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Stuff I should know. Maybe. > PALS > Flashcards

PALS Flashcards

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1
Q

Initial impression, what to assess for

A

Consciousness
Breathing
Color

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2
Q

Normal respiratory rate for infants <1 year

A

30-60 bpm

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3
Q

Normal respiratory rate for toddler’s 1-3y

A

24 to 40 bpm

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4
Q

Normal respiratory rate for Preschoolers 4-5y

A

22 to 34 bpm

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5
Q

Normal respiratory rate for School age 6-12y

A

18 to 30 bpm

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6
Q

Normal respiratory rate for Adolescent 13 to 18years

A

12 to 16 bpm

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7
Q

Central apnea

A

no respiratory effort because of an abnormality or suppression of the brain or spinal cord

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8
Q

Obstructive apnea

A

there is inspiratory effort without airflow.

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9
Q

Mixed apnea

A

There are periods of obstructive apnea and periods of central apnea

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10
Q

Causes of tachypnea

A 
high fever
pain
metabolic acidosis
sepsis
congestive heart failure
severe anemia
TPA
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11
Q

causes of bradypnea

A

muscle fatigue
central nervous system injury
hypothermia
medications

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12
Q

Mild to moderate breathing difficulty types of retractions

A

subcostal (retraction of the abd just below rib cage)
substernal (retraction of the abd at the bottom of breast bone)
intercostal (btwn ribs)

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13
Q

severe breathing difficulty types of retractions

A

Supraclavicular
Suprasternal
Sternal

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14
Q

Tidal volume

A

the volume of air inspired with each breath

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15
Q

Normal tidal volume #s

A

5 to 7ml/kg of body weight

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16
Q

what is stridor

A

coarse, higher pitched breathing sound heard on inspiration. A sign of upper airway obstruction

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17
Q

what is grunting

A

short, low pitched sound heard on expiration. It may be a response to fever. It helps keep small airways and alveolar sacs open.

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18
Q

What is wheezing

A

high pitched sound heard most often during expiration that is caused by airway obstruction. Caused by asthma or bronchiolitis.

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19
Q

Crackles/rales

A

crackling inspiratory sounds, indicate accumulation of alveolar fluid.

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20
Q

SpO2

A

the percentage of the child’s hgb that is saturated with o2.

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21
Q

Normal heart rate for newborn to 3 months

A

85 to 205

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22
Q

Normal heart rate 3 months to 2 years

A

100 to 190

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23
Q

Normal heart rate 2 years to 10 years

A

60 to 140

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24
Q

Normal heart rate greater than 10 years

A

60 to 100

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25
Most common cause of bradycardia
hypoxia
26
GCS criteria
``` Eye opening (spontaneous, speech, pain, none) Orientation (oriented, confused, inapp words, incomphrehensible sounds, none) Ability to follow commands (obeys, localizes, withdraws, abnl flexion, extensor response, none) ```
27
Lowest acceptable systolic bp > 10 years
90 mmHg
28
Lowest acceptable systolic bp 1-10 years
70 mmHg + (2 x age in years)
29
Lowest acceptable systolic bp 1mo -1 year
70 mmHg
30
Lowest acceptable systolic bp newborn
60 mmHg
31
Normal urine output values
1 ml/Kg per h or 30 mL/h for adolescent
32
early signs of cardiopulmonary compromise
tachycardia and tachypnea
33
Method for assessing breathing RACE
Rate-tachypnea or Airway sounds Color-- pink, pallid, cyanotic or mottled Effort/mechanics--positioning/retractions etc
34
Time limit for suctioning at once
10 seconds, may cause bradycardia and hypoxia
35
What to do for foreign body for a pt that can speak and is awake
allow them to cough and clear the airway. make no attempts to remove it
36
What to do for foreign body if it is completely obstructed
remove only if object is visible. do not to blind finger sweeps
37
flow rate of nasal cannula
1-4 L/min to deliver O2 concentrations of 25-40%
38
flow rate for simple o2 mask
6-10 L/min to deliver O2 concentrations of 35-60%
39
flow rate for o2 mask w reservoir
the reservoir bag must be greater than the tidal volume and 90% o2 can be delivered if rate is 10-15 L/min
40
noninvasive positive pressure ventilation advantages
decreases work of breathing, improving oxygenation, avoiding complications of intubation.
41
Indications for noninvasive positive pressure ventilation
status asthmaticus, bronciolitis, acute pulmonary edema, neuromuscular disease. Patient must be stable, spontaneously breathing, alert, and cooperative.
42
Contraindications for noninvasive positive pressure
hemodynamically unstable, lethargic, vomiting, or w cardiac dysrhythmias
43
Settings for inspiratory positive airy pressure for CPAP or BIPAP
8-10 cmH2O. Titrate these settings upwards in 2 cmH2O increments until the desired effects are achieved
44
Settings for expiratory positive airy pressure for CPAP or BIPAP
3-5 cmH2O. Titrate these settings upwards in 2 cmH2O increments until the desired effects are achieved
45
How to monitor patients on BIPAP or CPAP once treatment is started
watch for worsening respiratory failure with serial lung exams, vital sign measurements, and oxygen saturation. If their respiratory status deteriorates or worsens, discontinue NIPPV and perform tracheal intubation.
46
Fluid resuscitation bolus amount
20 ml/Kg. Can give additional boluses up to 60 ml/kg until vital signs and perfusion are restored. Consider inotropy if further fluid is needed. If patient is septic, fluid boluses as large as >60 ml/kg may be required.
47
epinephrine dose and indication
0.01mg/kg IV/IO (1:10,000; 0.1ml/kg) or .1 mg/kg 1:1000 solution bradycardia
48
atropine dose and indication
0.02 mg/kg IV/IO (Minimum dose: 0.1mg; maximum total dose for children: 1mg bradycardia
49
SVT treatment
adenosine .1mg/kg
50
Wide QRS with pulse treatment
amiodarone 5mg/kg iv over 20 to 60 minutes or Procainamide 15 mg/kg over 30 to 60 mins
51
WIDE QRS (torsades de points) treatment
magnesium 25-50mg/kg over 10 mins
52
SAMPLE history
``` Symptoms Allergies Medications Past history Last intake Events that caused the incident ```
53
signs of potential signs of respiratory failure
``` Tachypnea Tachycardia Anxiety Retractions Nasal flaring ```
54
signs of probable respiratory failure
Lethargy Head bobbing Grunting Cyanosis/pallor
55
signs of cardiopulmonary failure
Agonal breathing | bradycardia
56
signs of respiratory failure
slow breathing | bradycardia
57
Early signs of shock
tachycardia decreased perfusion of skin (cool, pale mottled or delayed cap refill) Altered mental status Discrepancy in volume between peripheral and central pulse
58
Symptoms: brisk capillary refill and bounding central pulses
septic shock
59
what is compensated shock
patient showing signs of shock with a normal b/p
60
shock tx
maintain airway administer high flow o2 maintain body temp ECG and pulse ox Admin fluid bolus 20 ml/kg NS or LR in under 20 min Pressors for refractory, cardiac or septic shock Reduce o2 demand by supporting breathing, controlling pain and anxiety, manage fever
61
what does low co2 mean during cardiac arrest
low perfusion
62
epinephrine dosing
.1 mg/kg 1:10,000 | repeat every 3-5 minutes
63
site for io placement
proximal tibia on the medial aspect 2 finger widths below the tibial tuberosity
64
shock fluid resuscitation bolus amount
20ml/kg of an isotonic crystalloid solution
65
What things to check to assess a patients hydration status
``` mental status quality of pulses blood pressure heart rate cap refill urine output ```
66
In patients with septic shock, what can you give them and how much
Large fluid volumes 60ml/kg and can give with 5% albumin in 10 ml/kg doses
67
Dopamine dose for cardiogenic shock
5-10mcg/kg per min. titrate to desired effect
68
Dobutamine dose for cardiogenic shock
2-10mcg/kg per min but at doses greater than 10 mcg/kg it might cause hypotension because of afterload reduction and decreased svr it is works on selective beta adrenergic receptors
69
Epinephrine dose
0.1-1mcg/kg per min
70
Epinephrine effects
It is an inotropic agent that increases myocardial perfusion pressure. Low dose causes inc hr, decreased svr, decreased diastolic blood pressure bc of beta 1 and beta 2 receptors.
71
What does epinephrine cause at doses >.3mcg/kg per min
alpha adrenergic effects result in increased blood pressure
72
What receptors does norepinephrine act on
alpha and beta adrenergic receptors to produce inotropic effects and beta peripheral vasoconstriction to increase MAP
73
What is the dose for norepinephrine
01.-1mcg/kg per min
74
Minimal glucose level before giving dextrose
<60 mg/dl
75
Dextrose dose to raise blood sugar
.5 gm/kg | Use 2 mL/kg of a 25% dextrose solution

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