Pediatric Advanced Life support (PALS) Exam with Absolute Solution

Pediatric Advanced Life support (PALS) Exam with Absolute Solution 1. List 11 clinical signs of tissue hypoxia that indicate respiratory distress.: - 1- tachypnea 2- bradypnea (late) 3-apnea (late) 4- tachycardia (early) 5- bradycardia (late and ominous) 6-cyanosis (late) 7-pallor 8-nasal flaring 9-fatigue 10-agitation 11-altered mental status The above were signs of what medical condition that can be immediately life threatening? 2. Explain difference between hypoxemia and tissue hypoxia.: 1-Hypoxemia is low oxygen content in arterial blood. Initially measured with pulse oximetry. 2- Tissue hypoxia is low oxygen content in tissues other than arterial blood. There is no direct test for measuring tissue hypoxia. We depend on clinical signs to detect this condition. 3- Hypoxemia and hypoxia are not mutually assured. You can have hypoxia without hypoxemia and vica-versa, 3. Is hypoxia the same as hypercarbia?: No. HypOxIA and HypERCARBIA are two different conditions. They have different clinical signs, but these signs do overlap, making the use of ABG critical in differentiating the two conditions. 4. What blood test can be used to differentiate hypoxia from hypercarbia as causes of signs of respiratory distress?: Arterial Blood Gas can pick up hypercarbia, but not hypoxemia. 5. Compare signs of hypoxia and hypercarbia.: Hypoxia Hypercarbia 1-tachypnea 1-tachypnea 2-bradypnea (late) 3-apnea (late) 4-tachycardia (early) 5-bradycardia (late) 6-cyanosis (late) 7-pallor 8-nasal flaring 2-nasal flaring 9-fatigue 3-fatigue 10- agitation 4-agitation 11- altered mental status 5-altered mental status 6. How is respiratory distress/failure categorized?: By severity (failure is more severe by definition than distress) By anatomic location of cause. 7. What are the possible anatomic sites causing respiratory distress?: 1-upper airway a-nose b-pharynx c-hypopharynx(=larynx) 2-lower airway a-trachea b-bronchi c-bronchioles 3-Lung tissue a-pneumonia b-pulmonary edema c-ARDS 4-Disordered respiratory control system a-CNS i-seizures ii-Central Nervous System infections iii-head injury iv-hydrocephalus v-brain tumor vi-neuromuscular disease 1)-myasthenia gravis 2)-Lou Gehrig's disease/Amyotrophic lateral sclerosis The above describe what? 8. Signs of upper airway obstruction (10)?: 1-tachypnea 2-increased respiratory effort 3- crying 4- change in voice ( hoarseness or "barky" cough) 5-stridor (usually inspiratory) 6- poor chest excursion (chest rise) 7- see-saw chest/abdominal motion on inspiration 8-poor air entry on auscultation 9- increased inspiratory respiratory effort ( inspiratory retractions, use of accessory muscles of respiration, nasal flaring) 10- drooling, snoring or gurgling sounds The above are signs of what condition or of what classification of cause of respiratory distress? 9. Signs of lower airway obstruction (6)?: 1-tachypnea 2-increased respiratory effort 3-wheezing (usually expiratory, but can be inspiratory) 4-coughing 5- prolonged expiratory phase 6- retractions, nasal flaring and prolonged expiration The above are signs of what classification of cause of respiratory distress? 10. Signs of lung tissue disease causing respiratory difficulty (7)?: 1-tachyp- nea 2-increased respiratory effort 3-diminished breath sounds 4-grunting 5- tachycardia 6- hypoxemia (despite administration of supplementary O2) 7-crackles (rales) and decreased air movement The above are signs of what classification of cause of respiratory distress? 11. Signs of disordered control of breathing (5)?: 1-Variable/irregular respiratory rate 2-Variable respiratory effort 3-Central apnea 4- Shallow breathing 5- normal or decreased air movement The above are signs of what classification of cause of respiratory distress? 12. Causes of upper airway obstruction?: 1-Croup 2-Anaphylaxis 3-FBO 4-tonsillar hypertrophy 5-epiglottis 6-pharyngeal or peritonsillar abscess, retropharyngeal abscess, or tumor 7-congenital airway abnormality( congenital subglottic stenosis) 13. Treatment of respiratory distress due to croup?: Mild croup 1-cool mist+oxygen 2-dexamethasone (0.6 mg/kg IM, not to exceed 10 mg) Mod.-Severe 1- cool mist+oxygen 2- dexamethasone (0.6 mg/kg IM, not to exceed 10 mg) or nebulized 3-L -epinephrine (1:1000) nebulized has proven to significantly reduce croup symp- toms 30 minutes after treatment. 4- Nebulized budesonide (2 mg) 5- Inhaled Decadron when budesonide unavailable 6-NPO Severe 1-6 above 7-Intubate 8-ventillate The above are current therapies for ? 14. Treatment of respiratory distress due to anaphylaxis?: 1-epinephrine 0.01 mg/kg IM or IV 2-Albuterol for wheezing MDI cont. nebulizer 3-benadryl Pediatric Dosage: 2-5 mg/kg. Adult Dosage: 25-50 mg. Routes: Slow IV push or deep IM. 4- H2blocker Zantac (ranitidine) Bolus IV: 50 mg IV q6-8h Continuous IV: 6.25 mg/h IV Oral Dosing: 150 mg PO bid Pepcid (famotidine) Oral dosing: 20 to 40 mg PO bid Tagamet (cimetidine) Bolus parenteral dosing: 300 mg IV or IM q6h Continuous IV Dosing: 37.5 mg/h IV Oral Dosing: 400 mg PO bid 5- methylprednisolone (SoluMedrol) 6- Trendelenburg+IV epi titrate+IV isotonic crystalloid 20 ml/kg 15. 1-Formula for calculating "Arterial Oxygen Content" (AOC)? 2-What clinical tests/observations are needed to be able to calculate AOC?: 1) AOC=[1.36 x Hgb conc. X SpO2]+[0.003xPaO2] 2) CBC, pulse oximetry, ABG 16. What clinical and laboratory measurable parameters do you need to be able to calculate the Arterial Oxygen Content?: 1-serum Hgb concentration (obtained from CBC) in units of g/dL 2- SpO2=Saturation pulse oxygen (Pulse ox machine reading) in units of % 3- PaO2=Partial pressure arterial oxygen (obtained from arterial blood gas test) in units of mm HG 17. What are 5 environmental or patient physiologic factors that can cause hypoxemia?: 1-low ambient PO2 2-Alveolar hypoventilation 3-Diffusion defect 4-Vent./Perfusion (V/Q) imbalance 5-Shunt 18. Mechanism by which causes hypoxemia? 1-Low ambient PO2 2-Alveolar hypoventilation 3-Diffusion defect 4- V/Q mismatch 5- Shunt: 1-decreased ambient partial pressure O2 (PO2) 2- increased arterial PCO2-increased alveolar CO2-decreased alveolar O2 avail- able for uptake 3- Alveolar/capillary memb. less gas permeable 4- Failure of arterioles to shut down in areas of lung that are hypo-inflated-not irreversible 5- Fixed ongoing perfusion in areas of lung that are not ventilated-not irreversible 19. How is hypoxemia from treated? 1-Low ambient PO2 2-Alveolar hypoventilation 3-Diffusion defect 4- V/Q mismatch 5- Shunt: 1-supplemental O2 2- supplemental O2, restore normal ventilation 3- supplemental O2+CPAP or intubation+PEEP+O2+mech. vent. 4-intubation, PEEP, O2, mech. vent. 5-Surgical repair 20. Management of hypoxia due to upper airway obstruction?: If mild: 1-Position comfortable if conscious 2-O2 via nonrebreathing mask If severe (unconscious) 1-Position head-tilt+chin lift 3-check airway 4-if obstructed a)12 mo old b)12 mos i-3 back slaps ii-3 chest thrusts ii-abdominal thrusts iii-inspect mouth-remove FOB iv-attempt PPV v-if unsuccessful PPV start CPR