PALS - Written Test and Case Study Exam Review Material with Complete solution

CPR Sequence - ANSWER C-A-B Circulation-Airway-Breathing Core Case Action Order (A,I,I) - ANSWER Assess Identify Intervene CBC (Assessment part 1 aka initial assessment) - ANSWER Consciousness Breathing Color ABCDE (Assessment part 2 aka primary assessment) - ANSWER Airway Breathing Circulation Disability Exposure SAMPLE (Assessment part 3) - ANSWER S/Sx Allergies Medications Past medical hx Last meal/drink Events leading to situation Reversible Causes of Pediatric Cardiac Arrest (H&T's) 6 H's (G,K,T,V,X,DRO) - ANSWER 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) - ANSWER 1. Tamponade, cardiac 2. Tension pneumothorax 3. Thrombosis, coronary 4. Thrombosis, pulmonary 5. Toxins UAO: Presentation, Causes, TX - ANSWER Stridor on inspiration, High pitched inspiration (Anaphylaxis, Croup, Foreign Body) Humid Oxygen, Neb Epi, Removal Croup presentation Tx - ANSWER O2 Racemic epinephrine (0.25mg/kg) Humidified epi (0.5 ml/kg/3cc's NS Core Case Resp 1: UAO (Anaphylaxis) - ANSWER Open airway Admin O2 100% non-rebreather, re-assess AED, Vitals (cardiac rhythm = sinus tachy) S/sx of UAO, resp distress TX: Epi IM, Steroids, CPAP Vascular access Prepare for intubation LAO: Presentation, Causes, TX - ANSWER Wheezing on expiration (Asthma, Bronchiolitis) Neb Albuterol, SQ Epi, Mag Sulf, Steroids Core Case Resp 2: LAO (Bronchiolitis or Asthma) - ANSWER Admin O2 100% non-rebreather after finishing neb tx, re-assess AED, Vitals (cardiac rhythm = sinus tachy) S/sx of LAO, resp distress Suction nose TX: Neb albuterol (2.5mg/3cc's NS), Non-invasive pos press vent (NIPPV), Steroids Vascular access, labs, ABGs, chest X-ray Prep for bag-mask vent, intubation Lung Tissue Disease: Presentation, Causes, TX - ANSWER Grunting, stiff lungs, increased breathing effort (I, E), tachypnea, crackles (Pneumonia) Antibiotics, Albuterol Core Case Resp 3: Lung Tissue Disease (Pneumonia or Aspiration) - ANSWER *Admin O2 100% non-rebreather after finishing neb tx, re-assess, titrate O2 to 94-99% TX: Neb albuterol, antibiotics, Non-invasive vent (CPAP or NIPPV - PEEP) Prep for bag-mask vent, intubation* AED, Vitals (cardiac rhythm = sinus tachy) S/sx of LTD, resp failure Suction nasopharynx Vascular access, labs, ABGs, chest x-ray Disordered Breathing: Presentation, Causes, TX - ANSWER Irreg breathing pattern (Drug OD, Injury) Antidote (narcan), DOPE, MASK AND BAG DOPE (Pediatric with airway, deteriorates rapidly) - ANSWER Displacement (airway is displaced on chin lift) Obstruction (tongue fluid) Pneumothorax (Lung is punctured or plugged) Equipment (Is it malfunctioning) IO vascular access components - ANSWER Less than 24 hour use Leg bone below knee is best Stop when POP Cannot use same bone twice Must have pressure to flow, PUSH HARD 10 mL/kg on IVF bolus Flush with 10 mL after any drug Core Case Shock 1: Hypovolemic (Dehydration) - ANSWER Admin high-flow O2 non-rebreather, re-assess AED, Vitals (cardiac rhythm = sinus tachy) S/sx of hypotensive shock Vascular access, labs, ABGs, chest x-ray Admin IVFs 20 mL/kg bolus, assess Repeat bolus as needed for BP, HR, pulses Admin BP help drug if needed (Dopamine) Epinepherine (increases HR) - ANSWER Bradycardia/Pulseless Arrest 0.01 mg/kg (1:10,000) every 3-5 min