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112 Cards in this Set
- Front
- Back
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Resp rate for: |
infant = 30-60
toddler = 24-40 preschooler = 22-34 school-age = 18-30 |
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Heart rate sleeping/awake for:
< 3months 3months-2years 2-10years 10+ years |
< 3months = 80/205
3months-2years = 75/190 2-10years = 60/140 10+ years = 50/100 |
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Hypotension by SBP for:
< 1month 1month-1year 1-10years 10+years |
< 1month = < 60
1month-1year = < 70 1-10years = < 70 + (2 x yo) 10+years = < 90 |
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decompensated shock = ?
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hypotension + signs of poor perfusion
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How many H's are there for possible cause of dysrthmias?
and What are they? |
6 H's
1.hypoxia 2.hypovolemia 3.hypothermia 4.hypoglycemia 5.hypo/hyperkalemia 6.hydrogen ions (acidosis) |
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How many T's are there for possible cause of dysrthmias?
and What are they? |
5 T's
1.Tamponade 2.Tension pneumothorax 3.Toxins (poisons, drugs) 4.Thrombosis (coronary = AMI; pulmonary = PE) 5.Trauma |
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Give the highpoints of the rapid cardiopulmonary assessment for an infant or child?
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1.general appearance
2.ABC's 3.perfusion 4.BP & UOP 5.physiological status 6.treatment algorithm |
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Important points for general appearance.
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1. level of consciousness - a.awake, b.responds to verbal, c.responds to pain, d.unresponsive
2.overall color - a.good, b.bad 3.muscle tone - a.good, b.floppy 3.mus |
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Cardiopulmonary assessment: important point about A of ABC's.
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A refers to airway
open and hold with head tilt-chin lift |
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Cardiopulmonary assessment: important point(s) about B of ABC's. (6)
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B = breathing
1.present/absent 2.rate: normal/too slow/too fast 3.pattern: regular/irregular/gasping 4.depth: normal/shallow/deep 5.nasal flaring/sternal retractions/accessory muscle use 6.stridor/grunting/wheezing |
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Cardiopulmonary assessment: important point(s) about C of ABC's. (4)
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C = circulation
1.central pulse: present/absent 2.rate: normal/too slow/too fast 3.rhythm: regular/irregular 4.QRS: narrow/wide |
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Cardiopulmonary assessment: important point(s) about perfusion (4)
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1.central pulse vs peripheral pulse: equal/unequal
2.skin color, pattern, temp: normal/abnormal 3.capillary refill: normal/abnormal (>2seconds) 4.liver edge palpated: at costal margin (normal or dry)/below costal margin (fluid overload) |
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Cardiopulmonary assessment: important point(s) about SBP.
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acceptable for age - normal/compensated
or hypotensive |
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Cardiopulmonary assessment: important point(s) about UOP.
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adequate for age: infants & children (1-2cc/kg/hr)/ adolescents (30ml/hr)
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Cardiopulmonary assessment: important point(s) about physiologic status.
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1.stable/unstable
2.respiratory distress/failure 3.compensated shock/decompensated shock |
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what does stable physiologic status mean?
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- needs little support, reassess frequently
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what does unstable physiologic status mean?
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- needs immediate support and intervention
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what does physiologic status resp distress mean?
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- increased rate; effort & noice of breathing; requires much energy
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what does physiologic status resp failure mean?
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- slow or absent rate; weak or no effort; very quiet
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what does physiologic status compensated shock mean?
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1.SBP acceptable
2.perfusion poor a.central vs peripheral pulse strength is unequal b.peripheral color poor d.skin is cool f.capillary refill prolonged |
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what does physiologic status decompensated shock mean?
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1.systolic hypotension
2.poor or absent pulses 3.poor color 4.weak compensatory effort |
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Cardiopulmonary assessment: what are the treatment algorithms?
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1.bradycardia w/ pulse
2.tachycardia w/ adeq perfusion 3.tachycardia w/ poor perfusion 4.pulseless arrest a.VF/PVt & asystole/PEA |
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how can you estimate endotracheal tube for infants and children?
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uncuffed = (age in yrs/4) + 4
cuffed = (age in yrs/4) + 3 |
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2 methods for confirming tube placement.
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clinical assessment
devices |
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clinical assessment for tube placement
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1.bilateral chest rise/fall
2.listen for breath sounds over stomach & 4 lung fields (left & right anterior and midaxillary) 3.water vaopr in tube (helpful but not definitive) |
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devices to check tube placement
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end-tidal CO2 detector
esophageal detector |
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what does ETD stand for?
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end-tidal CO2 detector
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weight for ETD
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> 2 kg
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how to use ETD
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attach b/t ET and Ambu bag
give 6 breaths w/ ambu bag |
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what changes color in ETD? what do color changes mean?
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litmus paper in center of device
original color during inhalation from O2 inhaled into trachea color change during exhalation from CO2 exhaled from trachea |
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what does it mean when you get original color with exhalation on a ETD?
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-litmus paper wet so replace ETD
-tube not in trachea so remove ET -cardiac output low during CPR |
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when can you use esophageal detector?
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weight > 20 kg
perfusing rhythm |
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what does the esophageal detector resemble?
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turkey baster
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how do you use esophageal detector? and what do findings mean?
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compress bulb and place ate end of ET
bulb inflates quickly = tube in trachea bulb inflates poorly = tube in esophagus |
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when are esophageal detectors not recommended for use?
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during cardiac arrest
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when sudden deterioration of an intubated patient occurs, immdiately check?
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DOPE
1.Displacement a.tube not in trachea b.tube moved down into bronchus (right mainstem most common) 2.Obstruction a.secretions b.kinking of tube 3.Pneumothorax a.chest trauma b.barotrauma c.non-compliant lung disease 4.Equipment a.check oxygen source b.check Ambu bag c.check ventilator |
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Cardiac arrest drug(s)
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epinephrine
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Antiarrhythmic drug(s)
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amiodarone
lidocaine magnesium procainamide |
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PALS Bradycardia drug(s)
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epinephrine
atropine |
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PALS Tachycardia drug(s)
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adenosine
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PALS Vasopressor drug(s)
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dobutamine
dopamine |
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PALS miscellaneous drug(s)
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glucose
naloxone sodium bicarbonate |
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Epinephrine drug class
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catecholamine
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Epinephrine MOA
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increases:
-HR -peripheral vascular resistance -cardiac output during CPR, increases -myocardial BF -cerebral BF |
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Epinephrine IV/IO dose
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0.01 mg/kg (0.1 ml/kg) of 1:10,000 solution q3-5min
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what routes can epinephrine be given?
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IV
IO ET |
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Epinephrine ET dose
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0.1 mg/kg (0.1 ml/kg) of 1:1,000 solution q3-5 min
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Amiodarone drug class and indications
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Class: atrial and ventricular antiarrhythmic
Indications: a.VF/PVT b.perfusing VT c.perfusing SVT |
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Amiodarone MOA
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1.slows AV node and ventricular conduction
2.increases QT interval 3.vasodilation possible |
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amiodarone routes
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IV
IO |
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Amiodarone route & dose for a.VF/PVT
b.perfusing VT c.perfusing SVT d.max |
a.IV/IO 5mg/kg bolus
b.IV/IO 5mg/kg over 20-60 min c.IV/IO 5mg/kg over 20-60 min d.15mg per 24 hrs |
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Amiodarone side effects
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hypotension
torsades half-life 40 days |
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ventricular antiarrhythmic to consider when amiodarone unavailable
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lidocaine
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lidocaine class & indications
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ventricular antiarrhythmic (considered when amiodarone unavailable)
1.VF/PVT 2.perfusing VT |
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lidocaine MOA
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decreases ventricular automaticity, conduction, and repolarization
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lidocaine routes and doses:
a.VF/PVT b.Perfusing VT c.infusion |
a.IV/IO: 1mg/kg bolus q5-15m
ET: 2-3 mg/kg b.IV/IO: same c.20-50mcg/kg/min |
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which PALS drugs listed as possible infusion?
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lidocaine
dobutamine dopamine |
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lidocaine caution
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neurotoxicity & seizures
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Magnesium class & indications (related to PALS)
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1.ventricular antiarrhythmic for Torsade
2.hypomagnesemia |
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Magnesium MOA
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shortens ventricular depolarization & repolarization (decreases QT interval)
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Magnesium routes & doses? and Max dose?
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IV/IO: 25-50 mg/kg over 10-20min; give faster in Torsades
max: 2gm |
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magnesium side effects?
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hypotension
bradycardia |
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procainamide class & indications
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atrial and ventricular antiarrhythmic for perfusing rhythms
1.perfusing recurrent VT 2.recurrent SVT |
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procainamide MOA
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1.slows conduction speed
2.prolongs ventricular de- adn repolarization (increases QT interval) |
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procainamide route & dose for:
a.perfusing recurrent VT b.recurrent SVT |
a.IV/IO: 15mg/kg infused over 30-60 min
b.IV/IO: same |
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procainamide side effects
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1.hypotension
2.use w/ extreme caution w/ amiodarone b/c can cause AV block or Torsades |
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which drug is the drug of chose for pediatric bradycardia AFTER oxygen & ventilation?
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epinephrine
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epinephrine dose for bradycardia?
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sames as for arrest
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atropine class & indication
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vagolytic
bradycardia (after O2, ventilation, & epi) |
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which drug should be considered after O2, ventilation, and epi?
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atropine
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atropine MOA
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blocks vagal input therefore increases SA node activity and improves AV conduction
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atropine routes, doses, and maxes
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IV/IO: 0.02mg/kg (may double amt for 2nd dose)
ET: 0.03mg/kg child max: 1mg adolescent max: 2mg |
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what PALS drugs can be given ET?
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epi
lidocaine atropine naloxene |
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atropine side effects
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worsened bradycardia with dose < 0.1 mg
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adenosine indication
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symtomatic SVT
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what is the drug of choice for symptomatic SVT?
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adenosine
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adenosine MOA
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blocks AV node conduction for a few seconds to interrupt AV node re-entry
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adenosine routes & doses
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IV/IO:
1st dose 0.1mg/kg (max 6mg) 2nd dose 0.2mg/kg (max 12mg) |
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adenosine side effects
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1.transient AV block or asystole
2.very short half-life |
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dobutamine class & indications
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synthetic catecholamine
1.decreases cardiac contractility 2.shock |
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dobutamine MOA
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1.increases force of contraction & HR
2.mild peripheral dilation 3.shock treatment |
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dobutamine route & doses
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IV/IO: 2-20mcg/kg/min infusion
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dobutamine side effects
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tachycardia
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dopamine class & indications
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catecholamine
1.hypotension 2.shock 3.increases cardiac contract & CO |
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what doses low dose dopamine do?
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1.increases force of contraction
2.increased CO |
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what does moderate dose dopamine do?
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1.increased peripheral vascular resistance
2.increased BP 3.increased CO |
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what does high dose dopamine do?
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1.higher increased peripheral vascular resistance
2.higher increased BP 3.increased cardiac work & O2 demand |
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dopamine route & dose
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IV/IO: 2-20 mcg/kg/min
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dopamine side effect
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tachycardia
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glucose MOA
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1.increases blood glucose in hypoglycemia
2.prevents hypoglycemia when insulin used to treat hyperkalemia |
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glucose route & dose
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IV/IO:
0.5-1g/kg = 2-4 ml/kg D25 -or- 5-10ml/kg D10 -or- 10-20ml/kg D5 |
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glucose caution
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max recommendated concentration should not exceed D25%; hyperglycemia may worsen neuro outcome
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naloxone class & indication
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opiate antagonist
reverses resp depression effects of narcotics |
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naloxone routes & doses
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<5yr or 20kg, IV/IO: 0.1mg/kg
>5yr or 20kg, IV/IO: upto 2mg |
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naloxone caution
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1.half-life usually less that half-life of narcotic, so repeat dose is often required
2.ET dose can be given but NOT preferred |
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what other routes can naloxone be given?
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IM
SQ |
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sodium bicarbonate class & indication
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pH buffer
1.prolonged arrest 2.hyperkalemia 3.tricyclic overdose |
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sodium bicarbonate MOA
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increases blood pH to correct metabolic acidosis
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sodium bicarbonate route & dose
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IV/IO: 1mEq/kg slow bolus; give ONLY after effective ventilation is established
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sodium bicarbonate caution
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causes other drugs to precipitate so flush IV tubing before and after
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what is important to note with ET drug administration?
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-distribution is unpredictable
-use this route when there is no IV/IO access -give down ET and flush with 5ml NS, followed w/ 5 ventilations to disperse drug |
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Child CPR sequence MAIN steps
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1.tap and ask: are you ok?
2.open airway w/ head tilt/chin lift 3.check carotid or femoral pulse for no more than 10 seconds 4.use AED when it arrives |
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explain child CPR step 1
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Tap and ask: Are you ok?
a.send someone to call 911 and bring an AED |
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how many main steps to child CPR?
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4
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who are AEDs approved for?
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children 1-8 yrs old
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explain child CPR step 2
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open airway w/ head tilt/chin lift
a.assess breathing b.if inadeq: give 2 breaths over 1 second each c.each breath should make chest rise |
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explain child CPR step 3
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check carotid or femoral pulse for no more than 10 seconds
a.if pulse is felt, give 12-20 breaths per minute (one every 3-5 seconds) b.if pulse NOT DEFINITELY FELT, give 30 compressions in center of chest, b/t nipples c. compression 1/3-1/2 depth of chest wall with one or two hands d.one cycle of CPR in 30 compressions & 2 breaths e.give 5 cycles of CPR w/ minimum interruptions (about 2mins) |
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explain child CPR step 4
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use AED when it arrives
a.after 5 cycles of CPR, turn on AED and follow voice prompts b.use child pads if age 1-8 yrs c.after AED shocks or says "no shock advised", resume CPR d.after 5 cycles of CPR, check rhythm/pulse |
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whats different with basic airway mngmt w/ 2 rescuer child CPR?
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a.one rescuer gives 15 compressions and pauses
b.other rescuer gives 2 breaths during pause c.one cycle of CPR is 15 compressions and 2 breaths (over 1 second each) d.rescuers change "compressor" role after every 5 cycles of CPR |
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whats different with advanced airway mgmt w/ 2 rescuer child CPR?
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a.give 100 continuous compressions per minute
b.give 8-10 breaths per minute (1 every 6-8 seconds) |
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what makes infant CPR different from child CPR?
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1.compress sternum with 2 fingers
2.no recommendation for or against AED in infants under 1 years old |
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what makes infant 2-rescuer CPR different from child 2-rescuer CPR?
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1.2 thumb-encircling hands technique
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