PALS with 100% correct questions and answers

Which pulses should be assessed to monitor systemic perfusion in a child? peripheral and central What should the first rescuer arriving on the scene of an unresponsive infant or child do? (in order) 1. verify scene safety 2. check for responsiveness 3. shout for help 4. activate the emergency response system Why may excessive ventilation during CPR be harmful? - it increases intrathoracic pressure - it impedes venous return If you cannot achieve effective ventilation (ie, the chest does not rise), do the following: - reposition/reopen the airway (sniffing position) - verify mask size and ensure a tight face-mask seal - suction the airway if needed - check the O2 source - check the ventilation bag and mask - treat gastric inflation (NG/OG) - consider 2-person bag-mask ventilation and inserting an OPA Ventilation rate 1 breath every 2-3 seconds delivered over 1 second (20-30 breaths per minute) Early signs of tissue hypoxia - tachypnea - increased respiratory effort (nasal flaring, retractions) - tachycardia - pallor, mottling, cyanosis - agitation, anxiety, irritability Late signs of tissue hypoxia - bradypnea, inadequate respiratory effort, apnea - increased respiratory effort (head bobbing, seesaw respirations, grunting) - bradycardia - pallor, mottling, cyanosis - decreased level of consciousness What is the role of the diaphragm during normal breathing in infants? pulls the ribs slightly inward S/S mild respiratory distress - mild tachypnea - mild increase in respiratory effort (nasal flaring, retractions) - abnormal airway sounds (stridor, wheezing, grunting) S/S Severe respiratory distress - marked tachypnea - marked increase in respiratory effort - paradoxical throacoabdominal breathing (seesaw breathing) - accessory muscle use (head bobbing) - abnormal airway sounds (grunting) - decreased level of consciousness S/S Impending respiratory arrest - bradypnea, apnea, respiratory pauses - low oxygen saturation (hypoxemia) despite high-flow supplemental oxygen - inadequate respiratory effort (shallow respirations) - decreased level of consciousness (unresponsive) - bradycardia What steps should be taken as part of initial management of a child in respiratory distress? - monitor O2 sat by pulse ox - monitor HR, rhythm, and, BP - support an open airway Stridor high-pitched breathing during inspirations Crackles breath sounds heart during expirations How should 1-rescuer infant compressions be delivered? - two fingers or two thumbs - rate of 100-120 - single rescuer (30:2) - two rescuer (15:2) How should 1-rescurer child compressions be delivered? either one or two hands - compress at least 1/3 the chest diameter (approximately 2 inches) Guidelines for rescue breathing for infants and children - give 1 breath every 2-3 seconds (about 20-30/min) - given each breath in 1 second - visible chest rise - check pulse every 2 minutes - use oxygen as soon as it is available 2-person bag mask ventilation may be necessary when: - making a seal is difficult - the provider's hands are too small - significant airway resistance (asthma) or poor lung compliance) - restricting spinal motion is necessary Best position to maintain an open airway - infant: place padding underneath shoulders - child: place padding underneath occiput Evaluate-Identify-Intervene Sequence evaluate (primary assessment, secondary assessment, diagnostic assessment) Evaluate - Primary Assessment a rapid hands-on ABCDE approach to evaluate respiratory, cardiac, and neurologic function; includes assessment of vital signs and pulse ox Evaluate - Secondary Assessment a focused medical history and focused physical exam Evaluate - Diagnostic Assessment laboratory, radiographic, and other advanced tests that help to identify the child's physiologic condition and diagnosis The evaluate-identify-intervene sequence should be continued until the child is stable Flow rate for pediatric nebulizer 5-6 L/min Causes of upper airway obstruction - foreign body aspiration - airway swelling (anaphylaxis, tonsillar hypertrophy, coup, epiglottitis) - masses - thick secretion - congenital airway abnormality - poor control of upper airway due to decreased level of consciousness S/S of Upper Airway Obstruction - stridor - hoarseness - change in voice or cry - inspiratory retractions - use of accessory muscles - nasal flaring - increased respiratory rate and effort - drooling, snoring, gurgling sounds - poor chest rise What is chest compression fraction? the proportion of time that chest compressions are performed during a cardiac arrest Mild Croup S/S: - occasional barking cough - little or no stridor at rest - absent or mild retractions treatment: - consider dexamethasone Moderate Croup S/S: - frequent barking cough - easily audible stridor at rest - retractions at rest - little or no agitation - good air entry in the peripheral lung fields treatment: - administer humidified O2 - NPO - administer nebulized epinephrine (observe for 2 hours after) - administer dexamethasone - consider using heliox Severe Croup S/S: - frequent barking cough - prominent inspiratory and occasional expiratory stridor - marked retractions - significant agitation - decreased air entry by auscultating the lungs treatment: - administer humidified O2 - NPO - administer nebulized epinephrine (observe for 2 hours after) - administer dexamethasone - consider using heliox Severe Croup Treatment - administer high concentration of O2 (nonrebreather) - administer dexamethasone - provide assisted ventilation - perform ET intubation (use a half size smaller than predicted for the childs age ET tube) - prepare for surgical airway if needed Mild allergic reaction interventions - remove the offending agent - get help - ask the child/caregiver about history of allergy - look for a medical alert bracelet or necklace - consider an oral dose of antihistamine Moderate to severe allergic reaction interventions - administer IM epinephrine every 10-15 minutes as needed, repeat doses as needed - treat bronchospasm (wheezing) with albuterol MDI or neb - give continuous nebulization if indicated - for severe respiratory distress anticipate airway spelling and prepare for intubation to treat hypotension: - place supine - methylprednisolone IV - diphenhydramine IV - administer isotonic crystalloid 20ml/kg bolus repeat as needed - if unresponsive to fluid administer epinephrine gtt Mild Asthma S/S: - talks in sentences - increased RR - moderate end expiratory wheezing - pulse less than 100 - SpO2 on room air >95% treatment: - administer humidified O2 - administer MDI or neb albuterol - administer oral corticosteroids Moderate Asthma S/S: - talks in phrases - increased RR - accessory muscle use with retractions - loud wheeze - pulse 100-120 - pulsus paradoxus may be present - SpO2 on room air 91-95% treatment: - administer humidified O2 - administer MDI or neb albuterol - administer oral corticosteroids Severe Asthma S/S: - talks in single words - usually agitated - accessory muscle use and retractions - usually loud wheezing - pulse >120 - pulsus paradoxus often present - SpO2 on room air <90% treatment: - administer O2 - administer albuterol MID or neb - administer ipratropium neb - administer IV/PO corticosteroids - consider mag bolus over 15-30min Asthma progressing to imminent respiratory arrest S/S: - drowsy or confused - paradoxical thoracoabdominal movement - absence of wheeze - bradycardia - respiratory muscle fatigue treatment: - admin O2 - continuous albuterol neb - IV corticosteroid - terbutaline - bilevel positive airway pressure - intubate for refractory hypoxemia and worsening clinical condition Lung Tissue Disease - involves the parenchyma or tissue of the lung - the lungs become stiff because of fluid accumulation in the alveoli and or interstitium causes: - pneumonia - pulmonary contusion (trauma) - allergic reaction - toxins - vasculitis - infiltrative disease treatment: - Disordered Control of Breathing increased ICP treatment: - verify open/patent airway, adequate oxygenation, and adequate ventilation - administer 20ml/kg IV isotonic crystalloid - administer pharamacological therapy (osmotic agent, hypertonic saline) - treat agitation and pain aggressively - avoid hypotension - avoid and aggressively treat fever