-
3 parts of initial assessment?
-
Actions if unresponsive & not breathing/only gasping?
shout for help/activate emergency response then check for a pulse
- with pulse: give breaths
- without a pulse or pulse <60: CPR
-
Evaluation of a child with no life-threatening problem?
primary assessment: ABCDE
secondary assessment: focused medical history & physical exam
diagnostic tests
assess scene for danger
-
Primary assessment?
- ABCDE
- Airway
- Breathing
- Circulation
- Disability
- Exposure
get VS, etc
-
When to do heimlich?
How?
if child has obstruction and is still awake
<1year old: 5 back slaps & 5 chest thrusts
</= 1 year: abd thrusts
-
Advanced airway interventions?
- 1. ET
- 2. CPAP - continuous positive airway pressure
- 3. trach
- 4. removal of foreign body: direct laryngoscopy
-
Normal RR by age?
- infants: 30 to 60
- toddler (1-3): 24-40
- preschooler: (4-5): 22-34
- school age (6 to 12): 18- 30
- adolescent (13-18): 12 to 16
-
Why may RR be increased?
anything that raises metabolic demands: anxiety, fever
-
RR rate of infants sleeping?
normal for RR to pause for 10-15 seconds during sleep
-
What is often the first sign of respiratory distress in infants?
tachypnea
-
Apnea?
cessation of breathing for 20 seconds or <20 seconds if accompanied by bradycardia, cyanosis, or pallor
-
Head bobbing and seesaw respirations?
sign of deterioration or respiratory distress
head bobbing: tilt head back during I and forward during E
seesaw: chest retracts & abd expands during inspiration & opposite during expiration
-
What may be indicated if child's WOB & other s/s indicate airway obstruction but no stridor or wheezing is heard?
may not be enough airflow to cause sounds
-
Stridor?
usually heard on I: indicates upper airway obstruction that may be critical
-
Grunting?
heard during E usually
caused by partially closed glottis
usually r/t alevolar collapse/lung problems
may indicate respiratory failure or may be response to pain from abd probs
-
Gurgling?
upper airway obstruction with liquid: vomit, blood, secretions, etc
-
Wheezing?
usually during E
usually means lower airway obstruction:; bronchiolitis, asthma, obstruction
-
Crackles?
alveolar fluid
dry crackles: atelectasis
-
Where should pulse ox be placed on a child?
finger, toe, or earlobe
-
When is O2 sat reading inaccurate?
low H&H/RBC's: inadequate HgB but all is saturated: shows normal O2 sat
inadequate circulation: may have adequate O2 but it can't circulate
carbon monoxide: shows high O2 sat
-
Normal heart rates for children?
- newborn - 3 months: 85 - 205
- 3 mo to 2 years: 100 to 190
- 2 yrs to 10 years: 60 - 140
- <10: 60 -100
-
Most common cause of bradycardia in children?
hypoxia
-
Sinus arrhythmia in children?
normal for HR to fluctuate with breathing in children: increase with I and decrease with E
-
Pulsus paradoxis?
2 causes?
fluctuation in pulse voume with respiratory cycle
severe asthma & pericardial tamponade
-
Normal cap refill?
< 2 seconds
-
Pallor of what areas are most clinically significant?
mm, lips, palms, and soles
-
Causes of mottling?
may be hypoxemia, hypovolemia, or shock that cause intense vasoconstriction from irregular supply of O2 blood
-
Central cyanosis?
cyanosis of mm and mouth
usually an emergency
-
Areas to check for cyanosis?
may be more apparent in mm and nail beds, soles of feet, tip of nose, and earlobes
-
Normal child BP?
- neonate (1 day): 60-75/30-45
- neonate (4 days): 65-85/35-55
- infant up to 1 year: 75-95/35-55
- 1 -2 years old: 85-105/45-65
- 7 years: 95-115/55-75
- 15 years: similar to adults
-
s/s of cerebral hypoxia?
- 1. decreased LOC
- 2. loss of muscular tone
- 3. seizures
- 4. pupil dilation
-
2 causes of hypotension r/t shock?
can be caused by decreased circulating volume: blood loss, dehydration
may be caused by vasodilation: septic shock
-
Ominous sign in a child with tachycardia and hypotension?
development of bradycardia
-
Good indicator of positive response to therapy for hypovolemia?
increasing UO
-
Way to rapidly eval cerebral cortex/LOC of a child?
- AVPU pediatric response scale
- Alert: awake, active, responsive
- Voice: responds only to voice calling name or speaking loudly
- Painful: responds only to painful stimulus
- Unresponsive: none
-
What is the most important part of the GCS for pt that are intubated or nonverbal?
motor response
-
GCS for adults and children?
- Eye Opening:
- 4 - spontaneous
- 3 - to speech
- 2 - to pain
- 1 - none
- Best verbal response:
- 5 - oriented
- 4 - confused
- 3 - inappropriate words
- 2 - incomprehensible speech
- 1 - none
- Best motor response
- 6 - obeys
- 5 - localizes
- 4 - withdraws
- 3 - abnormal flexion/flexion in response to pain
- 2 - extensor response/extension in response to pain
- 1 - none
-
GCS for infants?
- Eye Opening:
- 4 - spontaneous
- 3 - to speech
- 2 - to pain
- 1 - none
- Best verbal response
- 5 - coos & babbles
- 4 - irritable, cries
- 3 - cries in response to pain
- 2 - moans in response to pain
- 1 - none
- Best motor response
- 6 - moves spontaneouly & purposely
- 5 - withdraws in response to touch
- 4 - withdraws in response to pain
- 3 - decorticate posturing - abnormal flexion in response to pain
- 2 - decerebrate posturing: abnormal extension in response to pain
- 1 - none
-
Indication with absent pupillary response?
brainstem injury
-
Alterations in pupillary response to light or pupil size?
ocular trauma, ICP
-
Exposure assessment?
remove clothing one item and a time
look for trauma
check temp/temp differences on body
-
Focused Hx assessment?
- SAMPLE
- S - s/s at onset
- A - allergies
- M - meds
- Past medical Hx
- Last meal
- Events leading to current illness & Tx done
-
PaO2?
only indicates O2 dissolved in blood plasma - if HgB is low PaO2 may be normal anyway
-
Lactate concentration test?
high lactate shows hypoxia of tissues and anaerobic respiration
-
H's & T's
- hypotension
- hypo/hyperthermia
- hypoxia
- hypovolemia
- hyper/hypo electrolytes
- hypoglycemia
- tamponade
- toxin
- tension pneumothorax
- thrombosis
- trauma
-
Why can respiratory distress develop more rapidly in children?
higher metabolic rate
-
Compensation for tissue hypoxia?
As it worsens?
late signs?
increased RR and depth
- 1. first sign = tachycardia
- 2. tachypnea
- 3. s/s of resp distress
cyanosis, decreased LOC, bradypnea,/apnea, bradycardia
-
Hypercarbia?
Causes?
high CO2 - inadequate ventilation
. anything that depresses resp system: drugs, CNS probs
-
Critical indicator of inadequate ventilation, hypoxia, and hypercarbia?
decreased/decreasing LOC: even if O2 sat is normal suspect ventilation is inadequate & hypercarbia & resp acidosis may be present
-
4 factors that cause increased WOB?
- 1. increased airway resistance
- 2. decreased lung compliance
- 3. use of accessory muscles
- 4. disordered CNS control of breathing
-
Interventions for respiratory distress/failure?
Airway: positioning open, clear with suctioning, oropharyngeal or nasopharyngeal airway
Breathing: O2 sat, auscultate breath sounds, give O2, sit up, albuterol/epi, vent with bag, ET
Circulation: color, pulses, cap refill, HR & rhythm, BP, IV for fluid therapy & meds as indicated
-
Interventions for upper airway obstruction?
ABC's for respiratory distress/failure AND
- 1. remove foreign body if possible
- 2. suction nose/moouth
- 3. reduce airway swelling with meds
- 4. minimize agitation - can make swelling worse
- 5. may need surgery
- 6. CPAP
-
S/S of croup?
s/s of upper airway obstruction and barking cough
-
Tx of croup?
mild: dexamethasone
mod-sever: humidified O2, NPO, nebulized epi, dexamethasone, heliox
-
Tx of croup with impending respiratory failure?
- 1. O2 with nonrebreather
- 2. bag vent
- 3. dexamethasone
- 4. ET
- 5. surgical airway prn
-
Mgmt of anaphylaxis?
- 1. ABC interventions for resp failure and give IM injection of EPI q10-15 min prn
- 2. albuterol
- 3. ET
- 4. Tx hypotension: trendelenburg, isotonic solution 20mL/kg bolus, may give IV epi, 5. diphenhydramine & an H2 blocker 6. methylprednisolone/corticosteroids
-
Foreign body airway obstruction interventions?
if it is not complete obstructions: do not do anything, get help and let child try to cough it up
- if complete & child is conscious:
- 1year: 5 back slaps & 5 chest thrusts
- over 1 year: abd thrusts
if child becomes unresponsive: start CPR even if pulse is palpable starting with chest compressions - before giveing breaths see if there is a foreign body that can be removed
-
Asthma mgmt?
- 1. humidified O2
- 2. albuterol
- 3. oral/IV corticosteroids
- 4. ipratropium bromide
- 5. IV access & fluids
- 6. Mg sulfate IV slow (15 to 30 min): monitor HR & BP
- 7. DX tests: ABG, CXR
- 8. terbutaline SQ or by cont IV: relaxes and opens airways
- 9. positive airway pressure
- 10. ET
-
Mgmt of infectious pneumonia, chemical pneumonitis, & aspiration pneumonitis?
- 1. Dx tests: ABG, CXR, viral studies, CBC, blood culture, sputum gram stain & culture
- 2. admin ABX
- 3. albuterol for wheezing
- 4. CPAP or ET with vent prn
- 5. reduce metabolic demand by normalizing tem p & reducing WOB
-
Possible causes of cardiogenic pulmonary edema?
- 1. hear problems especially involving L ventricle
- 2. hypoxia
- 3. cardiac-depressant drugs: beta blockers, tricyclic antidepressants, Ca channel blockers
-
Interventions for cardiogenic pulmonary edema?
- 1. ventilatory suppoet: CPAP, PEEP with vent
- 2. diuretics
- 3. inotropic drugs
- 4. reduce metabloic demand by normalizing temp and decreasing WOB
-
AE of too much PEEP>
low BP
-
Cushing's triad?
- 1. irregular breathing or apnea
- 2. increase in mean arterial pressure
- 3. bradycardia
indicates impending brain herniation
-
Interventions for resp failure with increased ICP?
- 1. get neurosurgical consult
- 2. open airway with jaw-thrust
- 3. O2 - may hyperventilate if brain herniation is impending
- 4. poor perfusion or organ dysfunction r/t poor perfusion: IV with isotonic fluids
- 5. hypertonic & osmotic agents
- 6. Tx agitation & pain
- 7. Avoid hyperthermia
-
S/S of increased ICP?
- 1. irregular respirations/apnea
- 2. bradycardia
- 3. hypertension
- 4. unequal or dilated pupils not responsive to light
- 5. decerebrate or decorticate posturing
-
Interventions for poisoning or drug OD?
- 1. call poison control center
- 2. suction airway with vomiting
- 3. admin antidote as indicated
- 4. Dx tests: ABG, ECG, CXR, electrolytes, glucose, serum osmolality, & drug screen
-
Neuromuscular disease?
ineffective cough and secretions build up
-
What may be indicated by increased lung stiffness during ventilation?
airway obstruction, pneumothorax
-
Bag vent?
deliver each breath over 1 second
-
Shock?
metabolic demands of body are not met by BF/oxygenation
may be r/t loss of BV, maldistribution of blood, BV dilation, increased metabolic demands, heart malfunction
-
CO output of infants?
CO = HR x stroke volume (amnt pumped out)
infants need HR to maintain CO b/c they are unable to adjust their stroke volume to compensate for low HR
-
3 factors that effect stroke volume?
- preload - amnt in heart before it pumps
- contractility
- afterload - vascular resistance
-
Compensatory mechanisms as shock develops?
- 1. tachycardia
- 2. vasoconstriction to nonvital organs: decreased UO, decreased extremity perfusion, pulse, cap refill, paleness, etc
- 3. increased contractility
-
Relationship b/t SVR and diastolic pressure?
- increase in SVR = increased diastolic pressure
- decrease in SVR - decrease in diastolic pressure
-
What happens to BP as CO decreases?
will usually be maintained by increased SVR
-
Effect of increased SVR on BP?
narrowed pulse pressure r/t increase SVR = increase diastolic pressure
-
S/S of severe decreased tissue perfusion in shock?
- 1. hypotension
- 2. lactic acidosis
- 3. end-organ dysfunction:" altered mental status, decreased UO
- 4. myocardial dysfunction & cardiac arrest
-
Compensated/decompensated shock?
compensated - systolic BP maintained at normal
decompensated: low systolic BP
children are at risk even with compensated b/c they may have very low CO with high SVR keeping BP normal
-
Checking BP when there is inadequate perfusion of distal areas?
automated BP readings may be inaccurate if taken when there is no distal perfusion: weak pulses, cap refill, pale, etc
-
Key clinical sign of deterioration in hypotensive shock?
decreasing LOC
-
When may hypotension be an early sign of shock?
S/S?
septic shock - sepsis can cause vasodilation & decreased SVR
may still have warm extremities, brisk cap refill, and full peripheral pulses despite hypotension
-
Hypotension formula for children 1 to 10 years of age?
if child's BP is <
70 + (child's age X2)
-
S/S of shock progression?
- 1. s/s of decreasing profusion: decreasing pulse, cap refill, coloring
- 2. decreasing BP
- 3. increasing HR & RR
- 4. decreasing LOC
-
Major cause of hypovolemic shock in children?
diarrhea
-
Causes of hypovolemic shock?
- 1. diarrhea/vomiting
- 2. hemorerhage
- 3. inadequate fluid intake
- 4. osmotic diuresis: DKA
- 5. third-space losses
- 6. large burns
-
Why does tachypnea occur with hypovolemic shock?
metabolic acidosis occurs with hypovolemic shock - hyperventilation compensates for this
-
S/S of hypovolemic shock?
- 1. increased RR & HR
- 2. decreased BP & narrowed pulse pressure
- 3. metabolic acidosis
- 4. weak or absent peripheral pulses
- 5. delayed cap refill
- 6. cool, pale, diaphoretic skin
- 7. changes in LOC
- 8. oliguria
-
3 forms of distributive shock?
septic, neurogenic, anaphylactic
-
Patho of distributive shock?
vasodilation & increased vascular permeability cause relative hypovolemia and decreased perfusion
-
Neurogenic shock?
high cervical spine injury: hypotension and vasodilation occur r/t no CNS stimulation
not able to compensate with tacfhycardia so HR and BP will both be low
-
S/S of distributive shock?
same as hypovolemic except neurogenic shock will have decreased HR
in initial stages will have adequate CO with low SVR then progresses to same as hypovolemic with low CO & BP with high SVR
-
S/S of septic shock?
- 1. fever/hypothermia
- 2. low/high WBC
-
Complication of septic shock?
DIC
-
Alteration in the body's stress response caused by sepsis?
can cause ischemia to adrenal gland -> decreased cortisol -> low SVR & myocardial dysfunction
-
Anaphylactic shock s/s?
- 1. anxiety or agitation
- 2. NV
- 3. urticaria
- 4. angioedema
- 5. respiratory distress with stridor or wheezing
- 6. hypotension
- 7. tachycardia
-
S/S of cardiogenic shock?
- 1. s/s of hypovolemic shock
- 2. s/s of resp distress r/t pulm edema
- 3. s/s of CHF
- 4. cyanosis
-
Fluid admin with cardiogenic shock?
rapid fluids can worsen pulm edema
-
What cardiac rhythm may occur with cardiac tamponade?
PEA
-
S/S of cardiac tamponade?
- 1. respiratory distress
- 2. tachycardia
- 3. poor peripheral perfusion
- 4. muffled or diminished heart sounds
- 5. narrowed pulse pressure
- 6. pulsus paradoxus ( increase in systolic BP by >10 during inspiration)
- 7. distended neck veins
- 8. changes in LOC
-
ECG with cardiac tamponade?
small QRS complexes
use echo to Dx
-
Patho of tension pneumo?
air accumulates in pleural space -> presses on surrounding areas -> PEA
-
When should tension pneumo be suspectesd?
trauma
person with positive-pressure ventilation who suddenly deteriorates
-
s/s unique to tension pneumo?
- 1. tracheal deviation toward contralateral side
- 2. hyperresonance of affected side
- 3. diminished breath sounds on affected
other s/s are similar to cardiac tamponade
-
S/S of pulmonary embolism?
similar to hypovolemic shock
s/s of congestion & R heart failure distinguish it
may also complain of chest pain from ischemia to area
-
Tx of hypovolemic shock?
- 1. O2 admin, ventilation
- 2. may need blood admin
- 3. rapid admin of isotonic fluids
-
Tx of distributive shock?
- 1. rapid fluid admid
- 2. vasopressors to combat low SVR
-
CArdiogenic shock Tx?
- increase CO while decreasing cardiac demands
- 1. positive-pressure ventilation to reduce WOB
- 2. slow infusion ov IV fluid
- 3. inotropics and vasodilators
-
Relationship of K and acid?
acidosis = K+ increase r/t K+ forced out of cells by H+
shock pt may have hyperkalemia
-
Tx of metabolic acidosis r/t shock?
does not respond well to bicarb/buffer Tx unless solely due to buffer loss
must correct tissue perfusion to correct acidosis
still may give bicarb for severe acidosis
-
General Tx of shock?
- 1. stable - leave in position of comfort / hypotensive - trendelnburg
- 2. O2 admin
- 3. may need blood
- 4. may need vent
- 5. vascular access
- 6. fluid resuscitation: isotonic bolus 20mL/kg over 5 to 20 min & repeat (except in cardiogenic) / blood for hemorrhage
- 7. Monitor & assess SpO2, HR, BP, LOC, temp, & UO
- 8. labs
- 9. meds prn
-
2 causes of hypocalcemia in shock?
- 1. sepsis
- 2. blood transfusions
-
Inotropic drugs used for shock?
Effects?
- 1. EPI
- 2. dopamine
- 3. dobutamine
increase contractility & HR
-
Inodilators for shock/Phosphodiesterase inhibitors?
Effects?
milrinone & inamrinone
decrease SVR, improve contractility & cornonary artery BF
-
Vasodilators used in shock?
- nitro drugs:
- nitroglycerin, nitroprusside/nipride
-
Vasopressors used in shock?
- 1. EPI in doses >0.3mcg/kg per minute
- 2. NE
- 3. dopamine in doses >10mcg/kg per minute
- 4. vasopressin
-
Intervention if pulm edema occurs r/t fluid resusitation?
ventilation with PEEP
-
CI to rapid fluid admin?
- 1. DKA - high blood osmolality r/t increased glucose -> cerebral edema can occur
- 2. ingestion of Ca channel blockers or beta blockers
-
Hypoglycemia definition in infants and children?
- preterm & term neonates: <45
- infants, children, and adolescents: <60
-
Mgmt of hypoglycemia?
- 1. oral ingestion of glucose if possible
- 2. IV glucose 0.5 to 1g/kg (D5W)
-
Dx test that may be done if septic shock is supected?
- 1. lactate
- 2. glucose
- 3. calcium
- 4. ABG
- 5. CBC
- 6. cultures
-
What should be done if septic shock does not respond to initial fluid therapy?
give vasopressors & stress-dose hydrocortisone
-
What should be done after initial Tx of septic shock with fluids?
evaluate pt for improvement: BP, HR, peripheral perfusion to determine next intervention
improvement: take to ICU
-
Initial Tx of septic shock?
- 1. O2 and vent prn
- 2. IV access X2
- 3. fluid bolus 20mL/kg repeatedly
- 4. Testing: lactate, glucose, Ca, ABG, cultures, CBC
- 5. Correct any metabolic problems: hypoglycemia, hypocalcemia
- 6. first dose of broad spectrum ABX STAT
- 7. may give vasopressor or stress hydrocortisone
- 8. monitor for fluid overload
-
Tx of fluid-refractory septic shock?
- 1. Establish central venous access
- 2. vasoactive drug
- 3. additional fluids & consider colliod fluids
- 4. may give transfusion if HgB<10
- 5. may vent with PEEP
-
Medication given for child in septic shock with vasodilation & poor perfusion/low BP?
(warm shock)?
Effects?
What drug can be used if this drug doesn't work?
NE: vasoconstrictor, increase contractility
vasopressin
-
Med for septic shock that is normotensive?
dopamine
-
Med for septic shock with vasoconstriction?
AE?
EPI - inotropic effects
>/= 0.3mcg/kg per minute
can produce lactate
-
Tx for suspected/identified adrenal insufficiency?
- hydrocortisone 2mg/kg IV bolus
- max dose 100 mg
-
Tx of anaphylactic shock?
- 1. normal Tx of any shock
- 2. EPI: IM: 1:1000, may give infusion after 10-15min 1:10,000
- 3. isotonic solution
- 4. albuterol
- antihistamines: diphenhydramine, H2 blockers (tidines)
- 5. corticosteroids: methylprednisolone
- 6. may use vasopressors
-
3 major s/s of neurogenic shock?
hypotension, bradycardia, hypothermia
-
Tx of neurogenic shock?
- other shock Tx AND
- 1. position flat or head-down for venous return
- 2. trial of isotonic fluid
- 3. for fluid-refractory hypotension: vasopressors: EPI, NE
- 4. warming or cooling prn
-
Major objectives for cardiogenic shock?
improve cardiac function & decrease metabolic demand
-
Tx of cardiogenic shock?
- 1. cautious fluids (5-10 mL/kg over 10-20min)
- 2. O2
- 3. assist with ventilation prn
- 4. may est. central venous access for measureing CVP
- 5. Tests: ABG, HgB, lactate, cardiac enzymes, thyroid, CXR, ECG, echo
- 6. Meds: vasodilators, diuretics, inotropes
- 7. reduce metabolic demand: assist with vent, antipyretics, analgesics, sedatives,
-
Tx of cardiac tamponade?
- 1. fluid bolus may help perfusion at first
- 2. pericardial drainage with radiology guide or emergency pericardiocentesis
-
Tx of tension pneumo?
1. immediate needle decompression followed by thoracostomy for chest tube
-
Tx of pulmonary embolism?
- 1. O2 & vent assistance
- 2. fluid therapy prn
- 3. echo, CT, or angiography; ABG, CBC, Ddimer, ECG, CXR, VQ lung scan
- 4. anticoagulatns: heparin, lovenox
- 5. consider fibrinolytics
-
Sites for IO insertion?
- 1. proximal or distal tibia
- 2. distal femur
- 3. anterior-superior iliac spine
-
S/S of bradycardia?
- 1. hypotension(can't increase SV)
- 2. decreased LOC
- 3. shock
-
Causes of bradycardia?
- 1. hypoxia
- 2. hypotension
- 3. hydrogen - acidosis
- 4. hypothermia
- 5. heart block
- 6. toxins/poisons/drugs
-
Medication for tachycardia?
adenosine
-
Tx of tachycardia?
- 1. vagal maneuvers
- 2. adenosine
- 3. synchronized cardioversion
-
Meds for tachydysrhythmias?
- 1. adenosine - stops AV conduction for 10 seconds
- 2. amiodarone - atrial and vent tachy
- stable SVT refractory to adenosine
- unstable VT
- prolongs QT
- 3. procainamide: same as amiodarone
- use if amiodarone not working
- 4. lidocaine: alternative to amiodarone for stable VT
- not for SVT
- 5. MgSo: torsades
-
Synchronized cardioversion may be used for what tachyarrhythmias?
- 1. SVT
- 2. atrial flutter
- 3. VT with pulse
-
HR that = SVT?
- >220 for infant
- >180 for child
-
Admin of adenosine for tachyarrhythmias & dosage?
give rapid bolus with rapid flush r/t 10 second half life
- 0.1mg/kg first dose up to 6mg
- 02.mg/kg second dose up to 12 mg
-
Synchronized cardioversion admin?
- 1. give analgesic/sedative
- 2. start with 0.5 to 1 J/kg then increase to 2J/kg if needed
- 3. record and monitor ECG after each cardioversion attempt
-
Amiodarone dosage for children?
5mg/kg over 20-60 minutes
-
procainamide dosage for children?
15mg/kg over 30 to 60 minutes
-
4 arrest rhythms?
- 1. VF
- 2. VT with no pulse
- 3. asystole
- 4. PEA
-
Agonal rhythms?
slow wide QRS complex rhythms that immediatly preced asystole
-
Compression depth for CPR?
- adults - 2 inches
- children & infants: at least 1/3 A/P diameter
-
Rotate compressors q ___ min.
2
-
Ventilations with advanced airway?
1 breath q 6-8 seconds lasting 1 second
-
Vasopressors for peds cardiac arrest?
EP, vasopressin
-
Antiarrhythmics for peds cardiac arrest?
amiodarone, lidocaine, Mg
-
Use for Ca in peds cardiac arrest?
hypocalcemia, hyperkalemia, hypermagnesemia, Ca channel blocker OD
-
Sodium bicarb use during peds cardiac arrest?
- 1. hyperkalemia
- 2. tricyclic antidepressants OD
- 3. Na channel blocking drugs
-
Joules for defibrillation during ped cardiac arrest?
- first shock: 2J/kg
- all others: 4J/kg
Max 10J/kg or adult dose
-
EPI dose for children?
0.01mg/kg
Repeat q 3-5 min
-
Amiodarone dosage for kids?
5mg/kg bolus
repeat up to 2 times
-
Paddles/pads used for children?
- >10kg/1 yr or older = adult pads
- <10kg/<1yr = infant pads
-
Postresusitation care?
- 1. continue manual ventilation/ET insertion
- 2. make sure ET in proper position & document position in mouth & get CXR for correct postion
- 3. assessment of cardiopulmonary
- 4. PEEP prn: O2<90 while receiving 100% inspired O2
- 5. sedation & analgesia: all ET pt get this
- 6. UO with catheter
- 7. Admin fluids, blood prn
- 8. Hang amiodarone/procainamide if used?
-
Alprostadil?
- protaglandin E: vasodilator
- maintain patency of ductus arteriosus fo rductal dependent heart disease
-
Etomidate?
sedative-hypnotic with no anlgesic properties
sedation for rapid sequnce ET
-
2 uses for terbutaline?
- asthma/broncodilator
- hyperkalemia - moves K into cells
-
high flow and low flow O2?
high flow = >10L/min
low flow <10L/m
-
Maxiumum nasal cannula flow rate?
4L/min
-
Indications for OPA and NPA?
- OPA - unconscous victim without gag reflex
- NPA _ conscious or semiconscious
-
Max time for suctioning with OPA in place?
10 seconds
-
CI for IO?
- 1. bone disorders
- 2. previous attempt in same bone
- 3. infection over bone
-
Normal PR length?
0.12 - 0.20
-
-
-
ECG reading that can indicate hyperkalemia?
T waves are very large and peaked and may even be taller than QRS
-
Upper airway obstruction list?
- 1. team leader ID self and assign roles
- 2. assessment: responsiveness, breathing, & pulse, ABCDE, VS
- 3. airway maneuver & admin of 100% O2
- 4. s/s of upper airway obstruction stated
- 5. caegorize as resp distress or failure
- 6. IV/IO access
- 7. reassessment in response to Tx
- 8. Tell specific Tx for upper airway obstruction: EPI, CPAP, etc
- 9. Say indications for ET tube & need for smaller size than predicted for age: unable to maintain airway, O2 or vent despite interventions
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Lower airway checklist?
- 1. team leader ID self and assign roles
- 2. assessment: ABCDE, responsiveness, VS
- 3. provide 100% O2
- 4. state s/s of lower airway obstruction
- 5. categorize as resp distress or failure
- 6. state indications for assisted ventilations: ineffective ventilations or poor oxygenation
- 7. IV/IO access
- 8. reassessment after Tx: ABC's
- state specific Tx for lower airway obstruction
- 9. state indications for ET tube
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Lung tissue disease checklist?
- 1. team leader intro self and assign roles
- 2. ABCDE assessment, responsiveness, & VS
- 3. assisted ventilations with 100% O2
- 4. Ensure that bag ventilations are effective: chest rise & breath sounds
- 5. pads/leads placed properly & monitor turned on & pulse ox used
- 6. s/s of lung tissue disease
- 7. resp distress or failure?
- 8. Iv/IO
- 9. reassess ABC's after Tx
- 10. specific Tx for lung tissue disease?
- indications for ET tube?
-
Disordered control of breathing list?
exactly the same as lung tissue disorder except know s/s of disordered control of breathing & specific Tx
-
Hypovolemic shock checklist?
- 1. tema member intro & assign roles
- 2. ABCDE assessment, responsiveness, VS
- 3. 100% O2
- 4. pads/leads placed & pulse ox monitor
- 5. verbalize features of Hx & exam that indicate hypovolemic shock
- 6. verbalize whether pt is compensated or hypotensive
- 7. IV/IO
- 8. admin 20mL/kg isotonic fluids rapidly (over 5-20 min)
- 9. reassess ABC;s
- 10. ID parameters that indicate response to thearpy: HR, BP, distal pulses, cap refill, UO, mental status
-
Obstructive shock checklist?
- 1. team leader intro & assign roles
- 2. assessment: ABCDE, responsiveness, VS
- 3. pads/leads & pulse ox placed
- 4. verbalize DOPE mneumonic for intubated patient who deteriorates: displacement, obstruction, pneumothorax, equipment failure)
- 5. verbalize features of Hx & exam that indicate obstructive shock
- 6. State at least 2 common causes of obstructive shock: tension pneumo, cardiac tamponade, PE
- 7. state compensated or hypotensive
- 8. IV/IO
- 8. 10-20mL/kg rapid isotonic fluids
- 9. reassess ABC's
- 10.State Tx for tension pneumo: second intercostal space at midclavicular line
- 11. verbalize therapeutic endpoints: HR, BP, perfusion, UO, mental status
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Distributive shock checklist?
- 1. team leader intro self & assign roles
- 2. assessment: ABCDE, responsiveness, VS
- 3. 100% O2
- 4. pads/leads placed & monitor on, pulse ox
- 5. s/s of distributive/septic shock & verbalize pt Hx & physical that indicate it
- 6. compensated or hypotensive shock?
- 7. IV/IO
- 8. rapid admin of isotonic fluids
- 9. reassessment ABC's
- 10. admin of ABX
- 11. indications for vasoactive drug support: fluid-refractory septic shock
- 12. therapeutic end points: HR, BP, perfusion, UO, mental status
-
Cardiogenic shock checklist?
- 1. team leader intro & assign roles
- 2. assessment: ABCDE, responsiveness, VS
- 3. 100% O2
- 4. pads/leads, monitor on, pulse ox
- 5. verbalizes Hx & exam that indicate cardiogenic shock (s/s)
- 6. compensated or hypotensive?
- 7. IV/IO
- 8. isotonic fluid 5 to 10 mL/kg over 10 to 20 min & monitor for pulmonary edema/increased CHF
- 9. reassess ABC's
- 10. indications for use of vasoactive drugs: persistent s/s of shock despite fluid therapy
- 11. therapeutic end points: HR, BP, perfusion, UO, mental status, importance of reducing metabolic demand
-
SVT checklist?
- 1. team leader intro & assign tasks
- 2. assessment: ABCDE, responsiveness, VS
- 3. O2 by high-flow device
- 4. pads/leads, monitor on, & pulse ox
- 5. recognize narrow complex tachycardia & state diff b/t ST and SVT
- 6. compensated or hypotensive
- 7. perform vagal maneuvers: valsalva, blowing through straw, ice to face
- 8. IV/IO
- 9. adensoine: first dose 0.1mg/kg then 0.2mg/kg - state need for rapid admin with rapid flush
- 10. reassess ABC
- 11. verbalize indications & appropriate energy doses for synchronized cardioversion: 0.5-1J for initial dose then 2J
-
Bradycardia checklist?
- 1. leader intro self and assign roles
- 2. assessment: ABCDE, responsiveness, VS
- 3. assisted ventilatiohns with 100% O2
- 4. pads/leads place, monitor turned on, pulse ox
- 5. recognize bradycardia with cardiorespiratory compromise & verbalize to team members
- 6. compensated or hypotensive?
- 7. recall indications for chest compressions in a bradycardic pt: HR<60 with/without a pulse
- 8. IV/IO access
- 9. EPI: 0.01mg/kg admin & saline flush
- 10. reassessment of ABC's
- 11. verbalizes consideration of at least 3 underlying causes of bradycardia: hypothermia, drugs, increased ICP
-
Asystole/PEA checklist?
- 1. team leader intro & assign roles
- 2. recognize cardiopulmonary arrest: absence of responsiveness, breathing, and pulse
- 3. CPR: rotate role of chest compressor q2min
- 4. place pads/leads, turn on monitor
- 5. recognize asystole or PEA
- 6. IO/IV
- 7. EPI: 0.01mg/kg at appropriate intervals (q3-5min) and flush with saline
- 8. check rhythm approx q2min with change of compressors
- 9. verbalizes consideration of at least 3 reversible causes of PEA or asystole: all H's & T's
-
VF/pulseless VT checklist?
- 1. team leader intro & assign team roles
- 2. recognize cardiopulmonary arrest: no responsiveness, breathing, or pulse
- 3. start CPR
- 4. pads/leads place, monitor on
- 5. recognize VF or pulseless VT & verbalize to team members
- 6. defibrillation: 2J then 4J after that then immediately go back to CPR
- 7. IV/IO
- 8. prepare EPI: 0.01mg/kg
- 9. defibrillation 4J/kg or higher - no more than 10J/kg then CPR again
- 10. admin EPI then saline flush
- 11. verbalizes considertion of anti-arrhythmic using appropriate dose: amiodarone, lidocaine)
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