PALS - Written Test and Case Study Exam Review Material with Complete solution

CPR Sequence - ANSWER C-A-B Circulation-Airway-Breathing Core Case Action Order (A,I,I) - ANSWER Assess Identify Intervene CBC (Assessment part 1 aka initial assessment) - ANSWER Consciousness Breathing Colo ...

CPR Sequence - ANSWER C-A-B Circulation-Airway-Breathing Core Case Action Order (A,I,I) - ANSWER Assess Identify Intervene CBC (Assessment part 1 aka initial assessment) - ANSWER Consciousness Breathing Color ABCDE (Assessment part 2 aka primary assessment) - ANSWER Airway Breathing Circulation Disability Exposure SAMPLE (Assessment part 3) - ANSWER S/Sx Allergies Medications Past medical hx Last meal/drink Events leading to situation Reversible Causes of Pediatric Cardiac Arrest (H&T's) 6 H's (G,K,T,V,X,DRO) - ANSWER 1. Hypo-Glycemia 2. Hypo/hyper-Kalemia 3. Hypo-Thermia 4. Hypo-Volemia 5. Hypo-Xia 6. HyDROgen ion (acidosis) Reversible Causes of Pediatric Cardiac Arrest (H&T's) 5 T's (A,E,HC,HP,O) - ANSWER 1. Tamponade, cardiac 2. Tension pneumothorax 3. Thrombosis, coronary 4. Thrombosis, pulmonary 5. Toxins UAO: Presentation, Causes, TX - ANSWER Stridor on inspiration, High pitched inspiration (Anaphylaxis, Croup, Foreign Body) Humid Oxygen, Neb Epi, Removal Croup presentation Tx - ANSWER O2 Racemic epinephrine (0.25mg/kg) Humidified epi (0.5 ml/kg/3cc's NS Core Case Resp 1: UAO (Anaphylaxis) - ANSWER Open airway Admin O2 100% non-rebreather, re-assess AED, Vitals (cardiac rhythm = sinus tachy) S/sx of UAO, resp distress TX: Epi IM, Steroids, CPAP Vascular access Prepare for intubation LAO: Presentation, Causes, TX - ANSWER Wheezing on expiration (Asthma, Bronchiolitis) Neb Albuterol, SQ Epi, Mag Sulf, Steroids Core Case Resp 2: LAO (Bronchiolitis or Asthma) - ANSWER Admin O2 100% non-rebreather after finishing neb tx, re-assess AED, Vitals (cardiac rhythm = sinus tachy) S/sx of LAO, resp distress Suction nose TX: Neb albuterol (2.5mg/3cc's NS), Non-invasive pos press vent (NIPPV), Steroids Vascular access, labs, ABGs, chest X-ray Prep for bag-mask vent, intubation Lung Tissue Disease: Presentation, Causes, TX - ANSWER Grunting, stiff lungs, increased breathing effort (I, E), tachypnea, crackles (Pneumonia) Antibiotics, Albuterol Core Case Resp 3: Lung Tissue Disease (Pneumonia or Aspiration) - ANSWER *Admin O2 100% non-rebreather after finishing neb tx, re-assess, titrate O2 to 94-99% TX: Neb albuterol, antibiotics, Non-invasive vent (CPAP or NIPPV - PEEP) Prep for bag-mask vent, intubation* AED, Vitals (cardiac rhythm = sinus tachy) S/sx of LTD, resp failure Suction nasopharynx Vascular access, labs, ABGs, chest x-ray Disordered Breathing: Presentation, Causes, TX - ANSWER Irreg breathing pattern (Drug OD, Injury) Antidote (narcan), DOPE, MASK AND BAG DOPE (Pediatric with airway, deteriorates rapidly) - ANSWER Displacement (airway is displaced on chin lift) Obstruction (tongue fluid) Pneumothorax (Lung is punctured or plugged) Equipment (Is it malfunctioning) IO vascular access components - ANSWER Less than 24 hour use Leg bone below knee is best Stop when POP Cannot use same bone twice Must have pressure to flow, PUSH HARD 10 mL/kg on IVF bolus Flush with 10 mL after any drug Core Case Shock 1: Hypovolemic (Dehydration) - ANSWER Admin high-flow O2 non-rebreather, re-assess AED, Vitals (cardiac rhythm = sinus tachy) S/sx of hypotensive shock Vascular access, labs, ABGs, chest x-ray Admin IVFs 20 mL/kg bolus, assess Repeat bolus as needed for BP, HR, pulses Admin BP help drug if needed (Dopamine) Epinepherine (increases HR) - ANSWER Bradycardia/Pulseless Arrest 0.01 mg/kg (1:10,000) every 3-5 min Hypotensive Shock 0.1-1 mcg/kg per min Anaphylaxis 0.01 mg/kg every 3-5 min Core Case Shock 3: Distributive (Sepsis) - ANSWER Continue O2 AED, Vitals (cardiac rhythm = sinus tachy) Verify ET placement S/sx septic shock, uncompensated Verify patency of PAC, insert secondary PIV, labs, ABGs, blood cultures *TX: Admin fluid bolus 20 mL/kg, Repeat fluid bolus 20 mL/kg for continued shock, Admin antibiotics, Admin vasoactive drug if needed for continued shock Transfer to PICU Algorithm: Pediatric Septic Shock Fluid Responsive? - ANSWER Yes - ICU No - Vasoactive drug & titrate for normotension *Normo: begin dopamine Hypo/warm: norepi [0.1-2mcg/kg/min] (no Beta 2) Hypo/cold: epi [0.1-1mcg/kg/min]* Tx for neurogenic shock - ANSWER Bolus NS 20mg/kg Dopamin 2-20mcg/kg/min Core Case Shock 2: Obstructive (Tension Pneumothorax) - ANSWER DOPE Begin manual ventilation, re-assess AED, Vitals (cardiac rhythm = sinus tachy) S/sx of cardiopulmonary failure and shock, compensated IMMEDIATE TX: Needle thoracostomy (R, 2nd intercostal, midclav line), chest tube Vascular access, labs, ABGs, chest x-ray Fluid bolus for BP What should I do for a pneumothorax? - ANSWER Needle decompression Chest tube placement Core Case Resp 4: Disordered Control of Breathing (Respiratory Depression after Seizure or Drugs or IICP) - ANSWER Open airway Suction oropharynx AED, Vitals (cardiac rhythm = normal sinus) S/sx of DCB, resp failure Vascular access, labs, chest x-ray TX: Do not reverse drug, bag-mask/vent support Prepare for intubation, PEEP Algorithm: Pediatric Septic Shock First hour... - ANSWER Oxygen & support ventilation Establish IV, draw labs (glucose, blood cultures) Begin resuscitation Push repeated 20 mL/kg isotonic crystalloid (3-4) unless rales, resp distress, hepatomegaly Correct hypo-glycemia/calcemia Admin 1st dose antibiotics STAT STAT vasopressor drip/stress-dose hydrocortisone Establish 2nd IV Minimum SBP calc - ANSWER 70 + 2 X age in years Endotrach Tube Size calc (and difference between 2 types) - ANSWER Uncuffed = age / 4 + 4 Cuffed = age / 4 + 3 (prevents aspiration) Adenosine (slows HR) - ANSWER SVT 0.1 mg/kg - dose 1 0.2 mg/kg - dose 2 max = 6 mg RAPID push Amiodarone (antiarrythmic) - ANSWER VF VT (pulseless) 5 mg/kg Bolus max = 300 mg SVT VT (with pulses) 5 mg/kg over 20-60 mins max = 300 mg For SVT with pulse - ANSWER Vagal/Adenosine/Cardioversion Core Case Cardiac 1: SVT with pulses present - ANSWER Admin high-flow O2, re-assess AED, Vitals (cardiac rhythm = SVT with adequate perfusion) S/sx resp distress, SVT, adequate perfusion Vascular access, labs, ABGs, chest x-ray TX: Vagal (ice on face), admin Adenosine (0.1 mg/kg) plus second dose (0.2 mg/kg) if needed, sync cardioversion (0.5-1 j/kg) if needed Monitor for heart failure Not Shockable Rhythms - ANSWER PEA Asystole Core Case Cardiac 3: Asystole/PEA - ANSWER CPR, re-assess every 2 mins