PALS

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mthompson17
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PALS
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2014-06-30 15:45:08
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PALS nursing
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PALS
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  1. 3 parts of initial assessment?
    • LOC
    • breathing
    • color
  2. Actions if unresponsive & not breathing/only gasping?
    shout for help/activate emergency response then check for a pulse

    • with pulse:  give breaths
    • without a pulse or pulse <60:  CPR
  3. Evaluation of a child with no life-threatening problem?
    primary assessment:  ABCDE

    secondary assessment:  focused medical history & physical exam

    diagnostic tests

    assess scene for danger
  4. Primary assessment?
    • ABCDE
    • Airway
    • Breathing
    • Circulation
    • Disability
    • Exposure

    get VS, etc
  5. When to do heimlich?

    How?
    if child has obstruction and is still awake

    <1year old:  5 back slaps & 5 chest thrusts

    </= 1 year:  abd thrusts
  6. Advanced airway interventions?
    • 1. ET
    • 2. CPAP - continuous positive airway pressure
    • 3. trach
    • 4. removal of foreign body:  direct laryngoscopy
  7. Normal RR by age?
    • infants:  30 to 60
    • toddler (1-3):  24-40
    • preschooler:  (4-5):  22-34
    • school age (6 to 12):  18- 30
    • adolescent (13-18):  12 to 16
  8. Why may RR be increased?
    anything that raises metabolic demands:  anxiety, fever
  9. RR rate of infants sleeping?
    normal for RR to pause for 10-15 seconds during sleep
  10. What is often the first sign of respiratory distress in infants?
    tachypnea
  11. Apnea?
    cessation of breathing for 20 seconds or <20 seconds if accompanied by bradycardia, cyanosis, or pallor
  12. Head bobbing and seesaw respirations?
    sign of deterioration or respiratory distress

    head bobbing:  tilt head back during I and forward during E

    seesaw:  chest retracts & abd expands during inspiration & opposite during expiration
  13. What may be indicated if child's WOB & other s/s indicate airway obstruction but no stridor or wheezing is heard?
    may not be enough airflow to cause sounds
  14. Stridor?
    usually heard on I:  indicates upper airway obstruction that may be critical
  15. Grunting?
    heard during E usually

    caused by partially closed glottis

    usually r/t alevolar collapse/lung problems

    may indicate respiratory failure or may be response to pain from abd probs
  16. Gurgling?
    upper airway obstruction with liquid:  vomit, blood, secretions, etc
  17. Wheezing?
    usually during E

    usually means lower airway obstruction:; bronchiolitis, asthma, obstruction
  18. Crackles?
    • AKA rales
    •  I sounds

    alveolar fluid

    dry crackles:  atelectasis
  19. Where should pulse ox be placed on a child?
    finger, toe, or earlobe
  20. When is O2 sat reading inaccurate?
    low H&H/RBC's:  inadequate HgB but all is saturated:  shows normal O2 sat

    inadequate circulation:  may have adequate O2 but it can't circulate

    carbon monoxide:  shows high O2 sat
  21. Normal heart rates for children?
    • newborn - 3 months:  85 - 205
    • 3 mo to 2 years:  100 to 190
    • 2 yrs to 10 years:  60 - 140
    • <10:  60 -100
  22. Most common cause of bradycardia in children?
    hypoxia
  23. Sinus arrhythmia in children?
    normal for HR to fluctuate with breathing in children:  increase with I and decrease with E
  24. Pulsus paradoxis?

    2 causes?
    fluctuation in pulse voume with respiratory cycle

    severe asthma & pericardial tamponade
  25. Normal cap refill?
    < 2 seconds
  26. Pallor of what areas are most clinically significant?
    mm, lips, palms, and soles
  27. Causes of mottling?
    may be hypoxemia, hypovolemia, or shock that cause intense vasoconstriction from irregular supply of O2 blood
  28. Central cyanosis?
    cyanosis of mm and mouth

    usually an emergency
  29. Areas to check for cyanosis?
    may be more apparent in mm and nail beds, soles of feet, tip of nose, and earlobes
  30. Normal child BP?
    • neonate (1 day):  60-75/30-45
    • neonate (4 days):  65-85/35-55
    • infant up to 1 year:  75-95/35-55
    • 1 -2 years old:  85-105/45-65
    • 7 years:  95-115/55-75
    • 15 years:  similar to adults
  31. s/s of cerebral hypoxia?
    • 1. decreased LOC
    • 2. loss of muscular tone
    • 3. seizures
    • 4. pupil dilation
  32. 2 causes of hypotension r/t shock?
    can be caused by decreased circulating volume:  blood loss, dehydration

    may be caused by vasodilation:  septic shock
  33. Ominous sign in a child with tachycardia and hypotension?
    development of bradycardia
  34. Good indicator of positive response to therapy for hypovolemia?
    increasing UO
  35. Way to rapidly eval cerebral cortex/LOC of a child?
    • AVPU pediatric response scale
    • Alert:  awake, active, responsive
    • Voice:  responds only to voice calling name or speaking loudly
    • Painful:  responds only to painful stimulus
    • Unresponsive:  none
  36. What is the most important part of the GCS for pt that are intubated or nonverbal?
    motor response
  37. GCS for adults and children?
    • Eye Opening:
    • 4 - spontaneous
    • 3 - to speech
    • 2 - to pain
    • 1 - none

    • Best verbal response:
    • 5 - oriented
    • 4 - confused
    • 3 - inappropriate words
    • 2 - incomprehensible speech
    • 1 - none

    • Best motor response
    • 6 - obeys
    • 5 - localizes
    • 4 - withdraws
    • 3 - abnormal flexion/flexion in response to pain
    • 2 - extensor response/extension in response to pain
    • 1 - none
  38. GCS for infants?
    • Eye Opening:
    • 4 - spontaneous
    • 3 - to speech
    • 2 - to pain
    • 1 - none

    • Best verbal response
    • 5 - coos & babbles
    • 4 - irritable, cries
    • 3 - cries in response to pain
    • 2 - moans in response to pain
    • 1 - none

    • Best motor response
    • 6 - moves spontaneouly & purposely
    • 5 - withdraws in response to touch
    • 4 - withdraws in response to pain
    • 3 - decorticate posturing - abnormal flexion in response to pain
    • 2 - decerebrate posturing:  abnormal extension in response to pain
    • 1 - none
  39. Indication with absent pupillary response?
    brainstem injury
  40. Alterations in pupillary response to light or pupil size?
    ocular trauma, ICP
  41. Exposure assessment?
    remove clothing one item and a time

    look for trauma

    check temp/temp differences on body
  42. Focused Hx assessment?
    • SAMPLE
    • S - s/s at onset
    • A - allergies
    • M - meds
    • Past medical Hx
    • Last meal
    • Events leading to current illness & Tx done
  43. PaO2?
    only indicates O2 dissolved in blood plasma - if HgB is low PaO2 may be normal anyway
  44. Lactate concentration test?
    high lactate shows hypoxia of tissues and anaerobic respiration
  45. H's & T's
    • hypotension
    • hypo/hyperthermia
    • hypoxia
    • hypovolemia
    • hyper/hypo electrolytes
    • hypoglycemia
    • tamponade
    • toxin
    • tension pneumothorax
    • thrombosis
    • trauma
  46. Why can respiratory distress develop more rapidly in children?
    higher metabolic rate
  47. Compensation for tissue hypoxia?

    As it worsens?

    late signs?
    increased RR and depth

    • 1. first sign = tachycardia
    • 2. tachypnea
    • 3. s/s of resp distress

    cyanosis, decreased LOC, bradypnea,/apnea, bradycardia
  48. Hypercarbia?

    Causes?
    high CO2 - inadequate ventilation

    . anything that depresses resp system:  drugs, CNS probs
  49. Critical indicator of inadequate ventilation, hypoxia, and hypercarbia?
    decreased/decreasing LOC:  even if O2 sat is normal suspect ventilation is inadequate & hypercarbia & resp acidosis may be present
  50. 4 factors that cause increased WOB?
    • 1. increased airway resistance
    • 2. decreased lung compliance
    • 3. use of accessory muscles
    • 4. disordered CNS control of breathing
  51. Interventions for respiratory distress/failure?
    Airway:  positioning open, clear with suctioning, oropharyngeal or nasopharyngeal airway

    Breathing:  O2 sat, auscultate breath sounds, give O2, sit up, albuterol/epi, vent with bag, ET

    Circulation:  color, pulses, cap refill, HR & rhythm, BP, IV for fluid therapy & meds as indicated
  52. Interventions for upper airway obstruction?
    ABC's for respiratory distress/failure AND

    • 1. remove foreign body if possible
    • 2. suction nose/moouth
    • 3. reduce airway swelling with meds
    • 4. minimize agitation - can make swelling worse
    • 5.  may need surgery
    • 6. CPAP
  53. S/S of croup?
    s/s of upper airway obstruction and barking cough
  54. Tx of croup?
    mild:  dexamethasone

    mod-sever:  humidified O2, NPO, nebulized epi, dexamethasone, heliox
  55. Tx of croup with impending respiratory failure?
    • 1. O2 with nonrebreather
    • 2. bag vent
    • 3. dexamethasone
    • 4. ET
    • 5. surgical airway prn
  56. Mgmt of anaphylaxis?
    • 1. ABC interventions for resp failure and give IM injection of EPI q10-15 min prn
    • 2. albuterol
    • 3. ET
    • 4. Tx hypotension:  trendelenburg, isotonic solution 20mL/kg bolus, may give IV epi,     5. diphenhydramine & an H2 blocker             6. methylprednisolone/corticosteroids
  57. Foreign body airway obstruction interventions?
    if it is not complete obstructions:  do not do anything, get help and let child try to cough it up

    • if complete & child is conscious:
    • 1year:  5 back slaps & 5 chest thrusts
    • over 1 year:  abd thrusts

    if child becomes unresponsive:  start CPR even if pulse is palpable starting with chest compressions  - before giveing breaths see if there is a foreign body that can be removed
  58. Asthma mgmt?
    • 1. humidified O2
    • 2. albuterol
    • 3. oral/IV corticosteroids
    • 4. ipratropium bromide
    • 5. IV access & fluids
    • 6. Mg sulfate IV slow (15 to 30 min):  monitor HR & BP
    • 7. DX tests:  ABG, CXR
    • 8. terbutaline SQ or by cont IV:  relaxes and opens airways
    • 9. positive airway pressure
    • 10. ET
  59. Mgmt of infectious pneumonia, chemical pneumonitis, & aspiration pneumonitis?
    • 1. Dx tests:  ABG, CXR, viral studies, CBC, blood culture, sputum gram stain & culture
    • 2. admin ABX
    • 3. albuterol for wheezing
    • 4. CPAP or ET with vent prn
    • 5. reduce metabolic demand by normalizing tem p & reducing WOB
  60. Possible causes of cardiogenic pulmonary edema?
    • 1. hear problems especially involving L ventricle
    • 2. hypoxia
    • 3. cardiac-depressant drugs:  beta blockers, tricyclic antidepressants, Ca channel blockers
  61. Interventions for cardiogenic pulmonary edema?
    • 1. ventilatory suppoet:  CPAP, PEEP with vent
    • 2. diuretics
    • 3. inotropic drugs
    • 4. reduce metabloic demand by normalizing temp and decreasing WOB
  62. AE of too much PEEP>
    low BP
  63. Cushing's triad?
    • 1. irregular breathing or apnea
    • 2. increase in mean arterial pressure
    • 3. bradycardia

    indicates impending brain herniation
  64. Interventions for resp failure with increased ICP?
    • 1. get neurosurgical consult
    • 2. open airway with jaw-thrust
    • 3. O2 - may hyperventilate if brain herniation is impending
    • 4. poor perfusion or organ dysfunction r/t poor perfusion:  IV with isotonic fluids
    • 5. hypertonic & osmotic agents
    • 6. Tx agitation & pain
    • 7. Avoid hyperthermia
  65. S/S of increased ICP?
    • 1. irregular respirations/apnea
    • 2. bradycardia
    • 3. hypertension
    • 4. unequal or dilated pupils not responsive to light
    • 5. decerebrate or decorticate posturing
  66. Interventions for poisoning or drug OD?
    • 1. call poison control center
    • 2. suction airway with vomiting
    • 3. admin antidote as indicated
    • 4. Dx tests:  ABG, ECG, CXR, electrolytes, glucose, serum osmolality, & drug screen
  67. Neuromuscular disease?
    ineffective cough and secretions build up
  68. What may be indicated by increased lung stiffness during ventilation?
    airway obstruction, pneumothorax
  69. Bag vent?
    deliver each breath over 1 second
  70. Shock?
    metabolic demands of body are not met by BF/oxygenation

    may be r/t loss of BV, maldistribution of blood, BV dilation, increased metabolic demands, heart malfunction
  71. CO output of infants?
    CO = HR x stroke volume (amnt pumped out)

    infants need HR to maintain CO b/c they are unable to adjust their stroke volume to compensate for low HR
  72. 3 factors that effect stroke volume?
    • preload - amnt in heart before it pumps
    • contractility
    • afterload - vascular resistance
  73. Compensatory mechanisms as shock develops?
    • 1. tachycardia
    • 2. vasoconstriction to nonvital organs:  decreased UO, decreased extremity perfusion, pulse, cap refill, paleness, etc
    • 3. increased contractility
  74. Relationship b/t SVR and diastolic pressure?
    • increase in SVR = increased diastolic pressure
    • decrease in SVR - decrease in diastolic pressure
  75. What happens to BP as CO decreases?
    will usually be maintained by increased SVR
  76. Effect of increased SVR on BP?
    narrowed pulse pressure r/t increase SVR = increase diastolic pressure
  77. S/S of severe decreased tissue perfusion in shock?
    • 1. hypotension
    • 2. lactic acidosis
    • 3. end-organ dysfunction:"  altered mental status, decreased UO
    • 4. myocardial dysfunction & cardiac arrest
  78. Compensated/decompensated shock?
    compensated - systolic BP maintained at normal

    decompensated:  low systolic BP

    children are at risk even with compensated b/c they may have very low CO with high SVR keeping BP normal
  79. Checking BP when there is inadequate perfusion of distal areas?
    automated BP readings may be inaccurate if taken when there is no distal perfusion:  weak pulses, cap refill, pale, etc
  80. Key clinical sign of deterioration in hypotensive shock?
    decreasing LOC
  81. When may hypotension be an early sign of shock?

    S/S?
    septic shock - sepsis can cause vasodilation & decreased SVR

    may still have warm extremities, brisk cap refill, and full peripheral pulses despite hypotension
  82. Hypotension formula for children 1 to 10 years of age?
    if child's BP is <

    70 + (child's age X2)
  83. S/S of shock progression?
    • 1. s/s of decreasing profusion:  decreasing pulse, cap refill, coloring
    • 2. decreasing BP
    • 3. increasing HR & RR
    • 4. decreasing LOC
  84. Major cause of hypovolemic shock in children?
    diarrhea
  85. Causes of hypovolemic shock?
    • 1. diarrhea/vomiting
    • 2. hemorerhage
    • 3. inadequate fluid intake
    • 4. osmotic diuresis:  DKA
    • 5. third-space losses
    • 6. large burns
  86. Why does tachypnea occur with hypovolemic shock?
    metabolic acidosis occurs with hypovolemic shock - hyperventilation compensates for this
  87. S/S of hypovolemic shock?
    • 1. increased RR & HR
    • 2. decreased BP & narrowed pulse pressure
    • 3. metabolic acidosis
    • 4. weak or absent peripheral pulses
    • 5. delayed cap refill
    • 6. cool, pale, diaphoretic skin
    • 7. changes in LOC
    • 8. oliguria
  88. 3 forms of distributive shock?
    septic, neurogenic, anaphylactic
  89. Patho of distributive shock?
    vasodilation & increased vascular permeability cause relative hypovolemia and decreased perfusion
  90. Neurogenic shock?
    high cervical spine injury:  hypotension and vasodilation occur r/t no CNS stimulation

    not able to compensate with tacfhycardia so HR and BP will both be low
  91. S/S of distributive shock?
    same as hypovolemic except neurogenic shock will have decreased HR

    in initial stages will have adequate CO with low SVR then progresses to same as hypovolemic with low CO & BP with high SVR
  92. S/S of septic shock?
    • 1. fever/hypothermia
    • 2. low/high WBC
  93. Complication of septic shock?
    DIC
  94. Alteration in the body's stress response caused by sepsis?
    can cause ischemia to adrenal gland -> decreased cortisol -> low SVR & myocardial dysfunction
  95. Anaphylactic shock s/s?
    • 1. anxiety or agitation
    • 2. NV
    • 3. urticaria
    • 4. angioedema
    • 5. respiratory distress with stridor or wheezing
    • 6. hypotension
    • 7. tachycardia
  96. S/S of cardiogenic shock?
    • 1. s/s of hypovolemic shock
    • 2. s/s of resp distress r/t pulm edema
    • 3. s/s of CHF
    • 4. cyanosis
  97. Fluid admin with cardiogenic shock?
    rapid fluids can worsen pulm edema
  98. What cardiac rhythm may occur with cardiac tamponade?
    PEA
  99. S/S of cardiac tamponade?
    • 1. respiratory distress
    • 2. tachycardia
    • 3. poor peripheral perfusion
    • 4. muffled or diminished heart sounds
    • 5. narrowed pulse pressure
    • 6. pulsus paradoxus ( increase in systolic BP by >10 during inspiration)
    • 7. distended neck veins
    • 8. changes in LOC
  100. ECG with cardiac tamponade?
    small QRS complexes

    use echo to Dx
  101. Patho of tension pneumo?
    air accumulates in pleural space -> presses on surrounding areas -> PEA
  102. When should tension pneumo be suspectesd?
    trauma

    person with positive-pressure ventilation who suddenly deteriorates
  103. s/s unique to tension pneumo?
    • 1. tracheal deviation toward contralateral side
    • 2. hyperresonance of affected side
    • 3. diminished breath sounds on affected

    other s/s are similar to cardiac tamponade
  104. S/S of pulmonary embolism?
    similar to hypovolemic shock

    s/s of congestion & R heart failure distinguish it

    may also complain of chest pain from ischemia to area
  105. Tx of hypovolemic shock?
    • 1. O2 admin, ventilation
    • 2. may need blood admin
    • 3. rapid admin of isotonic fluids
  106. Tx of distributive shock?
    • 1. rapid fluid admid
    • 2. vasopressors to combat low  SVR
  107. CArdiogenic shock Tx?
    • increase CO while decreasing cardiac demands
    • 1. positive-pressure ventilation to reduce WOB
    • 2. slow infusion ov IV fluid
    • 3. inotropics and vasodilators
  108. Relationship of K and acid?
    acidosis = K+ increase r/t K+ forced out of cells by H+

    shock pt may have hyperkalemia
  109. Tx of metabolic acidosis r/t shock?
    does not respond well to bicarb/buffer Tx unless solely due to buffer loss

    must correct tissue perfusion to correct acidosis

    still may give bicarb for severe acidosis
  110. General Tx of shock?
    • 1. stable - leave in position of comfort / hypotensive - trendelnburg
    • 2. O2 admin
    • 3. may need blood
    • 4. may need vent
    • 5. vascular access
    • 6. fluid resuscitation:  isotonic bolus 20mL/kg over 5 to 20 min & repeat (except in cardiogenic) / blood for hemorrhage
    • 7. Monitor & assess SpO2, HR, BP, LOC, temp, & UO
    • 8. labs
    • 9. meds prn
  111. 2 causes of hypocalcemia in shock?
    • 1.  sepsis
    • 2. blood transfusions
  112. Inotropic drugs used for shock?

    Effects?
    • 1. EPI
    • 2. dopamine
    • 3. dobutamine

    increase contractility & HR
  113. Inodilators for shock/Phosphodiesterase inhibitors?

    Effects?
    milrinone & inamrinone

    decrease SVR, improve contractility & cornonary artery BF
  114. Vasodilators used in shock?
    • nitro drugs:
    • nitroglycerin, nitroprusside/nipride
  115. Vasopressors used in shock?
    • 1. EPI in doses >0.3mcg/kg per minute
    • 2. NE
    • 3. dopamine in doses >10mcg/kg per minute
    • 4. vasopressin
  116. Intervention if pulm edema occurs r/t fluid resusitation?
    ventilation with PEEP
  117. CI to rapid fluid admin?
    • 1. DKA - high blood osmolality r/t increased glucose -> cerebral edema can occur
    • 2. ingestion of Ca channel blockers or beta blockers
  118. Hypoglycemia definition in infants and children?
    • preterm & term neonates:  <45
    • infants, children, and adolescents:  <60
  119. Mgmt of hypoglycemia?
    • 1. oral ingestion of glucose if possible
    • 2. IV glucose 0.5 to 1g/kg (D5W)
  120. Dx test that may be done if septic shock is supected?
    • 1. lactate
    • 2. glucose
    • 3. calcium
    • 4. ABG
    • 5. CBC
    • 6. cultures
  121. What should be done if septic shock does not respond to initial fluid therapy?
    give vasopressors & stress-dose hydrocortisone
  122. What should be done after initial Tx of septic shock with fluids?
    evaluate pt for improvement:  BP, HR, peripheral perfusion to determine next intervention

    improvement:  take to ICU
  123. Initial Tx of septic shock?
    • 1. O2 and vent prn
    • 2. IV access X2
    • 3. fluid bolus 20mL/kg repeatedly
    • 4. Testing:  lactate, glucose, Ca, ABG, cultures, CBC
    • 5. Correct any metabolic problems:  hypoglycemia, hypocalcemia
    • 6. first dose of broad spectrum ABX STAT
    • 7. may give vasopressor or stress hydrocortisone
    • 8. monitor for fluid overload
  124. Tx of fluid-refractory septic shock?
    • 1. Establish central venous access
    • 2. vasoactive drug
    • 3. additional fluids & consider colliod fluids
    • 4. may give transfusion if HgB<10
    • 5. may vent with PEEP
  125. Medication given for child in septic shock with vasodilation & poor perfusion/low BP?
    (warm shock)?

    Effects?

    What drug can be used if this drug doesn't work?
    NE:    vasoconstrictor, increase contractility

    vasopressin
  126. Med for septic shock that is normotensive?
    dopamine
  127. Med for septic shock with vasoconstriction?

    AE?
    EPI - inotropic effects

    >/= 0.3mcg/kg per minute

    can produce lactate
  128. Tx for suspected/identified adrenal insufficiency?
    • hydrocortisone 2mg/kg IV bolus
    • max dose 100 mg
  129. Tx of anaphylactic shock?
    • 1. normal Tx of any shock
    • 2. EPI:  IM:  1:1000, may give infusion after 10-15min 1:10,000
    • 3. isotonic solution
    • 4. albuterol
    • antihistamines:  diphenhydramine, H2 blockers (tidines)
    • 5. corticosteroids:  methylprednisolone
    • 6. may use vasopressors
  130. 3 major s/s of neurogenic shock?
    hypotension, bradycardia, hypothermia
  131. Tx of neurogenic shock?
    • other shock Tx AND
    • 1. position flat or head-down for venous return
    • 2. trial of isotonic fluid
    • 3. for fluid-refractory hypotension:  vasopressors:  EPI, NE
    • 4. warming or cooling prn
  132. Major objectives for cardiogenic shock?
    improve cardiac function & decrease metabolic demand
  133. Tx of cardiogenic shock?
    • 1. cautious fluids (5-10 mL/kg over 10-20min)
    • 2. O2
    • 3. assist with ventilation prn
    • 4. may est. central venous access for measureing CVP
    • 5. Tests:  ABG, HgB, lactate, cardiac enzymes, thyroid, CXR, ECG, echo
    • 6. Meds:  vasodilators, diuretics, inotropes
    • 7. reduce metabolic demand:  assist with vent, antipyretics, analgesics, sedatives,
  134. Tx of cardiac tamponade?
    • 1. fluid bolus may help perfusion at first
    • 2. pericardial drainage with radiology guide or emergency pericardiocentesis
  135. Tx of tension pneumo?
    1. immediate needle decompression followed by thoracostomy for chest tube
  136. Tx of pulmonary embolism?
    • 1. O2 & vent assistance
    • 2. fluid therapy prn
    • 3. echo, CT, or angiography; ABG, CBC, Ddimer, ECG, CXR, VQ lung scan
    • 4. anticoagulatns:  heparin, lovenox
    • 5. consider fibrinolytics
  137. Sites for IO insertion?
    • 1. proximal or distal tibia
    • 2. distal femur
    • 3. anterior-superior iliac spine
  138. S/S of bradycardia?
    • 1. hypotension(can't increase SV)
    • 2. decreased LOC
    • 3. shock
  139. Causes of bradycardia?
    • 1. hypoxia
    • 2. hypotension
    • 3. hydrogen - acidosis
    • 4. hypothermia
    • 5. heart block
    • 6. toxins/poisons/drugs
  140. Medication for tachycardia?
    adenosine
  141. Tx of tachycardia?
    • 1. vagal maneuvers
    • 2. adenosine
    • 3. synchronized cardioversion
  142. Meds for tachydysrhythmias?
    • 1. adenosine - stops AV conduction for 10 seconds
    • 2. amiodarone - atrial and vent tachy
    •      stable SVT refractory to adenosine
    •      unstable VT
    •      prolongs QT
    • 3. procainamide:  same as amiodarone
    •      use if amiodarone not working
    • 4. lidocaine:  alternative to amiodarone for stable VT
    •      not for SVT
    • 5. MgSo:  torsades
  143. Synchronized cardioversion may be used for what tachyarrhythmias?
    • 1. SVT
    • 2. atrial flutter
    • 3. VT with pulse
  144. HR that = SVT?
    • >220 for infant
    • >180 for child
  145. Admin of adenosine for tachyarrhythmias & dosage?
    give rapid bolus with rapid flush r/t 10 second half life

    • 0.1mg/kg first dose up to 6mg
    • 02.mg/kg second dose up to 12 mg
  146. Synchronized cardioversion admin?
    • 1. give analgesic/sedative
    • 2. start with 0.5 to 1 J/kg then increase to 2J/kg if needed
    • 3. record and monitor ECG after each cardioversion attempt
  147. Amiodarone dosage for children?
    5mg/kg over 20-60 minutes
  148. procainamide dosage for children?
    15mg/kg over 30 to 60 minutes
  149. 4 arrest rhythms?
    • 1. VF
    • 2. VT with no pulse
    • 3. asystole
    • 4. PEA
  150. Agonal rhythms?
    slow wide QRS complex rhythms that immediatly preced asystole
  151. Compression depth for CPR?
    • adults - 2 inches
    • children & infants:  at least 1/3 A/P diameter
  152. Rotate compressors q ___ min.
    2
  153. Ventilations with advanced airway?
    1 breath q 6-8 seconds lasting 1 second
  154. Vasopressors for peds cardiac arrest?
    EP, vasopressin
  155. Antiarrhythmics for peds cardiac arrest?
    amiodarone, lidocaine, Mg
  156. Use for Ca in peds cardiac arrest?
    hypocalcemia, hyperkalemia, hypermagnesemia, Ca channel blocker OD
  157. Sodium bicarb use during peds cardiac arrest?
    • 1. hyperkalemia
    • 2. tricyclic antidepressants OD
    • 3. Na channel blocking drugs
  158. Joules for defibrillation during ped cardiac arrest?
    • first shock:  2J/kg
    • all others:  4J/kg

    Max 10J/kg or adult dose
  159. EPI dose for children?
    0.01mg/kg

    Repeat q 3-5 min
  160. Amiodarone dosage for kids?
    5mg/kg bolus

    repeat up to 2 times
  161. Paddles/pads used for children?
    • >10kg/1 yr or older = adult pads
    • <10kg/<1yr = infant pads
  162. Postresusitation care?
    • 1. continue manual ventilation/ET insertion
    • 2. make sure ET in proper position & document position in mouth & get CXR for correct postion
    • 3. assessment of cardiopulmonary
    • 4. PEEP prn:  O2<90 while receiving 100% inspired O2
    • 5. sedation & analgesia:  all ET pt get this
    • 6. UO with catheter
    • 7. Admin fluids, blood prn
    • 8. Hang amiodarone/procainamide if used?
  163. Alprostadil?
    • protaglandin E:  vasodilator
    • maintain patency of ductus arteriosus fo rductal dependent heart disease
  164. Etomidate?
    sedative-hypnotic with no anlgesic properties

    sedation for rapid sequnce ET
  165. 2 uses for terbutaline?
    • asthma/broncodilator
    • hyperkalemia - moves K into cells
  166. high flow and low flow O2?
    high flow = >10L/min

    low flow <10L/m
  167. Maxiumum nasal cannula flow rate?
    4L/min
  168. Indications for OPA and NPA?
    • OPA - unconscous victim without gag reflex
    • NPA _ conscious or semiconscious
  169. Max time for suctioning with OPA in place?
    10 seconds
  170. CI for IO?
    • 1. bone disorders
    • 2. previous attempt in same bone
    • 3. infection over bone
  171. Normal PR length?
    0.12 - 0.20
  172. Normal QT?
    0.42
  173. Normal QRS?
    <0.12
  174. ECG reading that can indicate hyperkalemia?
    T waves are very large and peaked and may even be taller than QRS
  175. Upper airway obstruction list?
    • 1. team leader ID self and assign roles
    • 2. assessment:  responsiveness, breathing, & pulse, ABCDE, VS
    • 3. airway maneuver & admin of 100% O2
    • 4. s/s of upper airway obstruction stated
    • 5. caegorize as resp distress or failure
    • 6. IV/IO access
    • 7. reassessment in response to Tx
    • 8. Tell specific Tx for upper airway obstruction:  EPI, CPAP, etc
    • 9.  Say indications for ET tube & need for smaller size than predicted for age:  unable to maintain airway, O2 or vent despite interventions
  176. Lower airway checklist?
    • 1. team leader ID self and assign roles
    • 2. assessment:  ABCDE, responsiveness, VS
    • 3. provide 100% O2
    • 4. state s/s of lower airway obstruction
    • 5. categorize as resp distress or failure
    • 6. state indications for assisted ventilations:  ineffective ventilations or poor oxygenation
    • 7. IV/IO access
    • 8. reassessment after Tx:  ABC's
    • state specific Tx for lower airway obstruction
    • 9. state indications for ET tube
  177. Lung tissue disease checklist?
    • 1. team leader intro self and assign roles
    • 2. ABCDE assessment, responsiveness, & VS
    • 3. assisted ventilations with 100% O2
    • 4. Ensure that bag ventilations are effective:  chest rise & breath sounds
    • 5. pads/leads placed properly & monitor turned on & pulse ox used
    • 6. s/s of lung tissue disease
    • 7. resp distress or failure?
    • 8. Iv/IO
    • 9. reassess ABC's after Tx
    • 10. specific Tx for lung tissue disease?
    • indications for ET tube?
  178. Disordered control of breathing list?
    exactly the same as lung tissue disorder except know s/s of disordered control of breathing & specific Tx
  179. Hypovolemic shock checklist?
    • 1. tema member intro & assign roles
    • 2. ABCDE assessment, responsiveness, VS
    • 3. 100% O2
    • 4. pads/leads placed & pulse ox monitor
    • 5. verbalize features of Hx & exam that indicate hypovolemic shock
    • 6. verbalize whether pt is compensated or hypotensive
    • 7. IV/IO
    • 8. admin 20mL/kg isotonic fluids rapidly (over 5-20 min)
    • 9. reassess ABC;s
    • 10. ID parameters that indicate response to thearpy:  HR, BP, distal pulses, cap refill, UO, mental status
  180. Obstructive shock checklist?
    • 1. team leader intro & assign roles
    • 2. assessment:  ABCDE, responsiveness, VS
    • 3. pads/leads & pulse ox placed
    • 4. verbalize DOPE mneumonic for intubated patient who deteriorates:  displacement, obstruction, pneumothorax, equipment failure)
    • 5. verbalize features of Hx & exam that indicate obstructive shock
    • 6. State at least 2 common causes of obstructive shock:  tension pneumo, cardiac tamponade, PE
    • 7. state compensated or hypotensive
    • 8. IV/IO
    • 8. 10-20mL/kg rapid isotonic fluids
    • 9. reassess ABC's
    • 10.State Tx for tension pneumo:  second intercostal space at midclavicular line
    • 11. verbalize therapeutic endpoints:  HR, BP, perfusion, UO, mental status
  181. Distributive shock checklist?
    • 1. team leader intro self & assign roles
    • 2. assessment:  ABCDE, responsiveness, VS
    • 3. 100% O2
    • 4. pads/leads placed & monitor on, pulse ox
    • 5. s/s of distributive/septic shock & verbalize pt Hx & physical that indicate it
    • 6. compensated or hypotensive shock?
    • 7. IV/IO
    • 8. rapid admin of isotonic fluids
    • 9. reassessment ABC's
    • 10. admin of ABX
    • 11. indications for vasoactive drug support:  fluid-refractory septic shock
    • 12. therapeutic end points:  HR, BP, perfusion, UO, mental status
  182. Cardiogenic shock checklist?
    • 1. team leader intro & assign roles
    • 2. assessment:  ABCDE, responsiveness, VS
    • 3. 100% O2
    • 4. pads/leads, monitor on, pulse ox
    • 5. verbalizes Hx & exam that indicate cardiogenic shock (s/s)
    • 6. compensated or hypotensive?
    • 7. IV/IO
    • 8. isotonic fluid 5 to 10 mL/kg over 10 to 20 min & monitor for pulmonary edema/increased CHF
    • 9. reassess ABC's
    • 10. indications for use of vasoactive drugs:  persistent s/s of shock despite fluid therapy
    • 11. therapeutic end points:  HR, BP, perfusion, UO, mental status, importance of reducing metabolic demand
  183. SVT checklist?
    • 1. team leader intro & assign tasks
    • 2. assessment:  ABCDE, responsiveness, VS
    • 3. O2 by high-flow device
    • 4. pads/leads, monitor on, & pulse ox
    • 5. recognize narrow complex tachycardia & state diff b/t ST and SVT
    • 6. compensated or hypotensive
    • 7. perform vagal maneuvers:  valsalva, blowing through straw, ice to face
    • 8. IV/IO
    • 9. adensoine:  first dose 0.1mg/kg then 0.2mg/kg - state need for rapid admin with rapid flush
    • 10. reassess ABC
    • 11. verbalize indications & appropriate energy doses for synchronized cardioversion:  0.5-1J for initial dose then 2J
  184. Bradycardia checklist?
    • 1. leader intro self and assign roles
    • 2. assessment:  ABCDE, responsiveness, VS
    • 3. assisted ventilatiohns with 100% O2
    • 4. pads/leads place, monitor turned on, pulse ox
    • 5. recognize bradycardia with cardiorespiratory compromise & verbalize to team members
    • 6. compensated or hypotensive?
    • 7. recall indications for chest compressions in a bradycardic pt:  HR<60 with/without a pulse
    • 8. IV/IO access
    • 9. EPI:  0.01mg/kg admin & saline flush
    • 10. reassessment of ABC's
    • 11. verbalizes consideration of at least 3 underlying causes of bradycardia:  hypothermia, drugs, increased ICP
  185. Asystole/PEA checklist?
    • 1. team leader intro & assign roles
    • 2. recognize cardiopulmonary arrest:  absence of responsiveness, breathing, and pulse
    • 3. CPR:  rotate role of chest compressor q2min
    • 4. place pads/leads, turn on monitor
    • 5. recognize asystole or PEA
    • 6. IO/IV
    • 7. EPI:  0.01mg/kg at appropriate intervals (q3-5min) and flush with saline
    • 8. check rhythm approx q2min with change of compressors
    • 9. verbalizes consideration of at least 3 reversible causes of PEA or asystole: all H's & T's
  186. VF/pulseless VT checklist?
    • 1. team leader intro & assign team roles
    • 2. recognize cardiopulmonary arrest:  no responsiveness, breathing, or pulse
    • 3. start CPR
    • 4. pads/leads place, monitor on
    • 5. recognize VF or pulseless VT & verbalize to team members
    • 6. defibrillation:  2J then 4J after that then immediately go back to CPR
    • 7. IV/IO
    • 8. prepare EPI:  0.01mg/kg
    • 9. defibrillation 4J/kg or higher - no more than 10J/kg then CPR again
    • 10. admin EPI then saline flush
    • 11. verbalizes considertion of anti-arrhythmic using appropriate dose:  amiodarone, lidocaine)

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