PALS - Written Test and Case Study
Review Material
CPR Sequence - C-A-B
Circulation-Airway-Breathing
Algorithm: Pediatric Septic Shock
First hour... - Oxygen & support ventilation
Establish IV, draw labs (glucose, blood cultures)
Begin resuscitation
Push repeated 20 mL/kg isotonic crystalloid (3-4) unless rales, resp distress,
hepatomegaly
Correct hypo-glycemia/calcemia
Admin 1st dose antibiotics STAT
STAT vasopressor drip/stress-dose hydrocortisone
Establish 2nd IV
Algorithm: Pediatric Septic Shock
Fluid Responsive? - Yes - ICU
No - Vasoactive drug & titrate for normotension
Normo: begin dopamine
Hypo/warm: norepi
Hypo/cold: epi
Adenosine (slows HR) - SVT
0.1 mg/kg - dose 1
0.2 mg/kg - dose 2
max = 6 mg
RAPID push
Amiodarone (antiarrythmic) - VF/VT (pulseless)
5 mg/kg
Bolus
max = 300 mg
SVT, VT (with pulses)
5 mg/kg
over 20-60 mins
max = 300 mg
,Atropine (increases HR) - Bradycardia
0.02 mg/kg
may repeat once
Epinepherine (increases HR) - Bradycardia/Pulseless Arrest
0.01 mg/kg (1:10,000) every 3-5 min
Hypotensive Shock
0.1-1 mcg/kg per min
Anaphylaxis
0.01 mg/kg every 3-5 min
Algorithm: Pediatric Cardiac Arrest - Shout for help
CPR
Oxygen, AED
If no shock - CPR for 2 min, IV, Epi q 3-5 min, reassess
If shock - after...CPR for 2 min, IV, reassess
If 2nd shock - CPR for 2 min, Epi q 3-5 min, reassess
If 3rd shock - CPR for 2 min, Amiodarone, treat cause, reassess...
Post Resuscitation Care
Shock Doses - 1st shock - 2 j/kg
2nd shock - 4 j/kg
Max 10 j/kg
Reversible Causes of Pediatric Cardiac Arrest (H&T's)
6 H's
(G,K,T,V,X,DRO) - 1. Hypo-Glycemia
2. Hypo/hyper-Kalemia
3. Hypo-Thermia
4. Hypo-Volemia
5. Hypo-Xia
6. HyDROgen ion (acidosis)
Reversible Causes of Pediatric Cardiac Arrest (H&T's)
5 T's
(A,E,HC,HP,O) - 1. Tamponade, cardiac
2. Tension pneumothorax
3. Thrombosis, coronary
4. Thrombosis, pulmonary
5. Toxins
Rescue Breaths - 1 every 6-8 secs
8-10 per min
, CBC
(Assessment part 1) - Consciousness
Breathing
Color
ABCDE
(Assessment part 2) - Airway
Breathing
Circulation
Disability
Exposure
SAMPLE
(Assessment part 3) - S/Sx
Allergies
Medications
Past medical hx
Last meal/drink
Events leading to situation
DOPE
(Pediatric with airway, deteriorates rapidly) - Displacement
Obstruction
Pneumothorax
Equipment
Begin CPR when HR is _____ and _____? - <60
poor perfusion
Algorithm: Pediatric Bradycardia, Pulse Present, Poor Perfusion - Airway, assess with
breathing if needed, oxygen
Cardiac monitor, BP, oximetry
IV access
ECG
Cardio compromise continues...
--- HR<60 = CPR
Brady continues...
---Epi, Atropine, Pacing, Treat Causes
If pulseless...
--- go to cardiac arrest algorithm
Algorithm: Pediatric Tachycardia, Pulse Present, Poor Perfusion - Airway, assess with
breathing if needed, oxygen
Cardiac monitor, BP, oximetry, IV access
ECG, evaluate QRS
--Wide:
Review Material
CPR Sequence - C-A-B
Circulation-Airway-Breathing
Algorithm: Pediatric Septic Shock
First hour... - Oxygen & support ventilation
Establish IV, draw labs (glucose, blood cultures)
Begin resuscitation
Push repeated 20 mL/kg isotonic crystalloid (3-4) unless rales, resp distress,
hepatomegaly
Correct hypo-glycemia/calcemia
Admin 1st dose antibiotics STAT
STAT vasopressor drip/stress-dose hydrocortisone
Establish 2nd IV
Algorithm: Pediatric Septic Shock
Fluid Responsive? - Yes - ICU
No - Vasoactive drug & titrate for normotension
Normo: begin dopamine
Hypo/warm: norepi
Hypo/cold: epi
Adenosine (slows HR) - SVT
0.1 mg/kg - dose 1
0.2 mg/kg - dose 2
max = 6 mg
RAPID push
Amiodarone (antiarrythmic) - VF/VT (pulseless)
5 mg/kg
Bolus
max = 300 mg
SVT, VT (with pulses)
5 mg/kg
over 20-60 mins
max = 300 mg
,Atropine (increases HR) - Bradycardia
0.02 mg/kg
may repeat once
Epinepherine (increases HR) - Bradycardia/Pulseless Arrest
0.01 mg/kg (1:10,000) every 3-5 min
Hypotensive Shock
0.1-1 mcg/kg per min
Anaphylaxis
0.01 mg/kg every 3-5 min
Algorithm: Pediatric Cardiac Arrest - Shout for help
CPR
Oxygen, AED
If no shock - CPR for 2 min, IV, Epi q 3-5 min, reassess
If shock - after...CPR for 2 min, IV, reassess
If 2nd shock - CPR for 2 min, Epi q 3-5 min, reassess
If 3rd shock - CPR for 2 min, Amiodarone, treat cause, reassess...
Post Resuscitation Care
Shock Doses - 1st shock - 2 j/kg
2nd shock - 4 j/kg
Max 10 j/kg
Reversible Causes of Pediatric Cardiac Arrest (H&T's)
6 H's
(G,K,T,V,X,DRO) - 1. Hypo-Glycemia
2. Hypo/hyper-Kalemia
3. Hypo-Thermia
4. Hypo-Volemia
5. Hypo-Xia
6. HyDROgen ion (acidosis)
Reversible Causes of Pediatric Cardiac Arrest (H&T's)
5 T's
(A,E,HC,HP,O) - 1. Tamponade, cardiac
2. Tension pneumothorax
3. Thrombosis, coronary
4. Thrombosis, pulmonary
5. Toxins
Rescue Breaths - 1 every 6-8 secs
8-10 per min
, CBC
(Assessment part 1) - Consciousness
Breathing
Color
ABCDE
(Assessment part 2) - Airway
Breathing
Circulation
Disability
Exposure
SAMPLE
(Assessment part 3) - S/Sx
Allergies
Medications
Past medical hx
Last meal/drink
Events leading to situation
DOPE
(Pediatric with airway, deteriorates rapidly) - Displacement
Obstruction
Pneumothorax
Equipment
Begin CPR when HR is _____ and _____? - <60
poor perfusion
Algorithm: Pediatric Bradycardia, Pulse Present, Poor Perfusion - Airway, assess with
breathing if needed, oxygen
Cardiac monitor, BP, oximetry
IV access
ECG
Cardio compromise continues...
--- HR<60 = CPR
Brady continues...
---Epi, Atropine, Pacing, Treat Causes
If pulseless...
--- go to cardiac arrest algorithm
Algorithm: Pediatric Tachycardia, Pulse Present, Poor Perfusion - Airway, assess with
breathing if needed, oxygen
Cardiac monitor, BP, oximetry, IV access
ECG, evaluate QRS
--Wide:
