PALS feb 20 Part 4-7 cardiac arrest and airway Flashcards
The survival rate for hospital to discharge for children who experience cardiac arrest is __% for out-of-hospital setting and __% for arrest that happens in the hospital.
8
43
In contrast, cardiac arrest does not usually result from a primary cardiac condition. It is typically the end result of what?
progressive respiratory failure or shock
the 2 pathways to cardiac arrest in children are what?
hypoxic / asphyxial
sudden cardiac arrest
the most common cause of cardiac arrest in children is what?
hypoxic / asphyxial
The H’s and T’s refer to reversible conditions that can cause cardiac arrest. What are the H’s?
Hypovolemia Hypoxia Hydrogen ions Hypoglycemia Hypo- Hyperkalemia Hypothermia
The H’s and T’s refer to reversible conditions that can cause cardiac arrest. What are the T’s?
Tension Pneumothorax Tamponade Toxins Thrombosis Pulmonary Thrombosis coronary
cardiac arrest is associated with one of these 4 rhythms, also known as arrest rhythms, what are they?
Asystole
PEA
VF
pVT
what two arrest rhythms are treated exactly the same?
pVT and VF
Polymorphic pVT is also known as what?
torsades
If Petco2 is less than __ to __ mmHg, cardiac output during CPR is low and not much blood is being delivered to the lungs.
10 to 15
ROSC is identifiable by the abrupt increase of Petco2 to over __ mmHg.
40
What are the three drug delivery routes during PALS in order of preference?
IV
IO
ET tube
True or false
Any drug or fluid that can be given by IV can also be given by IO
True
What type of drugs can be given via the ET route?
lipid soluble drugs
What drugs can be given via ET route as represented by the mnemonic LEAN?
What is one more drug not represented by the mnemonic?
Lidocaine epinephrine atropine naloxone vasopressin
The recommended ET dose of epinephrine is __ times the IV/IO dose.
10
The typical ET dose of drugs other than epinephrine are __ to __ times the IV/IO dose.
2 to 3
what is the procedure for giving drugs via the ET route?
briefly pause compressions and instill the drug into the tube
follow with a minimum 5 ml flush of NS
Provide 5 rapid positive pressure breaths after the drug is instilled
what are 7 pediatric cardiac arrest drugs?
Epinephrine Amiodarone Lidocaine Mag Sulfate Atropine Calcium Sodium Bicarbonate
When providing ventilations via advanced airway during CPR, provide 1 breath every __ seconds.
Should you pause compressions for breaths?
6 seconds
No, continue to give breaths and compressions simultaneously
First shock __ J/kg, second shock __ J/kg, maximum __J/kg or adult dose
2
4
10
Epinephrine IV/IO dose __ mg/kg and repeat every __ - __ minutes
0.01 mg
3 to 5 minutes
if no IV/IO access, you may give epinephrine via ET tube __ mg/kg
0.1
what is amiodarone used for?
refractory VF or pVT
how many times can you use amiodarone?
up to two times
What is the dose for amiodarone?
5 mg/kg bolus during cardiac arrest, may repeat up to two times
Using the pediatric cardiac arrest algorithm, you would first give epi after how many shocks?
2
What is the order of operations according to the pediatric cardiac arrest algorithm?
pg 89
CPR - attach AED shock yes (VF/pVT) no Asys/PEA if yes shock + cpr 2 min IV/IO access shock epi shock amiodarone
what is the maximum single dose of amiodarone?
300 mg
What ET tube consideration should be taken in cardiac arrest from anaphylaxis?
you may have to use a smaller than recommended ET tube due to airway edema
______ is generally defined as arterial O2 saturation that is below 94%.
Hypoxemia.
____ _____ is a pulse ox reading of less than 94% which may be appropriate in certain circumstances, such as congenital heart disease.
Permissive hypoxemia.
Due to the higher metabolic rate, O2 consumption in infants is __ to __ ml/kg, as compared to __ to __ per minute in an adult.
6 8
3 4
Hypercarbia is an increased CO2 tension in the arterial blood (PaO2). When hypercarbia is present, ______ is inadequate.
Ventilation
causes of hypercarbia are airway obstruction, lung tissue disease, decreased or inadequate respiratory effort (central hypoventilation).
A childs clinical condition deteriorates from anxiety and agitation to decreased responsiveness despite O2 saturation, this may indicate what?
An increase in PaO2 due to inadequate ventilation. Despite supplemental O2, CO2 isn’t being blown off enough.
The impedance of airflow within the airways is called what?
Airway resistance.
________ refers to the distensibility of the lung, chest wall, or both, and is defined as the change in lung volume produced by a change in driving pressure across the lung.
compliance, or lung compliance.
_____ _____ is a clinical state of increased respiratory rate, effort, and work of breathing
respiratory distress
_____ _____ is a clinical state of inadequate oxygenation, ventilation, or both that can be recognized by agitation or altered consciousness, poor color or reduced responsiveness.
Respiratory failure.
Increased respiratory effort, inspiratory retractions, use of accessory muscles, nasal flaring, stridor, drooling, snoring, or gurgling sounds can all be signs of what?
upper airway obstruction
what are two common causes of lower airway obstruction?
Asthma, bronchiolitis
Increased respiratory effort retractions, nasal flaring, decreased air movement, prolonged expiratory phase with active movement, wheezing, cough, can all be signs of what?
lower airway obstruction
what are the guidelines for rescue breathing (5)
give 12 to 20 breaths per minute each breath over 1 second each breath should have chest rise check pulse every 2 minutes use supplemental O2 as soon as it is possible
Tachypnea, increased respiratory effort, grunting, crackles, diminished breath sounds, tachycardia, and hypoxemia are all signs of what?
Lung tissue disease
In the case of lung tissue disease, what do pediatric patients demonstrate grunting?
partial closure of the glottis helps keep alveoli open
Inadequate respiratory effort, “breathing funny”, that may be resulting from a host of conditions including neurologic disorders such as seizures, CNS infections, head injury, brain tumor, or hydrocephalus is referred to as what?
Disordered control of breathing
this condition can range from causes that include swelling of the tonsils, adenoids, or other soft tissues to a foreign body lodged in the nose, pharynx, or larynx
Upper airway obstruction
what should you consider before suctioning the airway of a child with an upper airway obstruction caused by edema from infection like croup, allergic reaction?
Suctioning may cause increased agitation and increased respiratory distress. Instead, consider allowing the child to assume a position of comfort with nebulized epinephrine
A child with an obstruction caused by the tongue with a decreased level of consciousness may benefit from what?
an oral or nasal airway adjunct
If a child has a swollen airway, what is a consideration when choosing an ET tube?
In order to prevent injury, use a smaller tube, up to half the size predicted for the childs age
for a child that needs more than 40% O2 concentration, what should you consider using
Heliox, helium oxygen mixture
what is the first line medication for a child with an obsttructed airway from croup. What is further added with severity?
dexamethasone for mild case, with increased severity also consider nebulized epinephrine and nothing by mouth
for mild allergic reaction, what is the first line treatment?
oral dose of antihistamine
for mild to moderate allergic reaction, what are the steps you should be prepared to take?
IM epinephrine q 10 to 15 minutes as needed
IV prednisone
treat wheezing with albuterol neb
anticipate ET tube
for a child less than 1 year with a FBAO, what are the three steps you should take?
- confirm severe airway obstruction
- Give 5 back slaps and up to 5 chest thrusts
- Repeat step two until object is expelled or the child becomes unresponsive.
for a child older than 1 year with FBAO, what are the three steps you should take?
- ask the child if he or she is choking
- stand or kneel behind the child and give Heimlich maneuver
- Repeat steps until the object is expelled or the patient becomes unresponsive.
If a child with a FBAO becomes unresponsive, what do you do?
Begin CPR without pulse check
Check for FB every time you open the mouth and remove if you can see it. Do not do a blind finger sweep.
Continue CPR for 5 cycles or 2 minutes, if you are still alone leave the child to activate the emergency response system
Non cardiac pulmonary edema is also called what?
ARDS, it usually follows a pulmonary or systematic disease process that injures the interface between the alveoli and pulmonary capillaries and triggers the release of inflammatory mediators
what are three common conditions that cause upper airway obstruction?
croup
anaphylaxis
aspiration of foreign body
what are two steps in treating croup?
nebulized epinephrine
corticosteroids
what are four steps in treating anaphylaxis?
IM epinephrine
Albuterol
antihistamines
corticosteroids
what are two steps in treating aspiration of foreign body
allow position of comfort
specialty consultation
What are two common conditions that cause Lower airway obstruction?
bronchiolitis
asthma
what are two things that can be done for bronchiolitis?
nasal suctioning
bronchodilator trial
what are 5 steps in treating asthma?
albuterol + ipratropium corticosteroids subcutaneous epinephrine Magnesium sulfate terbutaline
what are two common causes of lung tissue disease?
PNA/pneumonitis pulmonary edema (ARDS)
what are three common causes of Disorderd control of breathing?
Increased ICP
poisoning / overdose
Neuromuscular disease
what is the best position to place a child to keep the airway open?
the sniffing position
due to their large head to body ratio, how do you get an infant into a sniffing position?
towel or diaper behind the shoulders
what are some steps to take in order to prevent gastric inflation in pediatric patients?
1 breath q 3 to 5 seconds
breaths delivered over 1 second to avoid peak inspiratory pressures
deliver enough volume to see the chest rise and nothing more
what is the suction power needed to generally remove airway secretions?
-80mmHg - -120mmHg
what are 5 possible complications of suctioning
hypoxia vagal stimulation resulting in bradycardia gagging or vomiting soft tissue injury agitation
what are two things to consider when suctioning regarding amount of time and preparation/recovery?
try not to suction for more than 10 seconds (but you may have to for excess blood or secretions)
give 100% O2 before and after suctioning
What is an OPA?
when is it ok to use it?
oropharyngeal airway
when the patient is unconscious and doesn’t have a gag reflex
