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?
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What is characterized as an abnormal breathing pattern that produces inadequate respiratory rate or effort, usually associated with neurological disorders?
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Increased work of breathing and tachypnea in a toddler may be classified as what?
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Moderate stridor and retractions along with a seal bark cough in a toddler may be best managed by administration of what?
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The child who presents with severe respiratory distress and signs of anaphylaxis must be treated promptly with what?
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What is defined as a critical condition resulting from inadequate tissue delivery of O2 and nutrients to meet tissue metabolic demands?
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Infants have tiny hearts and increase their cardiac output primarily by what?
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In order to recognize shock early, the healthcare provider must recognize signs of compensated shock such as what?
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Increased systemic vascular resistance or vasoconstriction may be recognized clinically in a child who has what symptoms?
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Stroke volume may be maintained in early shock by increased what?
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Anxiety, tachycardia, delayed capillary refill time, and a normal BP in a young child indicate what type of shock?
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Elevated temperature, lethargy, tachycardia, and tachypnea may be associated with what type of shock?
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What does a child who is febrile, lethargic, tachycardic, apneic, hypotensive, with a delayed capillary refill time need?
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What is the appropriate fluid bolus for shock resuscitation in a child with a normal heart?
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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?
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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?
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When an infant's heart rate falls to 70 bpm when suctioned, what must the healthcare provider administer?
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What is the correct treatment for a child who suddenly develops a heart rate of 240 bpm and has palpitations and dizziness?
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What is the correct way to perform vagal maneuvers on an infant with SVT and adequate perfusion?
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The correct intervention to perform when a child presents with lethargy, SVT, and signs and symptoms of inadequate perfusion is what?
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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?
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Where is the appropriate place to palpate a pulse in an infant?
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An unresponsive child presents with a rhythm that resembles sinus bradycardia but is not accompanied by a pulse. What must be treated?
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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?
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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?
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What is the most important drug to administer to a child in cardiac arrest while CPR is being performed?
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In a child who achieves ROSC, what is the appropriate target range for oxygen saturation?
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What type of shock is caused by inadequate blood volume?
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What type of shock is caused by inappropriate distribution of blood volume or flow?
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What type of shock is caused by impaired cardiac contractility?
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What type of shock is caused by obstructed blood flow?
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What presents when the BP is normal but there are other signs of inadequate tissue perfusion?
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What is a key sign of hypotensive shock?
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What is a late sign in most shocks?
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What is the hypotension formula for kids?
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What is key to treating shock?
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If nonhemorrhagic hypovolemic shock occurs, what is the treatment?
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What is the treatment for hemorrhagic hypovolemic shock?
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What is the treatment for anaphylactic distributive shock?
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What is the treatment for neurogenic distributive shock?
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What is the treatment for cardiogenic shock?
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What is the treatment for obstructive shock - ductal dependent?
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What is the treatment for tension pneumothorax - obstructive shock?
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What is the treatment for cardiac tamponade - obstructive shock?
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What is the treatment for pulmonary embolism - obstructive shock?
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What does the primary assessment ABCDE stand for?
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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.