PALS - Written Test and Case Study Review Material solved with complete solution

CPR Sequence C-A-B Circulation-Airway-Breathing Algorithm: Pediatric Septic Shock First hour... Oxygen & support ventilation Establish IV, draw labs (glucose, blood cultures) Begin resuscitation Push repeated 20 mL/kg isotonic crystalloid (3-4) unless rales, resp distress, hepatomegaly Correct hypo-glycemia/calcemia Admin 1st dose antibiotics STAT STAT vasopressor drip/stress-dose hydrocortisone Establish 2nd IV 00:02 01:01 Algorithm: Pediatric Septic Shock Fluid Responsive? Yes - ICU No - Vasoactive drug & titrate for normotension Normo: begin dopamine Hypo/warm: norepi Hypo/cold: epi Adenosine (slows HR) SVT 0.1 mg/kg - dose 1 0.2 mg/kg - dose 2 max = 6 mg RAPID push Amiodarone (antiarrythmic) VF/VT (pulseless) 5 mg/kg Bolus max = 300 mg SVT, VT (with pulses) 5 mg/kg over 20-60 mins max = 300 mg Atropine (increases HR) Bradycardia 0.02 mg/kg may repeat once Epinepherine (increases HR) Bradycardia/Pulseless Arrest 0.01 mg/kg (1:10,000) every 3-5 min Hypotensive Shock 0.1-1 mcg/kg per min Anaphylaxis 0.01 mg/kg every 3-5 min Algorithm: Pediatric Cardiac Arrest Shout for help CPR Oxygen, AED If no shock - CPR for 2 min, IV, Epi q 3-5 min, reassess If shock - after...CPR for 2 min, IV, reassess If 2nd shock - CPR for 2 min, Epi q 3-5 min, reassess If 3rd shock - CPR for 2 min, Amiodarone, treat cause, reassess... Post Resuscitation Care Shock Doses 1st shock - 2 j/kg 2nd shock - 4 j/kg Max 10 j/kg Reversible Causes of Pediatric Cardiac Arrest (H&T's) 6 H's (G,K,T,V,X,DRO) 1. Hypo-Glycemia 2. Hypo/hyper-Kalemia 3. Hypo-Thermia 4. Hypo-Volemia 5. Hypo-Xia 6. HyDROgen ion (acidosis) Reversible Causes of Pediatric Cardiac Arrest (H&T's) 5 T's (A,E,HC,HP,O) 1. Tamponade, cardiac 2. Tension pneumothorax 3. Thrombosis, coronary 4. Thrombosis, pulmonary 5. Toxins Rescue Breaths 1 every 6-8 secs 8-10 per min CBC (Assessment part 1) Consciousness Breathing Color ABCDE (Assessment part 2) Airway Breathing Circulation Disability Exposure SAMPLE (Assessment part 3) S/Sx Allergies Medications Past medical hx Last meal/drink Events leading to situation DOPE (Pediatric with airway, deteriorates rapidly) Displacement Obstruction Pneumothorax Equipment Begin CPR when HR is _____ and _____? <60 poor perfusion Algorithm: Pediatric Bradycardia, Pulse Present, Poor Perfusion Airway, assess with breathing if needed, oxygen Cardiac monitor, BP, oximetry IV access ECG Cardio compromise continues... --- HR<60 = CPR Brady continues... ---Epi, Atropine, Pacing, Treat Causes If pulseless... --- go to cardiac arrest algorithm Algorithm: Pediatric Tachycardia, Pulse Present, Poor Perfusion Airway, assess with breathing if needed, oxygen Cardiac monitor, BP, oximetry, IV access ECG, evaluate QRS --Wide: Possible VT If Cardiopulmonary Compromise: Sync Cardioversion If not: Adenosine, Amiodarone --Narrow: If Sinus Tachy: search for and treat cause If SVT: Vagal, Adenosine, Sync Cardioversion Core Case Action Order (A,I,I) Assess Identify Intervene To end the case... Therapeutic end Compensated or uncompensated Prepare to intubate Call pediatrics, other specialist needed Begin post resuscitation care UAO: Presentation, Causes, TX Stridor on inspiration, High pitched inspiration (Anaphylaxis, Croup, Foreign Body) Humid Oxygen, Neb Epi, Removal LAO: Presentation, Causes, TX Wheezing on expiration (Asthma, Bronchiolitis) Neb Albuterol, SQ Epi, Mag Sulf, Steroids