PALS Certification Course Questions with Complete Solutions, A+

Which topics are included in the PALS course ? - 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 - 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? - 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? - 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? - 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? - 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? - 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: - (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 - The main focus of initial management is to support airway, breathing, and circulation How can the clinician support the airway? - (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? - 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? - 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? - 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. - 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? - 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? - Early treatment of shock may prevent the progression to cardiopulmonary failure In children, does shock present with low or high cardiac output? - 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? - 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? - 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? - Hypotensive shock occurs when compensatory mechanisms fail to maintain systolic blood pressure. Define hypotension in term infants? - In term infants 0 to 1 month of age, systolic pressure 60 mmHg Define hypotension in infants 1 to 12 months of age? - For infants 1 to 12 months of age, hypotension is defined by systolic pressure 70 mmHg Define hypotension in infants 1 to 10 years of age? - In children 1 to 10 years of age, hypotension is defined as: Systolic pressure (5th percentile) (70 mmHg + [child's age in years x 2]) Define hypotension in children over 10 years of age? - In children over 10 years of age, systolic blood pressure 90 mmHg What is key to know about hypotensive "decompensated" shock in contrast to compensated shock? - Hypotensive shock may rapidly progress to cardiopulmonary failure. How can shock be classified according to its pathophysiology? - Shock can be classified as being hypotensive, distributive; cardiogenic or obstructive What is hypovolemic shock? - Shock that is characterized by inadequate circulating blood volume (from fluid loss). Common causes include diarrhea, hemorrhage (internal and external), vomiting, inadequate fluid intake, osmotic diuresis (eg, diabetic ketoacidosis), third-space losses, and burns.