AHA Pediatric Advanced Life Support 2023 Exam

1. Signs of poor perfusion 2. Adult pads on the AED 3. Initial impression assessment Temperature, AMS, Pulses, Skin (pale, mottling, and cyanosis) Use adult pads on victims 8 years of age and older Appearance: LOC, interactiveness, consolability, look/gaze/stare/ and speech/cry circulation: Skin color, petechiae or purport or visible bleeding wounds work of breathing: including position, and any audible breath sounds, respiratory effort 4. Evaluate If no life-threatening condition is present, evaluate the child's condition by using the clinical assessment tool Primary Assessment: ABCDE including vital signs 5. Primary Assess- ment Airway Breathing Circulation Disability Exposure 6. Evaluate Airway To assess the airway, determine if is is patent: Look for movement of the chest of abdomen, listen for air move- ment and breath sounds, feel for movement of air at the nose and mouth 7. S/S Upper Airway obstruction Increased inspiratory effort with retractions Abnormal inspiratory sounds (snoring or high-pitches stri- dor) Episodes where no airway or breath sounds are present despite respiratory effort (Complete upper airway obstruc- tion* *If upper airway is obstructed, determine if you can open and maintain the airway with simple measures or if you need advanced interventions 8. Simple measures Positioning: For responsive child allow a position of com- to maintain the airway fort or elevate the head of the bed. For unresponsive child turn on side or use a head told chin lift Suctioning Relief techniques for foreign-body airway obstruction Airway Adjuncts: Oropharyngeal airway to keep the tongue from falling back and obstructing the airway Relief techniques for foreign body airway obstruction: Ab- dominal thrusts and back slaps 9. Advanced Airway Endotracheal intubation Interventions 10. Assessment of breathing 11. Normal respira- tory rate 12. Causes of bradypnea 13. Increased respi- ratory effort Laryngoscopy Cricothyrotomy Respiratory rate and pattern Respiratory effort Chest expansion and air movement Lung and airway sounds Oxygen saturation and pulse ox Infant: 30-53 Toddler: 22-37 Preschool:20-28 School-aged child: 18-25 Adolescent: 12-20 Respiratory muscle fatigue Central nervous system injury Severe hypoxia Severe shock Hypothermia Drugs that depress the respiratory drive Some muscle diseases that cause muscle weakness 14. Locations of re- tractions Nasal flaring Retractions Head bobbing or seesaw respirations Mild to moderate: subcostal, substernal, intercostal Severe: supraclavicular, suprasternal, sternal 15. Stridor a coarse, usually higher-pitched breathing sound typically heard on inspiration Sign of upper airway obstruction 16. Grunting typically a short, low-pitched sound heard during expira- tion. Attempt to optimize oxygenation and ventilation Often a sign of lung tissue disease resulting from small airway collapse, alveolar collapse, or both ** Typically a sign of severe respiratory distress or failure 17. Urine Output In- fant and young children 18. Urine Output old- er children and adolescents 1.5-2 mL/kg/hr 1 mL/kg/hr 19. AVPU Response Alert Verbal Painful Unresponsive 20. Focused history S/S Allergies Medications Past Medical History Last Meal Events 21. Advanced Airway Breath q 6 seconds 22. Epi dose 0.01mg/kg q 3-5 minutes 23. Amio 5mg/kg bolus can give x 3 24. Lidocaine 1mg/kg loading dose 20-50mcg/kg/min 25. Manual Defibril- lator 26. Magnesium sul- fate 27. Causes of Upper Airway Obstruc- tion 28. S/S Upper airway obstruction 29. S/S Lower Airway Obstruction 30. Causes Lower airway obstruc- tion 2-4J/kg 25-50mg/kg IV IO Max 2g Foreign body aspiration, swelling, thick secretions, mass, congenital airway abnormality **Stridor Increased rate and effort, increased inspiratory and respi- ratory effort (retractions, use of accessory muscles, nasal flaring), inspiratory stridor, change in voice, cry, barking cough, drooling, snoring, gurgling sound, poor chest rise, poor air entry on auscultation **Wheezing Increased rate and effort, decreased air movement on auscultation, prolonged expiratory phase, cough Asthma bronchiolitis 31. Lung Tissue Dis- ease Causes PNU Cariogenic and noncardiogenic pulmonary edema (CHF or ARDS) 32. S/S Lung tissue **Grunting and crackles disease -Increased rate, effort, decreased air movement, tachycar- dia, hypoemia 33. Disordered con- Neurological disorders, metabolic abnormalities, drug trol of breathing overdose causes 34. S/S disordered Variable or irregular respiratory rate and pattern, shallow control of breath- breathing with inadequate effort ing 35. Croup Manage- Dexamethasone ment Humidified O2 Nebulizer Epi 36. Anaphylaxis remove the offending agent oral antihistamine IM Epi q 10-15 minutes Methylpred Albuterol 37. Management of Oral and nasal suctioning pro bronchiolitis Keep sats .94% 38. Management of Humidified O2 asthma Albuterol MDI or Nebulizer Corticosteroids Mag Sulfate 39. Management of antibiotic therapy PNU Albuterol CPAP Reduce metabolic demands by reducing temperature 40. Cariogenic pul- monary edema provide ventilator support (PEEP) Diuretics 41. Nasal Cannula 0.25 - 4L Gives 22-60% O2 42. Simple O2 mask 6-10L 35 - 60% 43. Nonrebreather Up to 95% 10-15L 44. High flow nasal cannula 4-40L 45. Nebulizer Set gas flow 5-6L 46. Fluid Resuscita- tion 3mL isotonic fluid for every 1mL blood lost Reassess after every fluid bolus 47. Fluid Bolus 20mL/kg of isotonic fluid over 5-10minutes 48. Goals of shock therapy 49. Initial shock sta- bilization Improve mental status, normalize heart rate, temperature, and adequate bp ABC, heart rate, bp, pulse ox IV/IO access, Fluid resuscitate and broad spectrum antibi- otics 50. Drugs in shock Cold extremities, delayed capillary refill, low bp = epi, dopamine Warm extremities, flash capillary refill, low diastolic pres- sure = norepi 51. Anaphylactic shock IM epic by auto injector 2nd dose may be needed albuterol for bronchospasm antihistamines corticosteroids - methylprednisone 52. Neurogenic shock hypotension, bradycardia head down to improve venous return trial of fluid therapy hypotension --> vasopressors norepi, epic 53. Cardiogenic shock 5-10mL/kg over 10-20 minutes frequently assess for pulmonary edema milrinone therapy 54. Ductal Depen- dent LV Outflow Obstruction Prostaglandin E 55. Tension Pneumo Needle decompression, tube thoracostomy 56. Cardiac Tampon- ade Pericardiocentesis 20mL/kg NS or LR 57. Pulmonary em- bolism 20mL/kg Ns or LR bolus Thrombolytics, anticoagulants 58. IO access proximal tibia, position the leg with slight external rotation 1-3cm below the tibial tuberosity, leave the stylet in the needle Use a twisting motion with gentle but firm pressure When there is a sudden decrease in resistance, should stand easily without support Infuse saline. If no edema, in correctly. May not aspirate bone marrow Tape over flange/gauze 59. Symptomatic bradycardia 60. S/S SVT in in- fants 61. S/S SVT in older children 62. Bradycardia with pulse algorithm 63. Causes of brady- cardia heart rate slower than normal for child's age Cardiopulmonary compromise - hypotension, AMS, de- creased LOC, signs of shock irritability, poor feeding, rapid breathing, unusual sleepi- ness, pale, mottles skin palpitations, SOB, chest pain, light headed, fainting airway, oxygen, cardiac monitor, bp, pulse ox, IV/IO, 12 lead CPR if HR <60 with poor perfusion and ventilation Epi 0.01mg/kg q 3-5 minutes Atropine 0.02mg/kg max dose 0.5mg hypoxia, hydrogen ions, elevated potassium, hypother- mia, heart block, toxins/poisons/drugs, trauma (brady = increased ICP) 64. Vagal manuevers ice to face, valsalva maneuver, carotid sinus massage 65. Synchronized cardioversion hemodynamically unstable its with palpable pulses 0.5 - 1J/kg cardioversion 2nd shock 2J/kg 66. Adenosine 0.1mg/kg 2nd dose 0.2mg/kg max dose 12mg 67. Amiodarone 5mg/kg over 20-60 minutes max dose 300mg 68. Procainamide treat atrial and ventricular arrhythmia resistant to other drugs loading dose 15mg/kg ver 30-60 minutes