PALS Study Guide for Pediatric Emergencies

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Questions and Answers

If the pulse rate on the pulse ox differs from the EKG monitor, what is the O2 saturation reading?

not reliable, the child needs oxygen in spite of possible O2 saturation above 94%

What BP reading in a neonate is considered hypotension?

less than 60 systolic

What airway obstruction is characterized by tachypnea, increased respiratory effort, cough, stridor, and poor air oxygenation?

upper airway obstruction

Typical signs and symptoms of upper airway obstruction occur predominantly during which phase of respiratory cycle?

inspiratory phase Signup and view all the answers

What is characterized as an abnormal breathing pattern that produces inadequate respiratory rate or effort, usually associated with neurological disorders?

disordered control of breathing Signup and view all the answers

Increased work of breathing and tachypnea in a toddler may be classified as what?

respiratory distress rather than failure Signup and view all the answers

Moderate stridor and retractions along with a seal bark cough in a toddler may be best managed by administration of what?

nebulizer epi Signup and view all the answers

The child who presents with severe respiratory distress and signs of anaphylaxis must be treated promptly with what?

IM/IV epi/corticosteroids as well as nebulized albuterol. Signup and view all the answers

What is defined as a critical condition resulting from inadequate tissue delivery of O2 and nutrients to meet tissue metabolic demands?

shock Signup and view all the answers

Infants have tiny hearts and increase their cardiac output primarily by what?

increasing heart rate Signup and view all the answers

In order to recognize shock early, the healthcare provider must recognize signs of compensated shock such as what?

tachycardia, increased stroke volume, and increased cardiac contractility Signup and view all the answers

Increased systemic vascular resistance or vasoconstriction may be recognized clinically in a child who has what symptoms?

cold extremities, poorly palpable peripheral pulses, delayed capillary refill time Signup and view all the answers

Stroke volume may be maintained in early shock by increased what?

increased contraction and venoconstriction which increases venous return to the heart, thus increasing preload. Signup and view all the answers

Anxiety, tachycardia, delayed capillary refill time, and a normal BP in a young child indicate what type of shock?

compensated shock Signup and view all the answers

Elevated temperature, lethargy, tachycardia, and tachypnea may be associated with what type of shock?

distributive shock Signup and view all the answers

What does a child who is febrile, lethargic, tachycardic, apneic, hypotensive, with a delayed capillary refill time need?

immediate IV/IO access and administration of fluid bolus such as normal saline or ringers lactate at 20 ml/kg over 5-10 minutes. Signup and view all the answers

What is the appropriate fluid bolus for shock resuscitation in a child with a normal heart?

20 ml/kg of isotonic crystalloid (normal saline) Signup and view all the answers

In a child with serious signs and symptoms of hypovolemic shock, the quickest and best way to establish vascular access is via the what route?

IO route Signup and view all the answers

What is the correct intervention when a child presents with severe respiratory distress, low oxygen saturation, absent breath sounds on the right side of the chest, and signs of obstructive shock?

needle decompression of the right chest Signup and view all the answers

When an infant's heart rate falls to 70 bpm when suctioned, what must the healthcare provider administer?

oxygen and ensure adequate oxygenation Signup and view all the answers

What is the correct treatment for a child who suddenly develops a heart rate of 240 bpm and has palpitations and dizziness?

vagal maneuvers Signup and view all the answers

What is the correct way to perform vagal maneuvers on an infant with SVT and adequate perfusion?

ice on the face over the upper half Signup and view all the answers

The correct intervention to perform when a child presents with lethargy, SVT, and signs and symptoms of inadequate perfusion is what?

cardioversion at 0.5-1 J/kg Signup and view all the answers

When caring for an infant who is unresponsive and not breathing, what is the maximum amount of time you should spend palpating for a pulse?

less than 10 seconds Signup and view all the answers

Where is the appropriate place to palpate a pulse in an infant?

brachial Signup and view all the answers

An unresponsive child presents with a rhythm that resembles sinus bradycardia but is not accompanied by a pulse. What must be treated?

pulseless electrical activity Signup and view all the answers

When a child is found in cardiac arrest, high-quality CPR is initiated. When a cardiac monitor reveals ventricular fibrillation, what is the appropriate intervention?

defib at a rate of 2 J/kg Signup and view all the answers

An infant presents with CPR in progress. The cardiac monitor shows an organized rhythm with a rate of 70 without a pulse. What is the correct intervention?

administer epi Signup and view all the answers

What is the most important drug to administer to a child in cardiac arrest while CPR is being performed?

epi at a dose of 0.01 mg/kg Signup and view all the answers

In a child who achieves ROSC, what is the appropriate target range for oxygen saturation?

94 to 99% Signup and view all the answers

What type of shock is caused by inadequate blood volume?

hypovolemic shock Signup and view all the answers

What type of shock is caused by inappropriate distribution of blood volume or flow?

distributive shock Signup and view all the answers

What type of shock is caused by impaired cardiac contractility?

cardiogenic shock Signup and view all the answers

What type of shock is caused by obstructed blood flow?

obstructive shock Signup and view all the answers

What presents when the BP is normal but there are other signs of inadequate tissue perfusion?

compensated shock Signup and view all the answers

What is a key sign of hypotensive shock?

decreased level of consciousness Signup and view all the answers

What is a late sign in most shocks?

hypotension Signup and view all the answers

What is the hypotension formula for kids?

70 mmHg + (child's age in years * 2) mmHg Signup and view all the answers

What is key to treating shock?

fluid bolus of 20 ml/kg but if a known cardiac child then 10 ml/kg Signup and view all the answers

If nonhemorrhagic hypovolemic shock occurs, what is the treatment?

20 ml/kg NS/LR bolus, repeat as needed. Consider colloid after 3rd NS/LR bolus. Signup and view all the answers

What is the treatment for hemorrhagic hypovolemic shock?

control external bleeding; 20 ml/kg NS/LR bolus repeated 2 or 3 times as needed; transfuse PRBCs as indicated. Signup and view all the answers

What is the treatment for anaphylactic distributive shock?

IM epi, antihistamines (Benadryl-Diphenhydramine), corticosteroids, epi infusion, and albuterol. Signup and view all the answers

What is the treatment for neurogenic distributive shock?

20 ml/kg NS/LR bolus, repeat as needed; vasopressor. Signup and view all the answers

What is the treatment for cardiogenic shock?

5 to 10 ml/kg NS/LR bolus, repeat as needed; vasoactive infusion; consider expert consultation. Signup and view all the answers

What is the treatment for obstructive shock - ductal dependent?

prostaglandin E; expert consultation. Signup and view all the answers

What is the treatment for tension pneumothorax - obstructive shock?

needle decompression; tube thoracotomy. Signup and view all the answers

What is the treatment for cardiac tamponade - obstructive shock?

pericardiocentesis; 20 ml/kg NS/LR bolus. Signup and view all the answers

What is the treatment for pulmonary embolism - obstructive shock?

20 ml/kg NS/LR bolus, repeat as needed; consider thrombolytics, anticoagulants; expert consultation. Signup and view all the answers

What does the primary assessment ABCDE stand for?

Airway, Breathing, Circulation, Disability (LOC or alertness), and Exposure (Temperature) Signup and view all the answers

Study Notes

Pulse Oximetry and EKG Monitoring

Discrepancy between pulse oximeter and EKG pulse rates indicates unreliable O2 saturation; children may require oxygen even with readings above 94%.

Blood Pressure in Neonates

Neonates are considered hypotensive with systolic blood pressure below 60 mmHg.

Upper Airway Obstruction

Characterized by tachypnea, increased respiratory effort, cough, stridor, and inadequate oxygenation; mainly affects the inspiratory phase of respiration.

Disordered Control of Breathing

Inadequate respiratory effort often linked to neurological issues such as brain tumors, seizures, and hydrocephalus.

Respiratory Distress in Toddlers

Increased work of breathing with tachypnea in toddlers is classified as respiratory distress, not failure.

Nebulized Epinephrine

Administered for moderate stridor, retractions, and seal bark cough in toddlers.

Anaphylaxis Management

Severe respiratory distress with signs of anaphylaxis requires immediate treatment with IM/IV epinephrine, corticosteroids, and nebulized albuterol.

Shock Definition

Shock is a critical condition caused by inadequate delivery of O2 and nutrients, failing to meet metabolic needs.

Pediatric Cardiac Function

Infants primarily increase cardiac output via heart rate.

Signs of Compensated Shock

Early recognition requires monitoring for tachycardia, increased stroke volume, and heightened cardiac contractility.

Clinical Indicators of Poor Perfusion

Increased systemic vascular resistance manifesting as cold extremities, weak pulses, and prolonged capillary refill suggests decreased perfusion.

Stroke Volume in Shock

May be preserved by enhanced contraction and venoconstriction, thereby improving venous return to the heart.

Compensated Shock Symptoms

Anxiety, tachycardia, delayed capillary refill, and normal blood pressure indicate compensated shock.

Signs of Distributive Shock

Elevated temperature, lethargy, tachycardia, and tachypnea associated with distributive shock.

Fluid Resuscitation in Shock

Immediate fluid bolus of 20 ml/kg normal saline or Ringer's Lactate is critical for fluid resuscitation.

Vascular Access in Hypovolemic Shock

In cases of severe hypovolemic shock, the quickest vascular access is via the intraosseous (IO) route.

Interventions for Severe Respiratory Distress

Needle decompression of the right chest indicated for absent breath sounds and signs of obstructive shock.

Responding to Bradycardia in Infants

In the event of an infant's heart rate dropping to 70 bpm due to suctioning, administer oxygen promptly.

SVT Treatment

Sudden onset of 240 bpm heart rate in a child should be addressed with vagal maneuvers.

Performing Vagal Maneuvers

For infants, apply ice to the face over the upper half for effective vagal maneuvers.

Cardioversion in Pediatric SVT

In cases of lethargy and SVT with inadequate perfusion, cardioversion should be administered at 0.5-1 J/kg.

Pulse Palpation Duration

Maximum time for palpating an unresponsive infant's pulse should be less than 10 seconds, preferably via the brachial site.

Pulseless Electrical Activity Protocol

Unresponsive children with sinus bradycardia-like rhythms not accompanied by a pulse should be treated with the pulseless electrical activity algorithm.

Defibrillation in Cardiac Arrest

For ventricular fibrillation in cardiac arrest, deliver defibrillation at a rate of 2 J/kg.

Epi Administration During CPR

Administer epinephrine to the infant showing organized rhythm (rate of 70) but lacking a pulse.

Cardiac Arrest Protocol

The most critical drug during CPR for a child is epinephrine at a dose of 0.01 mg/kg.

Oxygen Saturation Targets

For children achieving return of spontaneous circulation (ROSC), maintain oxygen saturation levels between 94% and 99%.

Types of Shock

Hypovolemic shock results from inadequate blood volume.
Distributive shock arises from abnormal distribution of blood volume.
Cardiogenic shock is due to impaired cardiac contractility.
Obstructive shock occurs from blocked blood flow.

Signs and Symptoms of Shock

Compensated shock can present normal BP but exhibit other signs of poor tissue perfusion.
Key hypotensive shock indicator: decreased level of consciousness.
Late sign of shock: hypotension.

Hypotension Formula

Pediatric hypotension calculated as 70 mmHg + (child’s age in years * 2) mmHg.

Treatment for Shock

Essential treatment is fluid bolus of 20 ml/kg; for known cardiac conditions, limit to 10 ml/kg.

Nonhemorrhagic and Hemorrhagic Shock Treatment

Nonhemorrhagic: administer 20 ml/kg normal saline or Ringer’s lactate, repeating as necessary.
Hemorrhagic: control bleeding, administer equivalent fluids, and transfuse PRBCs as needed.

Anaphylactic Shock Treatment

Treat with IM epinephrine, antihistamines, corticosteroids, albuterol, and possibly epi infusion.

Neurogenic Shock Management

Administer 20 ml/kg normal saline or Ringer's lactate and consider vasopressors.

Cardiogenic Shock Strategy

Use 5 to 10 ml/kg normal saline or Ringer's lactate with possible vasoactive infusion.

Obstructive Shock Treatments

Ductal dependent: use prostaglandin E and seek expert consultation.
Tension pneumothorax: needle decompression followed by thoracotomy.
Cardiac tamponade: pericardiocentesis and fluid bolus administration.

Pulmonary Embolism Management

Administer fluid bolus of 20 ml/kg normal saline or Ringer's lactate and consult for thrombolytics or anticoagulants.

Primary Assessment (ABCDE)

ABCDE stands for Airway, Breathing, Circulation, Disability (LOC or alertness), and Exposure (Temperature).

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Description

Explore essential concepts in Pediatric Advanced Life Support (PALS) with this study guide. The flashcards cover critical topics such as pulse oximetry reliability, hypotension in neonates, and airway obstruction signs. Ideal for healthcare professionals preparing for PALS certification.