QUESTIONS AND ANSWERS SURE A+
✔✔Primary Survey/ Resuscitation - ✔✔Survival rates in pediatric emergency can be
directly correlated with
1.RAPID AIRWAY MANAGEMENT,
2.INITIATION OF VENTILATORY SUPPORT, AND
3.EARLY RECOGNITION OF AND EARLY RESPONSE TO INTRA abdominal AND
intracranial hemorrhages
✔✔A STEMI is a __________ resulting from a _________. - ✔✔Complete Occlusion of
a coronary artery
caused by a ruptured Plaque leading to blood clot formation in the coronary.
✔✔STEMI diagnosis - ✔✔Chest pain + positive cardiac enzyme (TROP. >0.4), and --ST
segment ELEVATIONS greater than 1 mm in two or more contagious leads
V1-V6
-Reciprocal (depressions) changes in leads II, III, AVF
✔✔STEMI
EKG findings - ✔✔STEMI
✔✔STEMI
EKG findings more - ✔✔-St elevations > 1mm in Limb leads: 1, II, III, avF, avL
-St elevations > 2mm in precordial leads (v1-v6)
AND/OR
-NEW LBBB
Contiguous leads with reciprocal changes in opposite leads
✔✔First degree Heart Block EKG - ✔✔AV block
Prolonged PR Interval greater than 120-200 ms
✔✔second degree heart block type 1 Wenkebach - ✔✔AV block in which occasional
electrical impulses from the SA node fail to be conducted to the ventricles.
PR interval progressively lengthens greater than 120-200ms + dropped beats.
✔✔Maternal cardiopulmonary arrest...If any moribund patient is 24 weeks or more
perimortem c section must be considered. AHA recommends c section initiation within...
- ✔✔4 minutes... delivery with in 5 minutes of any unsuccessful maternal resuscitative
attempts.
✔✔Second Degree Heart Block (Mobitz II) - ✔✔= Damage AT av node - moderate
,• PR-interval is normal; QRS complexes are dropped erratically
• ALL must have a pacemaker in the next 72 hrs.
✔✔STEMI Nitro gtt - ✔✔5-10 mcg per minute
Titrate by 10 mcg
max dose 300 mcg per minute
✔✔How do you mix epi? - ✔✔Mix 1 mg in 1 L NS or D5W or LR for a concentration of 1
mcg/ ml
✔✔What's the epi dose for hypotension
s/p arrest? - ✔✔0.1 - 0.5 mcg/kg/min
✔✔What is the epi dose for anaphylaxis? - ✔✔
✔✔Pediatric Epinephrine dose - ✔✔
✔✔PALS 2020 update - ✔✔AHA 2020 BASIC BP
Diastolic BP of at least 25mmhg in infants
and at least 35 mmhm in children
correlates with better outcomes.
✔✔PALS Brady with a pulse - ✔✔Assess airway, breathing, mental status
Most common cause is hypoxia! could also be hypothermia and or medications.
s/s of shock? AMS? hypotensive?
Start CPR if any of these
Always start CPR if HR < 60 bpm
iv access
Give Epi 0.01 mg/kg (0.1ml of 0.1mg/ml solution)
Repeat Q 3-5 minutes
✔✔Initial management of pediatric respiratory distress or Failure A - ✔✔1. A-ABC.
Support open airway: Comfort or Head tilt chin lift. Jaw thrust.
Clear airway if indicated. (suction nose or mouth if indicated)
Consider OPA or NPA.
IDENTIFY type and Severity of respiratory problems
✔✔Initial management of pediatric respiratory distress or Failure B - ✔✔2. B-Monitor
Spo2 withPulse ox. Provide high concentration O2, via non rebreather
-Administer inhaled meds: Albuterol or Epi. as needed
-Assist ventilation with child ambu + o2 if needed. Prepare for intubation if needed.
✔✔Initial management of pediatric respiratory distress or Failure C - ✔✔3.C-Monitor
heart rate, rhythm and BP. Establish IV/IO access. and fluids/ meds as needed.
Evaluate Identify Intervene
, ✔✔What is an upper airway obstruction? - ✔✔Interruption in airflow through nose,
mouth, pharynx, or larynx. The large always outside the thorax.
✔✔PALS What causes upper airway obstruction? - ✔✔Airway Swelling
(anaphylactoid rx) ,Infection r/t croup
Aspirated foreign body
enlarged tonsils or adenoids
Decreased level of consciousness GCS of 8?
✔✔Infants and small children are especially vulnerable to - ✔✔Upper airway
obstruction.
Infants are obligate nose breathers.
✔✔PALS Management of upper airway obstruction - ✔✔position of comfort, or jaw
thrust chin lift
100% FIO2 via non rebreather
-Carefully weigh decision to suction. Don't do it if it's croup of anaphylaxis.
-give nebulizer epinephrine particularly if swelling is beyond the tongue.
-Give inhaled or IV cortical steroids
-OPA for AMS and NPA for ams with a gag.
- consider cpap.
-Only experienced intubation should be considered
ensure pt can be ventilated prior to paralytic
- prepare for difficult airway (needle cricothyroidotomy)
✔✔In infants and children, retraction of the skin, muscles, and other tissues around the
clavicle and between the ribs indicates:
A.
shallow breathing.
B.
labored breathing.
C.
see-saw breathing.
D.
normal breathing. - ✔✔
✔✔PALS Management of upper airway obstruction caused by croup. - ✔✔
✔✔PALS Management of Anaphylaxis - ✔✔In addition to ABC....
- Administer IM epic by auto injector or regular syringe every 10 to 15 minutes as
needed. Repeat doses may be needed.
-Treat bronchospasm with albuterol MDI or Nebulizer
-Give continuous nebulizer treatment if needed.