PALS, QUESTIONS WITH CORRECT AND COMPLETE ANSWERS GRADED TO PASS

Initial assessment of a Peds patient includes? - Appearance, work of breathing, and circulation Peds patient with no normal breathing, but a pulse? - Maintain airway through rescue breathing, Oxygen, and apply monitors. If a pulse is 60/min with poor perfusion despite oxygenation and ventilation, what is the next step? - CPR What are the signs of septic shock of a Peds patient? - -Altered mental status -Tachycardia or bradycardia -Fever or hypothermia -Altered perfusion -Hypotension Within the first 10-15 minutes of determining septic shock, what do you need to do? - -ABCs -Place monitors -Establish IV/IO access -Fluid boluses: Give 10-20mL/kg isotonic crystalloid boluses. 10mL/kg for neonates. Within the first 1 hour of determining septic shock, what do you do? - -Blood cultures & additional labs -Broad spectrum antibiotics -Monitor fluid boluses. Repeat boluses as needed to treat shock. Stop if rales, respiratory distress, or hepatomegaly develops What are the goals of treatment for septic shock? - -Improve mental status -Normalization of heart rate & temp -Adequate B/p -Improved perfusion During septic shock, if you gave 40-60mL/kg of total fluid or their is evidence of fluid overload, what is your next step? - - NO: Consider critical care consultation - YES: Obtain critical care consult & initiate titration of epinephrine or norepinephrine. -- Central venous access for monitoring -- Consider stress-dose hydrocortisone if hemodynamics remain inadequate. You find a pediatric patient in Cardiac Arrest. What is the next step? - Initiate CPR and find an AED or monitor. CARDIAC ARREST PATIENT: What are the two shockable rhythms? - Pulsless Ventricular Tachycardia & Ventricular Fibrillation CARDIAC ARREST PATIENT: After you shock the patient with pVT or VF, what is your next step if no ROSC? - CPR for 2 minutes and get IV/IO access CARDIAC ARREST PATIENT: After shocking the patient one time and performing CPR for 2 minutes/IV IO access, what is the next step if there is a shockable rhythm and if their is not a shockable rhythm? - If a shockable rhythm, shock again and resume CPR for 2 minutes. During this time Give Epinephrine every 3-5 minutes and consider an advanced airway. CARDIAC ARREST PATIENT: How much Epi per dose? - 0.01mg/kg (max 1mg) CARDIAC ARREST PATIENT: After the second round of CPR 2 minutes later and a dose of Epinephrine, the rhythm is shockable again. After the shock, what is the next step? - -CPR for 2 minutes and give Amiodarone or lidocaine. -Treat reversible causes. -Continue giving Epi every 3-5 minutes. CARDIAC ARREST PATIENT: What is the dose of Amiodarone? - 5mg/kg (max) CARDIAC ARREST PATIENT: What are the non-shockable rhythms? - Asystole & Pulseless Electrical Activity (PEA) CARDIAC ARREST PATIENT: If no shockable rhythm, what is the next step in care? - -If IV access, give Epinephrine ASAP 0.01mg/kg -CPR for 2 minutes -Gain IV/IO access -Epi every 3-5 minutes -Consider advanced airway and capnography CARDIAC ARREST PATIENT: It has been the first round of CPR after 2 minutes and you gave your first dose of EPI, what is the next step? - -No shockable rhythm do CPR for another 2 minutes and treat reversible causes. -If a shockable rhythm, you shock and move to the CPR 2 minutes & Amiodarone algorhythm. What is the dose of Dextrose (glucose) for children? - 0.5-1g/kg IV/IO (D25W 2-4mL/kg; D10W 5-10mL/kg) What is the dose of bolus fluids for children? - 10-20mL/kg (10mL/kg for neonates) over 10-20 minutes Rate of infant and child rescue breathing. - 1 breath every 2-3 seconds No breathing and a HR 60bpm what is the next step? - CPR For an infant or child, what is the cycle of CPR for one rescuer? - 30 compressions and 2 breaths For an infant or child, what is the cycle of CPR for two rescuer? - 15 compressions and 2 breaths What is the universal rate for compressions in cardiac arrest patients? - 100-120/min For an infant how far do you want to go with your compressions? - 1 1/2 inches (4cm) After 5 cycles or 2 minutes of CPR, if you are alone and the emergency response system has not been activated, what is the next step? - Leave the infant or take the infant with you and activate the system and get an AED. Where do you apply the AED on an infant or child? - Middle of chest and middle of back. For a child how far do you want to go with your compressions? - 2 inches (5cm) For 2 rescuer CPR what is the technique for infants? - 2 thumb encircling hands in the center of the chest, just below the nipple line. For 1 rescuer CPR what is the technique for infants? - 2 fingers or 2 thumbs in the chest, just below the nipple line. When monitoring the end-tidal CO2 (PETCO2), what is the goal when doing compressions? - Over 10-15mm Hg Above what end-tidal CO2 (PETCO2), is consistent with ROSC? - 40mm Hg