rescuers should use the 2 thumb encircling hands technique.
For an infant, what is the preferred method of delivering compressions?
the 2 thumb encircling hands technique.
After every __ compressions, pause and give __ rescue breaths lasting __ second each using the what technique?
15
2
1
Two rescuers should switch roles every __ cycles or __ minutes.
5
2
What are the three reasons you would stop performing CPR?
AED arrives
Advanced providers arrive
the child begins to breath, move, or otherwise respond.
What are the two methods of opening the airway?
head tilt, chin lift
jaw thrust.
For AED, use child pads, if available for infants and children under __ years of age. What do you do if you don’t have child pads?
8 years of age
If you don’t have child pads use adult pads, because a higher shock is better than no shock.
What type of AED is best for infants.
What is the next best thing.
A manual defibrillator, which can deliver a lower dose shock. It’s use is not covered in the PALS course.
The next best thing is an AED with a pediatric dose attenuator.
What are the three components of the pediatric assessment triangle?
Appearance
Work of breathing
Circulation
This three step ongoing process is a core component of systematic evaluation and care of the seriously ill or injured child.
Evaluate-identify-intervene
The PAT uses an A-B-C evaluation status. What is PAT and what does the A, B, and C stand for?
Pediatric assessment triangle
Appearance
work of Breathing
Circulation
When assessing the appearance of a child, what is the mnemonic that can be used as an adjunct?
TICLS
What does TICLS stand for, and what part of the PAT is it used as an adjunct?
Tone Interactiveness Consolability Look/gaze Speech/cry
What are some abnormal findings when assessing a childs breathing?
Positioning 4
Sounds
tripod, nasal flaring, use of accessory muscles. Normal expirations should be passive.
Wheezing, grunting, stridor
A flushed appearance may suggest a child with a fever, or what?
distributive shock such as with sepsis, toxins, or anaphylaxis.
You may see evidence of bleeding within the skin, called ____ or ____. This purplish discoloration of the skin is often a sign of what?
petechiae or purpura
May be a sign of a life threatening infection
Use this sequence every time there is a change in the childs condition or intervention.
What is the sequence and give some examples of interventions.
Evaluate
identify
intervene
Interventions; fluid boluses, oxygen
What is the difference between the use of the PAT and a primary assessment?
The pediatric assessment triangle is used for an across-the-room assessment.
The primary assessment uses an ABCDE approach
In the primary assessment, what does ABCDE stand for?
Airway Breathing Circulation Disability Exposure
If a child is less than one year of age, is responsive, has a complete airway obstruction(unable to make sound), what should you do?
give 5 back slaps, 5 chest thrusts
If a child is more than one year of age, is responsive, has a complete airway obstruction(unable to make sound), what should you do?
Give abdominal thrusts.
What are 4 advanced airway interventions that may be used to maintain patency?
ET tube
CPAP
removal of the foreign body via laryngoscopy
cricothyrotomy (needle puncture or surgical opening through the skin and cricothyroid membrane and into the trachea below the vocal cords).
Primary assessment
Breathing
what are 5 things to look for?
respiratory rate respiratory effort chest expansion lung and airway sounds O2 saturation
what are the normal breaths per minute for an infant?
30-53
what are the normal breaths per minute for a toddler?
22-37
what are the normal breaths per minute for a preschooler?
20-28
what are the normal breaths per minute for a school aged child?
18-25
what are the normal breaths per minute for an adolescent?
12-20
A consistent respiratory rate of less than __ or more than __ breaths per minute in a child of any age is often abnormal and warrants further assessment for the presence of a potentially serious condition.
10
60
Be aware that sleeping infants may have irregular (periodic) breathing with pauses lasting up to __ or even __ seconds.
10
15
Normal tidal volume is __ to __ ml/kg of body weight throughout life.
5 to 7
What is the location for lung sounds that is best for evaluating air movement into the lower parts of the lungs?
under the armpits
What is the name of a short, low pitched sound heard during expiration?
what may is indicate?
grunting
a progression from respiratory distress to respiratory failure.
____ is a high pitched or low pitched whistling sound that is heard most often during expiration, and less frequently during inspiration.
wheezing
A pulse oximeter will reflect a falsely ____ reading in the case of carbon monoxide poisoning. Why?
false high
the meter does not distinguish oxygen saturated hemoglobin from carboxyhemoglobin
Primary assessment
What are 5 things to evaluate?
Heart rate and rhythm Pulses capillary refill time skin color and temperature blood pressure
What is the normal heart rate for a neonate ?
sleeping / awake
100-205 / 90-160
What is the normal heart rate for an infant?
sleeping / awake
100-180/ 90-160
What is the normal heart rate for a toddler?
sleeping / awake
98-140 / 80-120
What is the normal heart rate for a preschooler?
sleeping / awake
80-120 / 65-100
What is the normal heart rate for a school-aged child?
sleeping / awake
75-118 / 58-90
What is the normal heart rate for a adolescent?
sleeping / awake
60-100 /50- 90
_____ can be considered normal, but when accompanied with signs of poor perfusion, warrants intervention.
Bradycardia
What is the most common cause of bradycardia in pediatrics?
hypoxia
_____ is a bluish discoloration of the hands and feet and of the skin around the mouth. It is a common normal finding during the newborn period.
Acrocyanosis
_____ ____ is a bluish discoloration of the hands and feet beyond the newborn period that can be cause by diminished O2 delivery to the tissues.
Peripheral cyanosis
_____ _____ is a blue color of the lips and other mucous membranes
central cyanosis
Hypotension in a neonate (28 days or less) is defined as what?
SBP < 60
Hypotension in a infant is defined as what?
SBP < 70
Hypotension in a child 1 to 10 years old is defined as what?
SBP < 70 + (age in years x 2)
Hypotension in a child 10 years or older is defined as what?
SBP < 90
Primary assessment
Disability
What are 5 assessment measures to evaluate neurological function?
AVPU TICLS GCS Pupils blood glucose
What does AVPU stand for?
Alert, responsive to Voice, responsive to Pain, Unresponsive
hypoglycemia refers to blood glucose lower than __ in an infant and less than __ in a child.
45
60
