PALS Exam Questions With 100% Correct Answers

PALS Exam Questions With 100% Correct Answers pulses in kiddos - ANSWER check brachial in infant carotid or femoral in child position infant - ANSWER external ear canal level with top of infants shoulder PAT ABC - ANSWER appearance, work of breathing, and circulation TiCLS - ANSWER tone, interactiveness, consolability, look/gaze, speech/cry Primary survey - ANSWER Airway, Breathing, Circulation, Disability, Exposure Tidal volume - ANSWER 5-7 mL/kg throughout life Tachycardia - ANSWER Heart rate that is greater than 180/min in an infant or toddler and greater than 160/min in a child older than 2 years of ae warrants further assessment and may be a serious condition. normal cap refill - ANSWER 2 seconds or less cuff size - ANSWER 40% mid upper arm circumference 50-75% of length of upper arm bp - ANSWER hypotension neonate 60 1-12 months 70 1-10 yo 70+agex2 AVPU - ANSWER Alert (15) Responsive to Voice (13) Responsive to pain (8) Unresponsive (6) Unilaterally dilated pupils with AMS - ANSWER Ipsilateral (same side) uncle herniation (lateral herniation of the temporal love, caused by increased intracranial pressure) hypoglycemia - ANSWER BS 45 in newly born BS 60 in child capillary blood gas - ANSWER arterialization of the capillary bed yields pH and PaCo2 comparable to arterial blood. A CBG analysis is useful for estimating arterial oxygenation. Normal SVo2 - ANSWER 70-75%, assuming arterial O2 saturation is 100% Depth of chest compression - ANSWER At least 2 inches in adults Children 1 year to puberty at least 1/3 AP diameter of chest, about 2 inches Infants At least 1/3, 1.5 inches PETCO2 - ANSWER Should be greater than 10-15 mm Hg ROSC over 40 mm hg What meds can be administered by ET? - ANSWER Lipid-soluble drugs-lidocaine, epinephrine, atropine, and naloxone (LEAN) and vasopressin ET dose of Epi is 10 times the IV/IO dose ET dose of other drugs is 2-3 times the IV/IO Technique for ET drug admin - ANSWER Instill the drug into the ET tube Follow with a minimum of 5mL NS Provide rapid positive pressure breaths after drug is instilled Shock and VF - ANSWER IF shock eliminates VF, continue CPR because most have PEA or systole after shock delivery Wt and pads - ANSWER 10 kg use large adult paddles (8-13 cm) 10 kg (1 yr) small infant paddles (4.5 cm) Cold? - ANSWER Rewarm to at least 30 degrees C Pulm HTN - ANSWER Correct hypercarbia and acidosis Bolus isotonic crystalloid If pt receiving pulm vasodilators such as NO or prostacyclin immediately before the arrest, be sure drug admin continues Consider admin of inhaled NO or prostacyclin to reduce pulm vascular resistance ECPR if instituted early during resuscitation Single ventricle heart failure consideration - ANSWER Heparin admin for pts with aortopulm or RV-pulm art shunt if shunt potency is concern Titrate O2 to optimum puls to systemic blood flow ratio Petco may not be reliable Consider permissive hypoventilation or even negative pressure vent in periarrest state to improve CO Extracorporeal life support or extracoporeal membrane oxygenation may be considered for pts in cardiac arrest who have undergone stage I palliation (Norwood) or Fontan-type procedures Tx hemorrhagic shock - ANSWER phases of septic shock tx - ANSWER Initial tx of septic shock - ANSWER algorithm for septic shock - ANSWER tx anaphylactic shock - ANSWER Bradycardia with a pulse algorithm - ANSWER drug table for tachy - ANSWER tachycardia with adequate perfusion algorithm - ANSWER tachy with pulse and poor perfusion algorithm - ANSWER ROSC Respiratory Failure - ANSWER ROSC algorithm - ANSWER Giving fluids in ROSC - ANSWER Rhythm disturbance check - ANSWER Vascular access check - ANSWER Upper airway check - ANSWER Lower airway check - ANSWER Lung tissue disease check - ANSWER Disordered control of breathing check - ANSWER Hypovolemic shock check - ANSWER Obstructive shock check - ANSWER Distributive shock check - ANSWER Cardiogenic shock check - ANSWER SVT check - ANSWER Bradycardia check - ANSWER Asystole/PEA check - ANSWER VF/Pulseless VT check - ANSWER airway management check - ANSWER Pals management of shock after ROSC algorithm - ANSWER PALS vitals - ANSWER Pediatric Tachy with a pulse and poor perfusion algorithm - ANSWER Pediatric Brady with a pulse and poor perfusion algorithm - ANSWER PALS systematic approach algorithm - ANSWER Details for pediatric cardiac arrest algorithm - ANSWER CPR algorithm - ANSWER Drugs used in PALS - ANSWER Colors PALS - ANSWER More drugs PALS - ANSWER 2nd half of Peds septic shock algorithm - ANSWER 1st half of Peds septic shock algorithm - ANSWER GCS infants - ANSWER Mild 13-15 Moderate 9-12 Severe 3-8 CPR for all ages - ANSWER atropine - ANSWER Calcium - ANSWER Sodium bicarb - ANSWER Epi - ANSWER Amiodarone - ANSWER Lidocaine - ANSWER Mg - ANSWER pediatric cardiac arrest algorithm - ANSWER Manual defibrillation - ANSWER ` Epi dose - ANSWER IV/IO 0.01 mg/kg (0.1 mL/kg) bolus ET 0.1 mg/kg (0.1 mL/kg) bolus CPR and vent with ET - ANSWER vent q6 sec or 10 breaths/min pulm HTN - ANSWER low atmospheric pco2 - ANSWER diffusion defect - ANSWER alveolar hypoventilation - ANSWER VQ imbalance - ANSWER right to left shunt - ANSWER Signs of resp probs - ANSWER Tx croup - ANSWER S/S croup - ANSWER ET and croup - ANSWER ET intubation of child upper airway is high-risk procedure and should be performed by a team ped airway expertise. Use NM blockade only if you are confident the child's oxygenation and ventilation can be supported with bag-mask ventilation. Tx allergic run - ANSWER Choking - ANSWER Classification of Acute Asthma - ANSWER Management of acute asthma - ANSWER General management of lung tissue disease - ANSWER I children with hypoxemia refractory to high inspired O2 concentrations, positive expiratory pressure (CPAP, noninvasive ventilation, or mechanical ventilation with positive end-expiratory pressure (PEEP)) is helpful in management of lung tissue disorder Causes of lung tissue disease - ANSWER Infectious PNA, chemical pneumonitis, aspiration pneumonitis, carcinogenic pulmonary edema, ARDS Interventions for PNA - ANSWER Perform diagnostic assessments (arterial blood gas, CXR, viral studies, CBC, blood culture, sputum gram stain and culture) as indicated Administer antibiotic therapy (goal to admin within first hour of medical contact) Treat wheezing with albuterol by MDI or neb solution Consider using CPAP or noninvasive positive-pressure ventilation. In severe cases, endotracheal intubation and mechanical ventilation may be required Reduct metabolic demand by normalizing temp and reducing the work of breathing Tx Chemical Pneumonitis - ANSWER Treat wheezing with nebulizer bronchodilator Consider using CPAP or noninvasive ventilation. Intubation and mechanical ventilation may be required. Consider early intubation particularly if the child retires transport to a tertiary facility, is not tolerating secretions, or demonstrates evidence of upper airway edema and obstruction In a child with rapidly progressive symptoms, obtain early consult. Consider referral to a specialized center for advanced technologies (high frequency oscillation or pediatric extracorporeal membrane oxygenation) Tx aspiration pneumonitis - ANSWER Consider using CPAP or noninvasive ventilation. Intubation and mechanical vent may be required if severe Consider admin of abx if child has ever and infiltrate is present on CXR. Prophy antimicrobial therapy is not indicated. Tx cardioogenic pulm edema - ANSWER Provide vent support (noninvasive vent or vent with PEEP) PRN Consider diuretics to reduct left atrial pressure, inotropic infusions, and after load reducing agents to improve ventricular function. Obtain expert consultation Reduce metabolic demand by normalizing temp (treat fever) and reducing the work of breathing PEEP is added during mechanical vent to help reduce the need for high O2 sat. It is usually started at 5 cm H2O and adjusted to O2 sat Characteristics of ARDS - ANSWER Acute onset (within 7 days of insult) PaO2/FIO2 300 or less (with full face-mask bilevel vent or CPAP 5 cm H2O or greater) Oxygenation Index 4 or greater New infiltrate on CXR consistent with acute pulmonary parenchymal disease No evidence for a carcinogenic or fluid overload cause of pulm edema Tx of ARDS - ANSWER Monitor heart rate and rhythm, BP, RR, and pulse ox, and end-tidal CO2 Obtain lab studies, including ABG, central venous blood gas, and CBC Provide vent support (noninvasive ventilation or mechanical vent with PEEP) PRN Maintain low tidal volumes (5-8 mL/kg; lower for children with decreased lung compliance) and keeping peak inspiratory pressure less than 30-35 cm H20 is more important than correcting PaCo2 Cushing's triad - ANSWER irregular breathing or apnea, increase MAP, bradycardia Tx resp compromise and increased ICP - ANSWER Self-inflating bag - ANSWER typically used for initial resuscitation.. Consists of bag with intake valve and a nonrebreathing outlet valve. Intake valve allows the bag to fill with either O2 or room air. When you compress the bag, the intake valve closes and the nonrebreathing outlet valve opens, allowing either room air or air-O2 gas mixture to flow to the child. When the child exhales, the nonrebreathing outlet valve closes and exhaled gases are vented. Prevents child from breathing CO2 O2 and nonrebreather - ANSWER To deliver high flow O2 [] (600-95%), attach an O2 reservoir to the intake valve. Maintain an O2 flow of 10-15 :/min into a reservoir attached to a pediatric bag and flow of at least 15 mL/min into an adult bag Pop-off valve - ANSWER Many self-inflating bags have a pressure-limited pop-off valve sees at 35-45 cm H2O to prevent development of excessive airway pressures. If the child's lung compliance is poor or airway resistance is high or CPR is needed, an automatic pop-off valve may prevent delivery of sufficient tidal volume, resulting in inadequate ventilation. Bags used during CPR should nave NO pop off valve, or should be twisted to close Do NOT use to provide supplementary O2 to a spontaneously breathing infant or child - ANSWER A self-inflating bag-mask devise with a fish-mouth or leaf-flap operated nonrebreathing outlet valve. These do not provide a continuous flow of O2. Only open if squeezed or child generates significant inspiratory force. Also, do not use self-inflating bag-masks equipped with PEEP to provide CPAP during spontaneous breathing because outlet valve in bag will not open unless significant negative inspiratory pressure Bag size - ANSWER Should have volume of 450-500 mLs or larger for infants and young children.Older children or adolescents use 1000 mL. Do not use flow-inflating bags. Pic of valves - ANSWER steps to suction - ANSWER rigid vs soft suction - ANSWER Types of oxygen delivery systems - ANSWER Low flow: nasal canula, simple oxygen mask High flow: Nonrebreathing mask with reservoir, high-flow nasal canula Low flow O2 delivery - ANSWER O2 flow into the delivery device is less than the child's inspiratory flow rate. When the child inhales, the child inspires some room air in addition to the oxygen provided by the device. As a result, the O2 from the device mixes with room air, so a variable concentration of O2 is delivered to the child. The higher the O2 flow, the higher the inspired O2 [] Low flow usually provides inspired O2 [] pf 22-60% Nasal cannula - ANSWER Typically a low-flow O2 delivery device. It delivers awn inspired O2 [] of 22-60% Appropriate O2 flow rate is 0.25-4 L/min Simple O2 mask - ANSWER Low-flow device. Delivers inspired O2 [] of 35-60% Appropriate flow rate for the simple O2 mask is 6-10 L/min Cannot deliver an inspired O2 [] greater than 60%. This is because room air enters the mask a MINIMUM O2 flow rate of 6 L/min is needed to maintain an increased inspired O2 [] and prevent rebreathing of CO2 Nonrebreathing mask - ANSWER High-flow delivery device Inspired O2 [] of 95% can be achieved with an O2 flow rate of 10-15 L/min and the use of a well-sealed face mask Consists of a face mask and reservoir bag with the addition of 2 one-way valves: -A valve in 1 or both exhalation port(s) to prevent room air from entering the mask during inspiration -A valve placed between the reservoir bag and the mask to prevent the flow of exhaled gas into the reservoir