PALS Certification Course
Which topics are included in the PALS course ? - ANS-PALS includes the following:
(1) Overview of assessment
(2) Recognition and management of respiratory distress and failure
(3) Recognition and management of shock
(4) Recognition and management of cardiac arrhythmias
(5) Recognition and management of cardiac arrest
(6) Postresuscitation management of patients with pulmonary and cardiac arrest
(7) Review of pharmacology
What should be the primary focus of the clinician on prevention of cardiopulmonary
failure - ANS-The clinician should primarily focus on prevention of cardiopulmonary
failure through early recognition and management of respiratory distress, respiratory
failure, and shock that can lead to cardiac arrest from hypoxia, acidosis, and ischemia.
What is the main cause of cardiac arrests in children? - ANS-In infants and children,
most cardiac arrests result from progressive respiratory failure and/or shock, thus one of
the aims of PALS rapid assessment model is to prevent progression to cardiac arrest.
What is the pediatric assessment triangle? - ANS-Brief visual and auditory observation
of child's overall (1) appearance, (2) work of breathing, (3) circulation
What are the components of the primary assessment? What signs should the clinician
look for? - ANS-The clinician should in rapid sequence assess:
(1) Airway (patent, patent with maneuvers/adjuncts, partially or completely obstructed)
(2) Breathing (respiratory rate, effort, tidal volume, lung sounds, pulse oximetry)
(3) Circulation (skin color and temperature, heart rate and rhythm, blood pressure,
peripheral and central pulses, capillary refill time)
(4) Disability: (a)AVPU pediatric response scale: Alert, Voice, Pain, Unresponsive; (b)
Pupillary response to light
(c) Presence of hypoglycemia (rapid bedside glucose or response to empiric
administration of dextrose) (d) Glasgow Coma Scale
What are the components of the secondary assessment? For what should the clinician
look for during the secondary assessment? - ANS-This portion of the evaluation
includes a thorough head to toe physical examination, as well as a focused medical
history that consists of the "SAMPLE" history:
,(S) Signs and Symptoms
(A) Allergies
(M) Medications
(P) Past medical history
(L) Last meal
(E) Events leading to current illness
What are the components of the tertiary assessment? - ANS-Injury and infection are
common causes of life-threatening illness in children. Thus, for this stage, ancillary
studies are frequently directed towards identifying the extent of trauma or an infectious
focus.
There are many causes of acute respiratory compromise in children. The clinician
should strive to categorize respiratory distress or failure into one or more of the
following: - ANS-(1) Upper airway obstruction (eg, croup, epiglottitis)
(2) Lower airway obstruction (eg, bronchiolitis, status asthmaticus)
(3) Lung tissue (parenchymal) disease (eg, bronchopneumonia)
(4) Disordered control of breathing (eg, seizure, coma, muscle weakness)
What is the focus of initial management - ANS-The main focus of initial management is
to support airway, breathing, and circulation
How can the clinician support the airway? - ANS-(1) Provide 100 percent inspired
oxygen
(2) Allow child to assume position of comfort or manually open airway
(3) Clear airway (suction)
(4) Insert an airway adjunct if consciousness is impaired (eg, nasopharyngeal airway or,
if gag reflex absent, oropharyngeal airway)
How can the clinician support breathing? - ANS-For supporting breathing, the clinician
should:
(1) Assist ventilation manually in patients not responding to basic airway maneuvers or
with inadequate or ineffective respiratory effort
(2) Monitor oxygenation by pulse oximetry
(3) Monitor ventilation by end-tidal carbon dioxide (EtCO2) if available
(4) Administer medications as needed (eg, albuterol, epinephrine)
T of F: in preparation for intubation, the patient should receive 100 percent oxygen? -
ANS-True! In preparation for intubation, the patient should receive 100 percent oxygen
, via a high-concentration mask, or if indicated, positive pressure ventilation with a
bag-valve-mask to preoxygenate and improve ventilation.
What should be done if the patient cannot maintain their airway, oxygenation, or
ventilatory requirements? - ANS-In such cases, the patient should undergo placement
of an artificial airway, usually via endotracheal intubation and less commonly with a
laryngeal mask airway or alternative device.
T or F some patients with upper airway obstruction and/or respiratory failure may
respond to noninvasive ventilation if airway reflexes are preserved. - ANS-True! Certain
populations of patients with upper airway obstruction and/or respiratory failure may
respond to noninvasive ventilation (CPAP or BiPAP) if airway reflexes are preserved.
When a patient appears to be in shock, what should be the goal of the next action
taken? - ANS-The goal should be to recognize and categorize the type of shock in order
to prioritize treatment options
Why is the early management of shock so critical for patient survival? - ANS-Early
treatment of shock may prevent the progression to cardiopulmonary failure
In children, does shock present with low or high cardiac output? - ANS-Shock in
children usually presents with low cardiac output, but some patients may have high
cardiac output, such as with sepsis or severe anemia.
How can shock be classified? - ANS-Shock severity is usually classified based on its
effect on systolic blood pressure at presentation (i.e. compensated vs. decompensated)
or based on its pathophysiology (i.e hypovolemic; distributive; cardiogenic; obstructive
shock)
What is the meaning of "compensated" shock, when does it occur? -
ANS-Compensated shock occurs when compensatory mechanisms (including
tachycardia, increased systemic vascular resistance, increased inotropy, and increased
venous tone) maintain a systolic blood pressure within a normal range
What is the meaning of hypovolemic "decompensated" shock? When does it occur? -
ANS-Hypotensive shock occurs when compensatory mechanisms fail to maintain
systolic blood pressure.
Define hypotension in term infants? - ANS-In term infants 0 to 1 month of age, systolic
pressure <60 mmHg
Which topics are included in the PALS course ? - ANS-PALS includes the following:
(1) Overview of assessment
(2) Recognition and management of respiratory distress and failure
(3) Recognition and management of shock
(4) Recognition and management of cardiac arrhythmias
(5) Recognition and management of cardiac arrest
(6) Postresuscitation management of patients with pulmonary and cardiac arrest
(7) Review of pharmacology
What should be the primary focus of the clinician on prevention of cardiopulmonary
failure - ANS-The clinician should primarily focus on prevention of cardiopulmonary
failure through early recognition and management of respiratory distress, respiratory
failure, and shock that can lead to cardiac arrest from hypoxia, acidosis, and ischemia.
What is the main cause of cardiac arrests in children? - ANS-In infants and children,
most cardiac arrests result from progressive respiratory failure and/or shock, thus one of
the aims of PALS rapid assessment model is to prevent progression to cardiac arrest.
What is the pediatric assessment triangle? - ANS-Brief visual and auditory observation
of child's overall (1) appearance, (2) work of breathing, (3) circulation
What are the components of the primary assessment? What signs should the clinician
look for? - ANS-The clinician should in rapid sequence assess:
(1) Airway (patent, patent with maneuvers/adjuncts, partially or completely obstructed)
(2) Breathing (respiratory rate, effort, tidal volume, lung sounds, pulse oximetry)
(3) Circulation (skin color and temperature, heart rate and rhythm, blood pressure,
peripheral and central pulses, capillary refill time)
(4) Disability: (a)AVPU pediatric response scale: Alert, Voice, Pain, Unresponsive; (b)
Pupillary response to light
(c) Presence of hypoglycemia (rapid bedside glucose or response to empiric
administration of dextrose) (d) Glasgow Coma Scale
What are the components of the secondary assessment? For what should the clinician
look for during the secondary assessment? - ANS-This portion of the evaluation
includes a thorough head to toe physical examination, as well as a focused medical
history that consists of the "SAMPLE" history:
,(S) Signs and Symptoms
(A) Allergies
(M) Medications
(P) Past medical history
(L) Last meal
(E) Events leading to current illness
What are the components of the tertiary assessment? - ANS-Injury and infection are
common causes of life-threatening illness in children. Thus, for this stage, ancillary
studies are frequently directed towards identifying the extent of trauma or an infectious
focus.
There are many causes of acute respiratory compromise in children. The clinician
should strive to categorize respiratory distress or failure into one or more of the
following: - ANS-(1) Upper airway obstruction (eg, croup, epiglottitis)
(2) Lower airway obstruction (eg, bronchiolitis, status asthmaticus)
(3) Lung tissue (parenchymal) disease (eg, bronchopneumonia)
(4) Disordered control of breathing (eg, seizure, coma, muscle weakness)
What is the focus of initial management - ANS-The main focus of initial management is
to support airway, breathing, and circulation
How can the clinician support the airway? - ANS-(1) Provide 100 percent inspired
oxygen
(2) Allow child to assume position of comfort or manually open airway
(3) Clear airway (suction)
(4) Insert an airway adjunct if consciousness is impaired (eg, nasopharyngeal airway or,
if gag reflex absent, oropharyngeal airway)
How can the clinician support breathing? - ANS-For supporting breathing, the clinician
should:
(1) Assist ventilation manually in patients not responding to basic airway maneuvers or
with inadequate or ineffective respiratory effort
(2) Monitor oxygenation by pulse oximetry
(3) Monitor ventilation by end-tidal carbon dioxide (EtCO2) if available
(4) Administer medications as needed (eg, albuterol, epinephrine)
T of F: in preparation for intubation, the patient should receive 100 percent oxygen? -
ANS-True! In preparation for intubation, the patient should receive 100 percent oxygen
, via a high-concentration mask, or if indicated, positive pressure ventilation with a
bag-valve-mask to preoxygenate and improve ventilation.
What should be done if the patient cannot maintain their airway, oxygenation, or
ventilatory requirements? - ANS-In such cases, the patient should undergo placement
of an artificial airway, usually via endotracheal intubation and less commonly with a
laryngeal mask airway or alternative device.
T or F some patients with upper airway obstruction and/or respiratory failure may
respond to noninvasive ventilation if airway reflexes are preserved. - ANS-True! Certain
populations of patients with upper airway obstruction and/or respiratory failure may
respond to noninvasive ventilation (CPAP or BiPAP) if airway reflexes are preserved.
When a patient appears to be in shock, what should be the goal of the next action
taken? - ANS-The goal should be to recognize and categorize the type of shock in order
to prioritize treatment options
Why is the early management of shock so critical for patient survival? - ANS-Early
treatment of shock may prevent the progression to cardiopulmonary failure
In children, does shock present with low or high cardiac output? - ANS-Shock in
children usually presents with low cardiac output, but some patients may have high
cardiac output, such as with sepsis or severe anemia.
How can shock be classified? - ANS-Shock severity is usually classified based on its
effect on systolic blood pressure at presentation (i.e. compensated vs. decompensated)
or based on its pathophysiology (i.e hypovolemic; distributive; cardiogenic; obstructive
shock)
What is the meaning of "compensated" shock, when does it occur? -
ANS-Compensated shock occurs when compensatory mechanisms (including
tachycardia, increased systemic vascular resistance, increased inotropy, and increased
venous tone) maintain a systolic blood pressure within a normal range
What is the meaning of hypovolemic "decompensated" shock? When does it occur? -
ANS-Hypotensive shock occurs when compensatory mechanisms fail to maintain
systolic blood pressure.
Define hypotension in term infants? - ANS-In term infants 0 to 1 month of age, systolic
pressure <60 mmHg
