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PALS > Systematic Approach > Flashcards

Systematic Approach Flashcards

1
Q

4 Types of Respiratory Problems

A
  1. Upper Airway Obstruction
  2. Lower Airway Obstruction
  3. Lung Tissue Disease
  4. Disordered Control of Breathing
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2
Q

4 Types of Circulatory Problems

A
  1. Hypovolemic Shock
  2. Distributive Shock
  3. Cardiogenic Shock
  4. Obstructive Shock
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3
Q

ABCDE

A 
Airway
Breathing
Circulation
Disability
Exposure
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4
Q

Signs of Maintainable Airway

A

Airway is obstructed but can be maintained by simple measures - head tilt-chin lift

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5
Q

Signs of not Maintainable Airway

A

Airway obstruction that cannot be maintained without advanced interventions - intubation

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6
Q

Signs of upper airway obstruction

A
  1. Increased inspiratory effort with retractions
  2. Abnormal inspiratory sounds (snoring or high pitched stridor)
  3. Resp effort but no airway/breath sounds
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7
Q

Ways to position a responsive child for optimal breathing

A

Allow the child to assume a position

Elevate HOB

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8
Q

Ways to position an unresponsive child for optimal breathing

A

Turn child on side if you do not suspect cervical injury

Use a head tilt-chin or jaw thrust

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9
Q

Foreign Body? <1 year of age

A

5 Back slaps and 5 Chest thrusts

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10
Q

Foreign Body? >1 year

A

Give abdominal thrusts

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11
Q

Fast Respiratory rate possibly reasons

A 
Sepsis
Fever
Pain
Dehydration
CHD
Anemia
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12
Q

What is an ominous clinical sign of impending arrest in infant or children

A

Bradypnea or irregular RR in acutely ill children

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13
Q

Three types of apnea

A
  1. Central Apnea
  2. Obstructive
  3. Mixed Apnea
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14
Q

Central Apnea is…

A

No respiratory effort

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15
Q

Obstructive Apnea is…

A

Inspiratory effort without airlfow

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16
Q

Mixed Apnea is…

A

Periods of obstructive and central apnea

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17
Q

When do agonal gasps present in a child?

A

Very late deterioration

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18
Q

Increased respiratory rate is from

A

conditions that increase resistance to airflow

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19
Q

Examples of conditions that increase resistance to airlfow

A

Bronchitis, Asthma

Anything that causes stiff lungs and difficult to inflate

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20
Q

3 objective signs of a child trying to compensate and increase respers

A
  1. Nasal Flaring
  2. Retractions
  3. Head bobbing/seesaw respirations
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21
Q

Retractions

A

inward movement of the chest wall/tissues/sternum during inspiration. Trying to move air into the lungs

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22
Q

Retractions w/ stridor or an inspiratory snoring

A

Upper Airway Obstruction

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23
Q

Retractions by expiratory wheezing

A

Lower Airway Obstruction

obstruction during both ins and exp

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24
Q

Retractions WITH

grunting or labored respirations

A

Lung Tissue Disease - Grunting to keep the alveoli open

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25
Q

Head Bobbing is using what muscles

A

neck muscles

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26
Q

Seesaw respirations are seen in children w/

A

neuromuscular disease

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27
Q

Tidal volume measurement

A

5 to 7ml/kg

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28
Q

Minute Ventilation Equation

A

RR X Tidal Volume

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29
Q

Stridor/Reason

A

High pitched - Upper Airway Obstruction

30
Q

Snoring reason

A

Soft tissue swelling or dec LOC

31
Q

Grunting/Reason

A

Low pitched sound during expiration
Exhale against a partially closed glottis
Lung Tissue Disease
Pain from abd pathology

32
Q

Gurgling/Reason

A

Bubbling sound during insp and exp

Upper airway obstruction due to secretions, vomit, blood

33
Q

Wheezing/Reason

A

Whistling - mostly during expiration

Usually intrathoracic

34
Q

Isolated inspiratory wheezing suggests

A

a foreign body / upper ariway/trachea

35
Q

Crackles mainly during exp or insp?

A

Inspiratory

Fluid filled alveoli opening causing crackles

36
Q

Wet crackles

A

Fluid filled alveoli

37
Q

Dry crackles

A

Atelectasis or interstitial lung disease (Scaring of the lung tissue)
Cause of RUBBING

38
Q

Infant/child develops “Barking”

A

Upper Airway Obstruction

39
Q

O2 saturation does not indiacte

A

02 delivery

40
Q

Profoundly anemic?

A

Saturation could be 100% but 02 content in the blood and 02 delivery may be low

41
Q

What to be careful with CO2 posioning

A

Falsely high 02 saturation bc it counts the carboxyhemoglobin as fully saturated hemoglobin

42
Q

What is methemoglobin

A

When the iron in the body is in the ferrite state not the normal ferrous
Cannot bind oxygen meaning - no O2 to tissues

43
Q

Methemoglobin clinical signs

A

if methemoglobin concentrations are above 5% - the pulse ox will read approximately 85% regardless of the degree of methemoglobinemia

44
Q

Some drugs that can cause methemoglobin

A

Nitrates, Topical anesthetics (benzoincaine), local anesthesia

45
Q

Pulsus Paradoxus

A

Cardiac Tamponade
Dec pulse strength (and BP) during inspiration
More than 10mmhg decrease systolically due to the preload causing the septum wall to curve in towards the left ventricle

46
Q

What is and Causes of cardiac tamponade

A

What is: Excessive accumulation of fluid within the pericardial sac
Cancer, Kidney failure
TB, pericarditis

47
Q

Beck’s Triad

A
  1. Low BP
  2. Increased JVD
  3. Muffled heart sounds
48
Q

Hypotension w/ hemorrhage is how much of a loss of circulation blood volume

A

20-25%

49
Q

UO for infants and young children

A

1.5 to 2ml/kg per hour

50
Q

UO for older children and adolescents

A

1 ml/kg per hour

51
Q

Disability is evaluating

A

neurologic function

52
Q

Standard evaulation

A
  1. APVU (alert, responsive to voice, responsive t pain, unresponsive)
  2. GCS
  3. Pupil reaction
  4. BS
53
Q

Eye Opening GCS

A

(4) Spontaneous
(3) Speech
(2) Pain
(1) No response

54
Q

Verbal GCS

A

(5) Oriented
(4) Confused
(3) Inappropriate Words
(2) Incomprehensible Words
(1) No Response

55
Q

Motor GCS

A

(6) Obeys Commands
(5) Localizes Pain
(4) Withdraws from pain
(3) Abnormal Flexion (Decorticate Rigidity)
(2) Abnormal Extension (Decerebrate Rigidity)
(1) No Response

56
Q

AVPU And GSC equivalent

A

Alert = 15
Verbal = 13
Painful Stimulation = 8
Unresponsive = 6

57
Q

Pinpoint puppils

A

Narcotic Ingestion

58
Q

Dilated puppils

A

Cocaine, ICP

Sympathetic autonomic activity

59
Q

Unilaterally dilated pupils w/ AMS

A

Ipsilateral (same side) uncal herniation (lateral herniation of the temporal lobe)

60
Q

Hypoglycemia in an infant vs child

A

infant: <45
child: <60

61
Q

Petechiae suggests

A

low PLT count

62
Q

Petechia and Purpura may be signs of..

A

Septic Shock

63
Q

Secondary Assessment Consists of

A
  1. Focused Hx
  2. Focused PE
  3. Ongoing Reassessment
64
Q

Focused Hx mnumonic

A

SAMPLE

65
Q

SAMPLE

A 
S/S
Allergies
Medications
PMH
Last Oral Intake
Events
66
Q

Focused PE

A

Brief head to toe

67
Q

Infants compensate for hypercarbia through

A

renal retention of bicarb

68
Q

Arterial Lactate means…

A

Metabolic acidosis - associated w/ tissue hypoxia

Anaerobic Metabolism

69
Q

What is lactic acid

A

When there is not enough oxygen to break down glucose/glycogen and the body instead breaks down carbohydrates for energy

70
Q

What lactic acid level is abnormal

A

> 2

71
Q

Retractions WITH

Stridor or Snoring

A

Upper Airway Obstruction

72
Q

Retractions WITH

Expiratory Wheezing

A

Lower Airway Obstruction (Asthma/Bronchitis)

PALS (9 decks)

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