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Flashcards in PALS Deck (75):
1

Initial impression, what to assess for

Consciousness
Breathing
Color

2

Normal respiratory rate for infants <1 year

30-60 bpm

3

Normal respiratory rate for toddler's 1-3y

24 to 40 bpm

4

Normal respiratory rate for Preschoolers 4-5y

22 to 34 bpm

5

Normal respiratory rate for School age 6-12y

18 to 30 bpm

6

Normal respiratory rate for Adolescent 13 to 18years

12 to 16 bpm

7

Central apnea

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

8

Obstructive apnea

there is inspiratory effort without airflow.

9

Mixed apnea

There are periods of obstructive apnea and periods of central apnea

10

Causes of tachypnea

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

11

causes of bradypnea

muscle fatigue
central nervous system injury
hypothermia
medications

12

Mild to moderate breathing difficulty types of retractions

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

13

severe breathing difficulty types of retractions

Supraclavicular
Suprasternal
Sternal

14

Tidal volume

the volume of air inspired with each breath

15

Normal tidal volume #s

5 to 7ml/kg of body weight

16

what is stridor

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

17

what is grunting

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

18

What is wheezing

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

19

Crackles/rales

crackling inspiratory sounds, indicate accumulation of alveolar fluid.

20

SpO2

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

21

Normal heart rate for newborn to 3 months

85 to 205

22

Normal heart rate 3 months to 2 years

100 to 190

23

Normal heart rate 2 years to 10 years

60 to 140

24

Normal heart rate greater than 10 years

60 to 100

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