PALS Concepts Flashcards by Troy Green

EWL

Estimated Weight Loss

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FBAO

Foreign Body Airway Obstruction

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LVOT

Left Ventricular Outflow Tract

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PEFR

Peak Expiratory Flow Rate

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ROSC

Return Of Spontaneous Circulation -A prominent sign of ROSC is a sudden increase in EtCO2

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RVOT

Right Ventricular Outflow Tract

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Agonal Breathing (Agonal Gasps)

https://www.youtube.com/watch?v=CBMxH4xtE8w

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Agonal Rhythm

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Acryocyanosis

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Apnea

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Central vs. Obstructive Apnea

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Most Common Cause of Bradycardia In Kids

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Bradycardia Definition

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Broselow Tape

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Channelopathy

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Child Definitions (According to the AHA)

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Chest Compression Fraction (CCF)

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Croup

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Cyanosis

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Febrile

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Hypoxemia

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Hypoglycemia

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Treatment for Hypoglycemia

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Hypotension (Systolic BP Readings)

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Heliox

Mottling

Pallor

Signs of Bad Peripheral Perfusion

Signs of Good Peripheral Perfusion

Permissive Hypoxemia

Petechiae & Purpura

Petechiae & Purpura, Poikilothermia

Factors that Affect Pulse Pressure (3)

* *1. Stroke volume** - Stroke volume PRIMARILY affects (and is proportional to) systolic blood pressure - Increased stroke volume = increased systolic pressure - Decreased stroke volume = decreased systolic pressure * *2. Systemic vascular resistance (SVR)** - SVR PRIMARILY affects (and is proportional to) diastolic blood pressure - Increased SVR (vasoconstriction) = increased diastolic BP - Decreased SVR (vasodilation) = decreased diastolic BP * *3. Aortic compliance** - If the aorta has good vascular compliance (like in younger, healthy patients), the systolic pressure will be lower during systole - If the aorta is noncompliant/“stiff” (like in older patients), systolic pressure will be much higher during systole - In other words, systolic pressure (and thus pulse pressure) is inversely proportional to aortic compliance

Capillary Refill Time

Normal Heart Rate

Oxygen Consumption

Sp0₂

ScvO₂

Urine Output

Normal Respiratory Rate (RR)

PALS ABCDEs

Airway, Breathing, Circulation, Disability, Exposure

Laminar & Turbulent Airflow

Opening & Clearing the Airway

Proper Positioning

Severe Choking In Responsive Children

Severe Choking In A Responsive Infant

Severe Choking In Unresponsive Patients

After the Obstruction is Relieved

Possible Treatments in the Airway Scenarios ## Footnote **High Flow Nasal Cannula**

Possible Treatments in the Airway Scenarios ## Footnote **Low Flow vs. High Flow Oxygen Delivery Systems**

Possible Treatments in the Airway Scenarios ## Footnote **Breathing Treatments (3)**

Possible Treatments in the Airway Scenarios ## Footnote **Heliox**

Clinical Uses For Heliox (2)

Possible Treatments in the Airway Scenarios ## Footnote **Humidified Oxygen Advantages (2) and Indications (1)**

Possible Treatments in the Airway Scenarios ## Footnote **Racemic Epinephrine**

Airway Equipment in PALS ## Footnote **Self Inflating Ambu Bag**

Self Inflating Ambu Bag (Without A Reservoir Bag)

Self Inflating Ambu Bag (With A Reservoir Bag)

Airway Equipment in PALS ## Footnote **Flow Inflating (Anesthesia) Bag**

Formula To Determine Correct ETT Size, Based On Age ## Footnote **Uncuffed Tracheal Tubes**

Formula To Determine Correct ETT Size, Based On Age ## Footnote **Depth of Insertion Formula**

Confirming Correct Endotracheal Tube Placement

Endotracheal Tube Medications in PALS ## Footnote **Medications and Methods of Administration**

Lung Sounds

[http://www.youtube.com/watch?v=cVjfAyPT\_sI](http://www.youtube.com/watch?v=cVjfAyPT_sI)

Rales (Crackles, Crepitation)

Rhonchi

Wheezing

Lung Percussion Examination

[https://www.youtube.com/watch?v=P4Ryk5IKf\_4](https://www.youtube.com/watch?v=P4Ryk5IKf_4) (0.00-0:05) [https://www.youtube.com/watch?v=bHGlFmd4Fuk&feature=iv&src\_vid=P4Ryk5IKf\_4&annotation\_id=annotation\_4172287091](https://www.youtube.com/watch?v=bHGlFmd4Fuk&feature=iv&src_vid=P4Ryk5IKf_4&annotation_id=annotation_4172287091) (2:15-2:41)

Resonant & Dull Sounds on Percussion

Hyperresonant Sounds on Percussion

[https://www.youtube.com/watch?v=4MTjEV2E61o](https://www.youtube.com/watch?v=4MTjEV2E61o)

Airway Scenarios in PALS (4)

DOPE Pneumonic

Notes on Breathing

Reasons To Avoid Excessive Ventilation (3)

Inspiratory Muscles

Breathing Protocol | (C-A-B, not A-B-C)

Signs of Labored Breathing/Respiratory Distress ## Footnote **Disorded Control of Breathing**

Signs of Labored Breathing/Respiratory Distress ## Footnote **Causes of Disordered Control of Breathing (3)**

Signs of Labored Breathing/Respiratory Distress ## Footnote **Head Bobbing, Grunting**

[https://www.youtube.com/watch?v=vvgTCG18oZo](https://www.youtube.com/watch?v=vvgTCG18oZo) (Head Bobbing)

Signs of Labored Breathing/Respiratory Distress ## Footnote **Nasal Flaring**

Signs of Labored Breathing/Respiratory Distress ## Footnote **Retractions**

[http://ttps://www.youtube.com/watch?v=bYso\_Oz-35k](http://ttps://www.youtube.com/watch?v=bYso_Oz-35k) "–It’s caused by increased airway resistance (or “stiff” lungs) impairing air movement"

Signs of Labored Breathing/Respiratory Distress ## Footnote **Seesaw Respirations**

[https://www.youtube.com/watch?v=Hv68EQ3tCBI](https://www.youtube.com/watch?v=Hv68EQ3tCBI)

Indications of seesaw respirations

Signs of Labored Breathing/Respiratory Distress ## Footnote **Stridor, Quiet Tachypnea**

Retractions With Other Signs of Airway Obstruction

Respiratory Distress vs. Respiratory Failure

The most immediate causes of pediatric cardiac arrest are: (2)

25%

Cardiac Arrest Stats

Checking For A Pulse

Effective CPR

Two Hand CPR Technique

One Hand CPR Technique

“Thumb Encircling” CPR Technique

“Compression Only” CPR?

CPR Summary

BLS Cardiac Arrest Algorithm for the Single Rescuer

Methods for Evaluating “Disability”

Disability | (Quick Evaluation of Neurologic Function) ## Footnote **Glucose**

Disability | (Quick Evaluation of Neurologic Function) ## Footnote **Pupil Response to Light**

Disability | (Quick Evaluation of Neurologic Function) ## Footnote **AVPU**

Disability | (Quick Evaluation of Neurologic Function) ## Footnote **Glasgow Coma Scale**

Exposure

Fluid Estimations

Estimated Weight Loss (EWL)

Estimated Weight Loss And Dehydration

1. Notice how younger children can better tolerate volume loss (i.e., they it takes a higher overall volume loss before they are considered “dehydrated” - This is due to the fact that younger have higher circulating blood volumes (per kg), so water takes up a larger portion of their total body weight (i.e., they have more water to lose) 2. Older children can’t tolerate as much volume loss (in mL/kg), because water takes up a lower percentage of their total body weight (i.e., they don’t have as much water to lose) 3. Dehydration can lead to hypotensive (non-hemorrhagic) shock

Clinical Management Of Dehydration ## Footnote **Hypotensive (non-hemorrhagic) Shock**

Crystalloid Therapy

Colloid Therapy

Blood Therapy

Why Only O- Blood For Females?

Fluid Boluses in the Scenarios

Fluid Therapy in Diabetic Ketoacidosis (DKA)

Fluid Therapy With Febrile Illnesses

Fluid Administration Summary

Pediatric Manual Defibrillator Pads

Pediatric AED Pads & Pediatric Dose Attenuator

Adult AED Pads

Using Paddles

The Choice Of Defibrillator & Pads In PALS

Defibrillator Dosing In PALS

Epinephrine and Defibrillation

There Are 2 Sets of “ABCs” in PALS

Pediatric Assessment Triangle (First Set of ABCs)

Steps To The Pediatric Assessment Triangle (PAT)

“Primary Assessment” (Second Set of ABCs)

Steps to the Primary Assessment (ABCDE’s)

The Pediatric Assessment Triangle And Primary Assessment | (Both Sets Of ABCs)

Recap of Initially Approaching a Pediatric Patient

Secondary Assessment (SAMPLE)

Diagnostic Assessment

**Evaluate**, Identify, Intervene (“EII”) Cycle

Evaluate, **Identify**, Intervene (“EII”) Cycle

Back to “Evaluate, Identify, **Intervene**” (EII)

Steps to Diagnose and Follow in Each Scenario

1. Start out with the initial ABCs (Appearance, Breathing, Circulation) 2. Check responsiveness - If unresponsive, check pulse, activate EMS, & start resuscitation 3. Start the primary assessment (ABCDEs) with C-A-B - Check signs of perfusion (color, capillary refill, strength of pulse, temperature, etc) - Verbalize “monitors, IV, oxygen (if needed)” - Also remember to auscultate and check for breathing difficulty 4. Finish the primary assessment by completing the “D & E” steps - Get a glucose/check pupils/AVPU - Look over the child for any bodily abnormalities (i.e., signs of trauma) 5. Intervene (start therapy) at the earliest appropriate time during the primary assessment - For instance, the “monitors, IV, oxygen” count as an intervention 6. Reevaluate by performing the secondary and diagnostic assessments while your initial intervention is going on - In other words, “what happened?” How did the child get to this state?” - Verbalize “SAMPLE” the H’s & T’s (more for cardiac arrest patients) - Get labs and diagnostic tests (CXR, ultrasound, etc) 7. Intervene again, based on the additional information - Fluids, breathing treatments, etc 8. Frequently reassess the patient to determine the next step - Determine if the child’s condition is improving based on the initial interventions - Determine whether or not additional interventions are necessary 9. Intervene again and continually reassess after every intervention

Possible Causes of Low Cardiac Output

Symptoms Of Low Cardiac Output (Low ScvO2)

Symptoms Of Low Afterload (Vasodilation) (7)

High Afterload (Vasoconstriction)

Central Venous O2 Saturation (ScvO2)

Possible Causes Of Low ScvO2

Possible Causes Of High ScvO2

If cardiac output is low, will ScvO2 always be low?

If ScvO2 is low, will cardiac output always be low?

ScvO2 Scenarios In PALS (3)

Low ScvO2 & Low Blood Pressure Scenario | (Hypotensive Shock Scenario)

Treatment For Hypotensive Shock | (Low ScvO2 & Low Blood Pressure)

Low ScvO2 With Normal BP | (“Normotensive Shock” Scenario)

Treatment For “Normotensive/Compensated Shock” | (Low Cardiac Output With Vasoconstriction)

High ScvO2, Warm Extremities, and Low BP Scenario

Examples Of Warm Shock | (High Cardiac Output & Low Blood Pressure)

Treatment For Warm Shock | (High Cardiac Output & Low Blood Pressure)

Summary of Therapy Based on ScvO2

Shock Definition

Common Shock Symptoms (4)

Compensated (Normotensive) Shock

Decompensated (Hypotensive) Shock

Warm Shock

Cold Shock

Normotensive Shock

Treatments For The Shock States

Hypovolemic Shock

Cardiogenic Shock

Dissociative Shock

Obstructive Shock

Obstructive Shock (Pulmonary Embolism)

Obstructive Shock (Cardiac Tamponade)

Obstructive Shock (Tension Pneumothorax)

Treatment of Tension Pneumothorax

Obstructive Shock (Ductal Dependent Lesions)

Distributive Shock

Distributive Shock (Anaphylactic Shock)

Treatment For Anaphylactic Shock

Distributive Shock (Neurogenic Shock)

Spinal Shock

Distributive Shock (Septic Shock)

Cardiac Output in Septic Shock

Symptoms Unique To Septic Shock

Treatment Unique To Septic Shock

Steroid Therapy In Septic Shock

Septic Shock Management

ABCDE’s Of Shock

Summary of Shock Therapy

Overall Resuscitation Notes

Goals of Post Resuscitation Management

Targeted Temperature Management (TTM) in PALS

Atropine In PALS Bradycardia

Is There A Minimum Dose Of Atropine?

Epinephrine In PALS Bradycardia

Amiodarone And Procainamide In PALS SVT/Stable Vtach

Drug Dosing In PALS Vfib/Pulseless Vtach

BLS, ACLS, PALS Changes (2015)

[https://www.slideshare.net/MCSCPR/aha-2015-algorithms-for-bls-acls-pals](https://www.slideshare.net/MCSCPR/aha-2015-algorithms-for-bls-acls-pals)

Web Based Integrated Guidelines

[https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-12-pediatric-advanced-life-support/](https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-12-pediatric-advanced-life-support/)

Supplementary Reading

[https://www.medschool.lsuhsc.edu/emergency\_medicine/docs/PALS%20Cases.pdf](https://www.medschool.lsuhsc.edu/emergency_medicine/docs/PALS%20Cases.pdf) (PALS Cases) ## Footnote [https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-12-pediatric-advanced-life-support/](https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-12-pediatric-advanced-life-support/%C2%A0) (Web based integrated guidelines)

PALS Concepts Flashcards

Lance Carter, CAA