Pals

Front 1

croup

Back 1

1. nebulized epinephrine
2. dexamethasone

(if intubating use a half size smaller than age predicted norm)

Front 2

Procainamide is used for

Back 2

Expert consultation required
SVT (use if resistant to adenosine), V tach (Only WITH pulses)
prolongs QT, don't give with Amiodarone

Slow infusion 15 mg/kg

Front 3

Amiodarone is used for

Back 3

Expert consultation required
V Tach With pulse
SVT, V Fib, pulseless V Tach
Causes hypotension, prolongs QT- don't give with procainamide
Slow infusion 5mg/kg if using for v tach with pulse, give 5 mg/kg bolus for pulseless v tach or VF

Front 4

Dexamethasone

Back 4

Croup, asthma

Front 5

Methylprednisone

Back 5

Anaphylactic shock
Asthma

Front 6

Atropine

Back 6

Used for primary bradycardia (vagal), blocks caused by drugs or intrinsic conduction defect
Not for secondary bradycardia (hypoxia or acidosis)
May use to prevent bradycardia during intubation

Front 7

Adenosine

Back 7

Drug of choice for SVT (av node reentry)
Give fast

Front 8

Child is adequately perfused with V tach

Treatment?

Back 8

Procainamide 15 mg per kg slow

OR

Amiodarone 5 mg per kg slow

May consider synchronized cardioversion

Front 9

Child is poorly perfused with V tach

Treatment?

Back 9

Synchronized cardioversion first if there is hypotension or signs of shock

Otherwise;
Procainamide 15 mg per kg slow

OR

Amiodarone 5 mg per kg slow

May consider synchronized cardioversion

Front 10

Child is adequately perfused with SVT

Treatment?

Back 10

Vagal twice then Adenosine 0.1 mg per kg rapid
Increase to 0.2 mg per kg if necessary

Stop

Front 11

Child is poorly perfused with SVT

Treatment?

Back 11

May try Vagal quickly then Adenosine 0.1 mg per kg rapid
Increase to 0.2 mg per kg if necessary
Synchronized cardioversion if adenosine is ineffective

Front 12

Causes of nonhemorrhagic hypovolemic shock
Treatment for same

Back 12

Gastrointestinal, DKA (urinary), capillary leak ( burns or peritonitis)
Rapid fluid resuscitatation with O2/ ventilatory support
Correct metabolic derangement

Front 13

Treatment for normotensive septic shock?

And if svo2 <70%.......

Back 13

dopamine then if svo2 <70%.......
transfuse Hgb to >10
additional fluid bolus
Milrinone OR nitroprusside
consider dobutamine

Front 14

Treatment for hypotensive vasodilated warm septic shock (svo2 > 70%)

Back 14

norepinephrine
consider adding vasopressin

Front 15

Treatment for hypotensive vasoconstricted cold septic shock (svo2 < 70%)

Back 15

epinephrine OR
dobutamine AND norepinephrine

Front 16

for shock AFTER ROSC

3 drugs for hypotensive shock

Back 16

epinephrine
dopamine
norepinephrine

Front 17

for shock AFTER ROSC

4 drugs for normotensive shock

Back 17

epinephrine
dopamine
dobutamine
milrinone

Front 18

things to monitor in all critically ill children

Back 18

Spo2
hypo/hyperglycemia
serum electrolytes / calcium
ABG / VBG (acid/base imbalance, metabolic demand)
Svo2
HR / rhythm
breath sounds
RR / signs if increased WOB
signs of pain / agitation
urine output
signs of venous congestion
peripheral / central pulse quality
BP