PGY 1 - PALS

Question 1

Peds Normal HR:

Answer 1

0-1: 140

1-4: 120

4-12: 100

>12: 80

Question 2

PALS Normal RR by Age

Answer 2

0-1: 40

1-4: 30

4-12: 20

12+: 15

Question 3

PALS Bradycardia Resus:

Answer 3

• ABCs, IV, O2, monitor/defib, VS, EKG
• HR <60 + Poor Perfusion: CPR, Epi (0.01 mg/kg) q 3-5 min
  
  • Add atropine (0.02 mg/kg, max 0.1 mg) if increased vagal tone or AV block
• HR < 60 and perfusing: Supportive care, treat cause

Question 4

PALS Tachycardia - Narrow QRS

Answer 4

• If QRS narrow (< 0.09 sec) and HR < 220 infant/ < 180 in kid = likely sinus tach
  
  • Treat causes
  • (sinus tach = P waves, rate varies)
• If QRS narrow (< 0.09 sec) and HR > 220 infant/180 kid = likely SVT
  
  • Vagal maneuvers
  • Adenosine 0.1mg/kg IV (may repeat w double dose)
  • Synchronized shock at 0.5-2 J/kg
  • (SVT = no P waves, rate constant)

Question 5

PALS Tachycardia - Wide QRS

Answer 5

ASAP: ABCs, IV/IO, O2, monitor / defibrillator, VS, EKG

If QRS wide (> 0.09 sec) (or unstable VS)-possible ventricular tachycardia

• VT or unstable, then:
• Synchronized shock at 0.5-2 J/kg
• Amiodarone 5mg/kg IV/IO over 1 hr
• Procainamide 15 mg/kg IV/IO over 1 hr
• Adenosine 0.1 mg/kg (max 6 mg), second dose 0.2 mg/kg (max 12 mg)- if regular and monomorphic

Question 6

PALS Arrest - Asystole/PEA

Answer 6

• ASAP: ABCs, IV/IO, O2, monitor /defibrillator, VS, EKG
• If asystole/PEA:
  
  • CPR (15:2) x 2 min
  • Epinephrine 0.01mg/kg (1:10,000) IV/IO q 3-5min
  • Repeat eval for potential causes (H’s & T’s)

Question 7

PALS Arrest - VT/VFib

Answer 7

• ASAP: ABCs, IV/IO, O2, monitor /defibrillator, VS, EKG
• If VT/VF
  
  • Shock- 2J/kg, second 4J/kg (max 10J/kg or adult dose)
• If still VT/VF
  
  • Shock at 4 J/kg and continue CPR
  • Epinephrine 0.01mg/kg (1:10,000) IV/IO q 3-5min
• After 5 cycles CPR, check rhythm
• If still VT/VF
  
  • Shock at >4 J/kg
  • Continue CPR
  • Consider Amiodarone 5mg/kg IV/IO
  • Consider Lidocaine loading dose 1mg/kg

Question 8

PALS Epi Dose

Answer 8

0. 01 mg/kg IV
1. 1mg/kg ETT (use 1:1000 concentration)

Question 9

PALS Amiodarone Dose

Answer 9

5mg/kg bolus

Can repeat up to 3 total doses

Question 10

PALS Rescue Breathing Rate

Answer 10

q2-3 seconds

Question 11

PALS Defib Dose

Answer 11

Intital 2 J/kg

Subsequent 4 J/kg

Subsequent >4 J/kg - max 10 J/kg or adult dose

Question 12

PALS Atropine Dose

Answer 12

0.02 mg/kg

May repeat once

Max dose 0.1 mg

Question 13

PALS Adenosine Dose

Answer 13

First: 0.1 mg/kg (max 6 mg)

Second: 0.2 mg/kg (max 12 mg)

Question 14

PALS Syncronized Cardioversion Dose

Answer 14

First: 0.5-1 J/kg

Increase to 2 J/kg if needed