PALS 2022 QUESTIONS WITH CORRECT ANSWERS GRADED TO PASS

BLS Assessment Verify scene safety Check for responsiveness Shout for help Active the emergency response system Where are pulses checked on a child? Carotid or femoral Where are pulses checked on an infant? Brachial An infant has normal breathing and a pulse, what is the next step? Monitor until emergency responders arrive An infant or child does not have normal breathing but has a pulse, what is the next step? Give 1 breath every 2-3 seconds (about 20-30 breaths/minute) HR is 60 and signs of poor perfusion, what do you do? Start CPR HR is 60 what do you do? Continue rescue breathing Check pulse every 2 minutes If no pulse, start CPR You are alone and witness the sudden collapse of an infant or child, what do you do? Activate the emergency response system Retrieve an AED/defibrillator You are alone and did not witness the sudden collapse of an infant or child, what do you do? Start high-quality CPR for 2 minutes Infant and child compression rate and compression-to-ventilation ratio for single rescuer 100-120 30:2 Infant and child compression rate and compression-to-ventilation ratio for 2 rescuers 100-120 15:2 Compression technique for most children heel of one hand with heel of other hand on top of 1st hand 1/3 of chest or 2 inches Compression technique for infants 2 fingers or thumbs to center of sternum just below the nipple line 1/3 of chest or 1 1/2 inches AED use on children less 8 yrs old Turn on AED Apply pads per instructions Analyze heart rhythm Deliver shock if indicated The AED indicates no shock advised, what do you do? Immediately start CPR beginning with chest compressions Pediatric Assessment Triangle (PAT) Appearance Work of Breathing Circulation PAT - appearance LOC Tone Interactiveness Consolability Look/gaze Speech/cry PAT - work of breathing Tripod Sniffing position Retractions Adventitious breath sounds (stridor or sonorous respirations) PAT - Circulation Pale Mottled Cyanotic When is the pediatric assessment triangle performed to make an initial assessment? During the "from the doorway" observation Evaluate-Identify-Intervene Cycle is used when caring for a seriously ill or injured child to help determine the best treaetment or intervention. It is repeated after interventions) EII - Evaluate Primary assessment Secondary assessment Diagnostic assessments Primary assessment Rapid Hands-on ABCDE to evaluate respiratory, cardiac, and neuro function. (Includes V/S and SpO2) Secondary assessment Focused medical history and focused physical exam Diagnostic assessments Lab X-ray Other tests ABCDE approach Airway Breathing Circulation Disability Exposure Decreased or asymmetrical chest expansion may result from inadequate effort airway obstruction atelectasis pneumothorax hemothorax pleural effusion mucous plug foreign body aspiration Stridor is a sign of upper airway obstruction Snoring can be a sign of airway obstruction (soft tissue swelling or decreased LOC may cause airway obstruction and snoring) Grunting is heard during _____ and occurs as the child exhales against _____ Expiration A partially closed glottis Gurgling is heard during _____ and results from _____ Expiration Upper airway obstruction due to secretions, vomit or blood Wheezing is most often heard during _____ and typically indicates _____ Expiration (less frequently during inspiration) Lower airway obstruction If an infants cry becomes very soft with only short sounds during expiration (more like the "mewing" of a cat) or an older child begins to talk in short phrases or single words instead of sentences, this may indicate Severe respiratory distress and SOB Crackles happen during inspiration Increased respiratory effort results from conditions that Increase resistance to airflow (e.g asthma or bronchiolitis) cause the lungs to be stiffer and difficult to inflate (eg. PNE, pulmonary edema, or pleural effusion) Nasal flaring is commonly observed in _____ and is usually a sign of _____ Infants and younger children Respiratory distress Retractions signify the child is trying to move air into the lungs using chest muscles but movement is impaired by increased resistance or stiff lungs Head Bobbing is caused by Using neck muscles to assist breathing (the child lifts the chin and extends the next during inspiration and allows the chin to fall forward during expiration) Head bobbing is most frequently seen in _____ and can be a sign of _____ Infants Respiratory failure Seesaw respirations are present when The chest retracts and the abdomen expands during inspiration and then the chest expands and the abdomen moves in word during expiration Children with neurologic problems may have Irregular respiratory patterns Irregular patterns that are serious and require urgent evaluation are A deep gasping breath followed by a period of apnea A rapid respiratory rate, followed by periods of apnea or very shallow breaths The first sign of respiratory distress in infants is A fast respiratory rate A slower than normal respiratory rate may be caused by Respiratory muscle fatigue CNS injury or problem that affects the respiratory control center Severe hypoxia Severe shock Hypo thermia Drugs that depress respiratory drive Some muscle diseases that cause muscle weakness Apnea Breathing stops, typically defined as longer than 20 seconds Normal SBP for children 1 to 10 years of age 90 mm Hg + (2 x age in years) Hypotension for children 1 to 10 years of age 70 mm Hg + (2 x age in years) Automated BP may give inaccurately high readings when the child is in shock An arterial catheter is often inserted to monitor a child's intra-arterial pressure when a child is in shock Common causes of sluggish, delayed, or prolonged capillary refill (2 secs) are Dehydration Shock Hypothermia Central pulses include femoral brachial carotid axillary Peripheral pulses include radial DP PT Week central pulses are worrisome and indicate the need for Rapid intervention to prevent cardiac arrest Assess skin temperature Slide back of your hand up extremity to determine a line where the skin changes from quarter warm Monitor this line of demarcation overtime to determine the child's response to therapy (the line should move distally as the child improves) Skin findings that may indicate inadequate 02 delivery to the tissues are Pallor Mottling Cyanosis Unequal pupils message just Increased ICP Eye injury Consensual constriction both pupils will start to constrict if one has some light put on it Slow construction or no construction may indicate Increased ICP If one or both pupils are dilated, particularly if they don't react to light, the child may have a severe and life-threatening increase in ICP Hypoglycemia in a newborn blood glucose 45 mg/dl or less Hypoglycemia in a child blood glucose of 60 mg/dl or less Hypoglycemia may result in _____ if not recognized and effectively treated altered LOC brain injury AVPU Response Scale Assesses alertness and response to stimuli AVPU asks Is child alert? Is child responsive to voice? Only responsive to pain? Unresponsive? A child does not respond to voice, what do you check next? Response to painful stimulus such as a sternal rub Even though infections are usually associated with fever, serious infections, especially in infants and immunocompromised children may cause hypothermia SAMPLE pneumonic S/S Allergies Medications Past medical history Last meal Events leading up to condition