PALS

Croup treatment

Nebulized epi
Corticosteroids

Anaphylaxis treatment

IM epi (auto injector)
Albuterol
Antihistamines
Corticosteroids

Bronchiolitis treatment

Nasal suctioning
Bronchodilator trial

Asthma treatment

Albuterol +/- ipratropium
Corticosteroids
SC epi
Mg Sulfate
Terbutaline

Pulmonary edema with ARDS treatment

- Noninvasive OR invasive ventilatory support w/ PEEP
- Consider vasoactive support
- Consider diuretic

With a disorder of bleeding, if there is increased ICP, avoid...

Hypoxemia
Hypoercarbia
Hyperthermia

With a disorder of bleeding, if there is a neuromuscular disease present, consider...

Consider noninvasive or invasive ventilatory support

What are the 3 circumstances to give atropine?

1.) If you suction and, due to vagal maneuver, they go brady and the HR doesn't go back up
2.) If heart block + Bradycardia
3.) Organophosphate OD (think farming)

If you are going to give atropine, what dose?

0.1

What is the HR for SVT in:
- Infants
- Adults
- Kids

- Infant: 220 bpm+
- Adults: 150 bpm +
- Kids: 180+

When should you treat SVT? What would you use?

ONLY way to tell: Symptomatic and...
BP
- 1 mo - 1 yo = at least 70
- 1 yr - 10 yr = 70+age x 2
- birth - 1 mo = 60 sys
Adenosine 0.1 mg/kg, (max dose of 6 mg)
- 2nd dose: 0.2 mg/kg IV (max dose of 12 mg)

PALS VT tx

- Expert consult strongly advised
1. Find cause & treat
2. Obtain 12 lead
3. Consider drugs:
- Amiodarone 5 mg/kg IV over 20-60 minutes
- Procainamide 15 mg/kg IV over 30-60 minutes
4. Consider cardioversion 0.5 - 1 J/kg (can inc to 2 J/kg if initial dose

How much should you cardiovert (joules)

- 0.5-1 J/kg
- if that doesn't work do 2 J/kg
- sedate if you can

In what situations will pediatric patients be in VTach?

- Near drowning
- TCA OD
- Underlying heart disease
- Prolonged QT

If a patient has a pulse but is in SVT, give:

Adenosine same dose (o.1 mg/kg)
- if that doesn't work: Amiodarone 5 mg/kg, over 20 minutes, max dose 15 mg/kg
- max dose 300 mg

How does a pediatric patient be in VFib?

- Lightning strike
- Play with fork in the outlet
- Hit in the chest

PALS VFib

1st) CPR
2nd) Shock (twice)
3rd) w/ epi 0.01 mg/kg 1:10,000
4th) Amiodarone 2-3 minutes same dose, 5-15 mg/kg

If a patient has PEA, give

Give 2nd dose of Amiodarone 5-15 mg/kg

Normal HR for newborn to 3 mo:

85-205 bpm

Normal HR for 3 mo to 2 years:

100-190 bpm

Normal HR for 2-10 yo:

60-140 bpm

Normal HR for > 10 yo:

60-100 bpm

Compensated shock

when the patient is developing shock but the body is still able to maintain perfusion

Distributive shock

A condition that occurs when there is widespread dilation of the small arterioles, small venules, or both.

Obstructive shock

Shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body's tissues.

Signs of compensated shock

a. Tachycardia
b. Increased RR
c. Altered mental status
d. Change in pulses
e. Prolonged capillary refill
f. Skin color changes
g. Skin temperature

What types of obstructive shock exist?

i. Tamponade
ii. Pneumothorax
iii. PE
iv. Ductal dependent lesion (ie PDA won't close)

Ductal dependent lesion
- what is it?
- treatment

1. Child is born with Coarctation of Aorta (*tetralogy is born blue so it's not this condition), once the Ductus Arteriosus closes that circulation closes!
a. Give Prostaglandin to the child for treatment
i. Will open the ductus back open

How would you treat hypovolemic shock?

20 ml/kg bolus of NS
1. Give based on look of child:
- If no BP = push as fast as possible
- If BP still ok = push over 10 minutes

What types of distributive shock exist?

a. Sepsis
b. Neurogenic
c. Allergic

How would you tx cardiogenic shock?

20 ml/kg bolus of NS
- give based on look of child
- If no BP = push as fast as possible
- If BP is still good --> push over 10 min

cardiogenic shock

A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions.

PALS
If there is a cardiac arrest, with a shockable rhythm, what do you do?

VT/VF
1.) Start CPR (give 02, attach monitor/defibrillator)
- shock the patient
2. CPR for 2 min
a. Get IV/IO access
3. Is rhythm shockable?
- YES = SHOCK given;
- CPR for 2 min
- Administer Epinephrine 0.01mg/kg every 3-5 min; consider advanced airway
4.

PALS
If there is a cardiac arrest, with a non- shockable rhythm, what do you do?

Asystole/PEA
1. CPR for 2 min (IO/IV access)
- Epi every 3-5 minutes
- Consider advanced airway
2. Shockable rhythm?
- Yes --> Shock + CPR
- No --> CPR for 2 min and treat reversible causes
3. Shockable rhythm?
- if asysotle/PEA continue CPR
- Organized r

Shock amount for defibrillation in PALS

- 1st shock = 2 J/kg
- 2nd shock = 4 J/kg
- Subsequent shocks � 4 J/kg
- Maximum = 10 J/kg or adult dose

If you are giving amiodarone during a pediatric cardiac arrest, give this amount

5 mg/kg bolus during cardiac arrest
- may repeat up to 2x for refractory VF or pulseless VT

If a patient has a pulse and has VT what med can you give?

1. Adenosine 0.1 mg/kg
= push
- if that doesn't help, synch cardiovert
2. Amiodarone 5 mg/kg over 20 mine to 1 hour

High flow O2 is considered

> 10 mL, O2 flow exceeds patient inspiratory flow
- i.e. nonbreathing mask with resevoir

Low flow O2 is considered

< 10 L/min
- patinet inspiratoyr flow exceeds O2 flow
- Ie nasal nasal cannula, simple O2 mask

What is the difference between OPA (Oropharyngeal airway) and NPA (Nasopharyngeal Airway)?

a. OPA (oropharyngeal airway) = only for unconscious victim without gag reflex
b. NPA (nasopharyngeal airway) = for conscious or semiconscious victim

How do you find the right ET tube size?

16 + age / 4

When could you do a synchronized cardioversion?

- Unstable SVT
- VT with pulses
- Afib
- Aflutter

Cardioversion J vs Defibrillation J

Cardioversion: 0.5-1 J/kg
Defibrillation: 2-4 J/kg

PALS
if there is an advanced airway, how many respirations per min?

8-10