PALS

Signs of distributive shock

Tachypnea, tachycardia, WARM SHOCK (bounding pulses, brisk cap refill, warm, flushed extremities, hypotension with wide pulse pressure) then COLD SHOCK (delayed cap refill, pale mottled skin, hypotension), fever

Atropine: Class, indication, Dose, Special considerations

*class: Anticholinergic *Indication: Symptomatic bradycardia caused by vagal stimulation, toxins /overdose. *Dose: IV- 0.02 mg/kg (max 1mg) ET: 0.04-0.06 mg/kg.

Epinephrine: Class, indication, Dose, Special considerations

*class: Catecholamine, vasopressor, Inotrope *Indication: Anaphylaxis, Ashtma, Bradycardia, Croup, Cardiac arrest, Shock *dose: 0.01 mg/kg every 3-5 min for cardiac arrest

Mag sulfate: Class, indication, Dose, Special considerations

*class: Electrolyte *Indication : Asthma, Trosades de pointes, hypomag *Dose: Varies 25-50 mg/ kg

Dobutamine: Class, indication, Dose, Special considerations

*class: Selective B-adrenergic agent *Indication: Ventricular dysfuncion *Dose: 2 -20 mcg/kg per minute. Do NOT mix with sodium bicarbinate.

Management of Neurogenic shock

*minimal response to fluid resuscitation. Use vasopressors (norepinephrine, epi) Warming methods, position child flat or head down to increase venous return

When is Atropine first line drug over epi for bradycardia?

When bradycardia is caused by increased vagal tone, cholinergic drug toxicity, or complete AV block. Preferred if brady is because of symptomatic AV block due to *primary bradycardia.

What is the purpse of identify step?

To identify the type and severity of the childs problem

Define shock

critical condition that results from inadequate tissue delivery of o2 and nutrients to meet tissue metabolic demand.

Dextrose:

*Class: Carbohydrate *Indication: Hypoglycemia *Dose: IV 0.5-1 g/kg.

AbG result of aklalosis

ph >7.45

Poor contractility causes what shock?

(also referred to as myocardial dysfunction) It can lead to cardiogenic shock. Can be caused by myocarditis, hypoglycemia, toxic injections

Sodium Bicarbinate: Class, indication, Dose, Special considerations

*Class: Alkalinizing agent *Indication: Metabolic acidosis, hyperkalemia *Dose: 1 meq/ kg

Amiodarone: Class, indication, Dose, Special considerations

*Class: Antiarrythmic *Indication: SVT, VT w/pulse, VF/ pulseless VT. *dose: SVT/ VT with pulse 5 mg/kg load over 20 -30 min, pulseless arrest 5 mg/kg rapid bolus.

Ipratropium Bromide: Class, indication, Dose, Special considerations

*Class: Anticholinergic, Bronchiodilator *Indication: Asthma *Dose: Neb: 250-500 mcg every 20 min

Vasopressin: Class, indication, Dose, Special considerations

*Class: Antidiuretic *Indication: Cardiac arrest *Dose: 0.4-1 unit/ kg max dose 40 units

Diphenhydramine: Class, indication, Dose, Special considerations

*Class: Antihistmaine *Indication: Anaphylaxis *Dose: 1 to 2 mg/kg every 4-6 hours. Decreases allergic respone

Hydrocortisone: Class, indication, Dose, Special considerations

*Class: Corticosteroid *Indication: Adrenal insufficiency *Dose: 2mg/kg Bolus Max 100

Dexamethasone: Class, indication, Dose, Special considerations

*Class: Corticosteroid *Indication: Croup, Asthma *Dose: PO/IM/IV 0.6 mg/kg x 1 dose. (croup) 0.6 mg/kg every 24hours for asthma.

Calcium Chloride: Class, indication, Dose, Special considerations

*Class: Eletrolyte *Indication: Hypocalcemia, Hyerkalemia *dose: 20 mg/kg IV bolus. Flush before and after infusion. Do not use routinely during cardiac arrest.

Norepinephrine:Class, indication, Dose, Special considerations

*Class: Inotrope, Vasopressor, Catecholamine *Indication: Hypotensive shock (associated with LOW SVR. "Warm shock". *Dose: 0.1 to 0.2 mcg/kg per minute infusion

Naloxone: Class, indication, Dose, Special considerations

*Class: Opioid Receptor anatagonist *Indication: Narcotic Reversal *dose: 0.1 mg/kg

Nitroglycerin: Class, indication, Dose, Special considerations

*Class: Vasodilator, antihypertensive *Indication: Congestive heart failure, cardiogenic shock

Prostaglandin E (alprostadil) Class, indication, Dose, Special considerations

*Class: Vasodilator, prostoglandin *Indication: Maintain patent ductus areteriousis for ductal dependent congenital heart disease. * Dose: Initial 0.05 to 0.1 mcg/kg , maintance 0.1 to 0.5 mcg/kg.

LIdocaine: Class, indication, Dose, Special considerations

*class: Antiarrhythmic *indication: VF/pulseless CT, Wide complex Tach (with pulse) *Dose: Initial 1 mg/kg loading bolus. Maintenance: 20 to 50 mcg/ kg per minute infusion

Management of Tachyarrythmias with SVT

1. Check for pulse. 1a. Absent: Initiate cardiac arrest 1b. Present: check if perfuson adequate. 2. Evaluate QRS duration. If SVT consider vagal maneuvers, Consider adenosine 0.1 mg/kg

Septic shock, signs

Most common form of distributive shock. Subtle signs at first (fever, decreased, normal or incresased WBC) left shift (increased percent of bands or immature WBC)

Glucose dosing

0.5 - 1 g/kg IV

Cardioversion dose:

0.5-1 J/kg if not effective increase to 5 J/kg

Types of AV block

1. First degree, May be present in healthy children, myocarditis, hypoxemia, cardiac surgery, drugs. Prolonged PR interveral. 2. Second degree: Mobitz type I (Wenckeback) *Causes: May be present in healthy children, Drugs, Myocardial infarction .*Character: Progressive prolongation of the PR interval until a P wave is no conducted then repeats, 3. Second degree: Mobitz II: *Causes: Intrinsic conduction system, cardiac surgery, myocardial infarction *Character: Some but not all P waves are blcoked before the reach the venticle PR interval constant 4. Third degree: No relation between P waves and QRS.

Stroke volume is determined by what three factors?

1. Preload (volume of blood present in the ventricle before contractions. 2. Contractility (strength of contraction) 3. Afterload (resistance against which the ventricle is ejecting)

How much blood do you give if needeD?

10ml/kg

Procainamide dose

15 mg/kg over 30-60 min

Drugs to manage shock after ROSC. Hypotensive vs normotensive

Hypo: Epi, Dopamine, Norepi Normo: Dobutamine, Dopamine, Epi, Milrinone

Name some metabolic Derangments that contribute to shock

Hypoglycemia, Hypocalcemia, Hyperkalemia, Metabolic acidosis

Amiodarone dose

5mg/kg over 20-60 min

Fluid Rescusitaion rates

<10 kg: 4 ml/kg per hour 10-20 kg: 40 ml/ hour + 2 ml/kg per hour >20 kg: 60 ml/hour + 1 ml/kg per hour

Size of paddles according to weight

>10 kg (app 1 year or older)- Large "adult" pads <10 kg (<1 year)- Small "infant" pads

Signs of Cardiopulmonary Compromise

Hypotension, Acutely altered mental status, Signs of shock

Signs of cardipulmonary compromise associated with bradycardia:

Hypotension, Decreased LOC, shock, poor end organ perfusion, respiratory distress or failure, sudden callapse

How are Tachycardia classified? What are they?

Aaccording to QRS complex width. Narrow complex: Sinus tach, SVT, Atrial flutter Wide complex: Vtach, SVT with abberrant intraventricular conduction

What is SVT?

Abnormally fast rhythm originating above the ventricles.

What would you watch to monitor the effectiveness of of ventilation?

Visible chest rise, o2 saturation, heart rate, blood pressure, distal air entry, signs of improvement in color and agitation.

Management of anaphylaxis

Administer IM epinephrine every 10-15 min as needed, treat bronchospasm with albuterol, for hypotension place in tredelenburg, administer isotonic crystalloid (NS, LR)

Management of mild to mod asthma

Administer o2, albuterol, oral corticosteroids

Compression depth for adults vs children vs infant

Adult: 2 inches Children: 1/3 AP Diameter (about 2 inches) Infant: 1/4 AP diammeter (about 1 1/2 inches)

Factors associated with increased work of breathing

Airway resistance, lung compliance, Inspiratory and expiratory flow, central nervous system control of breathing.

What is ABCDE of primary assessment?

Airway, Breathing, Circulation, Disability, Exposure

AVPU Pediatric response scale

Alert (awake, active), Voice (Childs responce to voice) Painful (response to pain) Unresponsive

Adenosine: Class, indication, Dose, Special considerations

Antiarrythmics, SVT, first dose 0.1 mg/kg. second dose 0.2 mg/kg. (rapid push)

What are the arrest rhythms?

Asystole, Pulseless Electrial activity (PEA), VF, Pulseless VT, including torsades de pointes

Name the reversible H's(6) and T's(4) related to causes of cardiac arrest

Hypovolemia, Hypoxia, Hydrogen ion, Hypoglycemia, Hypo-/Hyperkalemia, Hypothermia, Tension pneumo, Tamponade, Toxins, Thrombosis (pulmonary and Coronary)

types of circulatory issues and severity

Hypovolemic shock, distributive shock, cardiogenic shock, obstructive shock. Severity: compensated shock vs hypotensive shock

Respiratory failure

Clinial state of inadequate oxygenation, ventilation or both. Often the end stage of resp distress. Signs: Marked tachypnea (early), Bradypnea (late), increased, decreased or no resp effort, poor distal air movement, tachycardia (early)_, Bradycardia(late) Cyanosis, stupor

Respiratory distress

Clinical state characterized by abnormal respiratory rate or effort. Signs include tachypnea, nasal flaring, retractions, Hypoventilation, bradypnea, stridor, wheezing, grunting, tachycardia, pale -cool skin, changes in LOC

Stridor: What do you hear? Indicates?

Coarse, usualy high-pitched breathing heard on inspiration. Sign of upper airway obstruction. Ex: croup, laryngomalacia, tumor or cyst.

Sequence of events with non shockable rhythm.

CPR for 2 min then administer epineprhine and if not shockable continue CPR 2 min

Vent/Perf imbalance and hypoxemia

Causes: Pneumonia, atelectasis, ards, asthma, bronchiolitis Treat: PEEP to increase mean airway pressure

Diffusion defect and hypoxemia

Causes: pulmonary edema, interstitial pneumonia, alveolar proteinosis Mech: impaired O2 and CO2 between the alveolus and blood esults in decreased PaO2 Treat: Supp O2

Management of VT

Check for pulse. Administer Adenosine. Treat reversible causes, consider pharm conversion Amiodarone 5 mg/kg over 20 - 60 min or procainamide 15 mg/kg over 30 to 60 min. Consider electrical conversion Cardioversion 0.5 to 1 J/kg

How does norepinephrine help with warm shock? (hypotensive (vasodilated))

Chosen for its vasoconstricting effects, which ran raise diastolic blod pressure by increasing SVR, it is chosen for its ability to increase cardiac contractility with little change in heart rate.

Albumin: Class, indication, Dose, Special considerations

Class: Blood product derivative, Indication: Shock, trauma, burns. Dose: 0.5-1 g/kg rapid infusion. Expands intravascular volume . *monitor for signs of pulmonary edema

Albuterol: Class, indication, Dose, Special considerations

Class: Broncodilator *Indication- Asthma, Anaphylaxis, Hyperkalemia. *dose: <20 kg- 2.5 mg/dose, >20 kg -5 mg/dose Continuous 0.5 mg/kg. May consider ipratropium bromide with continous.

Furosemide: Class, indication, Dose, Special considerations

Class: Loop Diuretic *Indication: Pulm edema, Fluid overload *Dose: 1 mg/kg

Dopamine: Class, indication, Dose, Special considerations

Class: Vasopressor, inotrope *Indication: Vent dysfunction including cardiogenic shock, distribute shock, *Dose: 2-20 mcg/kg per minute

What three things are you looking at during the inital impression?

Consciousness, Breathing, Color

Management of cardiogenic shock

Consider slow administration ( 10-20 min) fluid bouls (5-10 ml/kg bolus). Medications, Mechanical circulatory support, Diuretics if pulmonary edema is present,

ABG result of acidosis

Ph <7.35

Bradycardia Algorithm

Maintain/ treat underlying cause--> If cardiopulmonary compromise then CPR if HR <60/min -->If Brady persists give Epinephrine then Atropine , consider pacing, treat underlying cause

Improving volume and distribution of cardiac output and *obstructive shock

Fluid bolus, possible vasoactive agents.

Secondary assessment contains what?

Focused history and focused examination. Signs and symptoms, allergis, medicine, past medical history, last meal, events

Torsades de pointes

Form of VT. QRS changes in polarity and amplitude appearing to rotate. Typically indcates need for mag sulfate. Can indicate hypomag, hypokalemia, or drug toxicity.

What acronym do you use to figure out cause of deteriated intubated patient

DOPE: D: Displacement of tube O: Obstruction of the tube- secretion, blood, pus and foreign body P: Pneumothorax- E: Equipment failure

Physiology of hypovolemic shock and compensatory mech

Decreased preload to reduced stroke volume and low cardiac output. Compensatory mech: Tachycardia, increased SVR, and increased cardiac contractility.

Hypotensive shock (decompensated shock)

Develops with physiologic attempts to maintain systolic blood pressure and perfusion are no longer effective. Marked by decrease LOC.

Management of anyphylactic shock

Goal to reverse uncontrolled allergic response. Primary therapy to administer epinephrine to reverse hypotensions and release of histamine. IM epi, may be repeated 10-15 min if severe. Give isotonic bolus. Albuterol, Antihistamines, corticosteroids

Name Inotropes

Dopamin, epinephrine, dobutamine - increase cardiac contractility, increase heart rate, produce variable effects on SVR

What are advanced airway interventions?

Endotrachial intubation, CPAP, Removal of foreign body, cricothyotomy

Vasopressor (vasoconstrictors)

Epinephrine, Norephinephrine, Dopamine, Vasopression - INcrease SVR, INcrease myocardial contractility

What is preferred treatment for "cold shock"?

Epinephrine, vasoactive it has a potent inotropic effect that improve stroke volume. At low volume can lower SVR, and at higher rates can increase SVR.

Epi dose and Atropine dose for bradycardia

Epinephrine: 0.01 mg/kg Repeat every 3-5 minutes. ET tube 0.1 mg/kg. Atropine: 0.02 mg/kg repeat once, max dose of 0.2 mg

Name several central pulses

Femoral, Brachial, Carotid, Axillary

Adenosine dose

First 0.1 mg/kg rapid bolus, second 0.2 mg/kg rapid bolus

What does prrimary assessment consist of

Hands on ABCDE approache, Evaluate respiratory, cardiac, neurologic function

Management of upper airway obstruction

Head tilt chin lift, remove foreign object, suction the nose or mouth, minimize agitation, Decided need for advanced airway

circulation assessment consists of:

Heart rate and rhythm, pulses, cap refill, skin color and temp, blood pressure

What happens to blood flow if o2 delivery is compromised.

IT is redirected from nonvital organs (skin, skeletal muscles, gut, kidneys) to vital organs (brain, heart). This redirection occurs by a selective "increase in SVR (vasoconstriction)" Which results in decreased peripheral perfusion (decreased cap refill, cool extremities, less easily palpable pulses, decreased urine output)

How is cardiac output affected with bradycardia?

If heart rate decreases then stroke volume will need to be increased and ability to increase stroke volume is limited so cardiac output generally declines.

At what point do you begin CPR with bradycardia?

If heart rate is less than 60 despite adequate oxygenation

Tachycardia effects on cardiac output

If heart rate too fast stroke volume decreases because diastole is shortened and there is insufficient time for filling of ventricles during diastole. Can lead to CHF.

Signs of hypovolemic shock

Impaired LOC, tachypnea, tachycardia, adequate systolic blood pressure, weak or absent peripheral pulses, normal/ weak central pulses, delayed cap refill, cool,pale, mottled extremities.

What are causes of decreased or asymmetrical chest expansion?

Inadequate effor, airway obstruction, atelectasis, pneumothroax, hemothoras, pleural effusion, mucous plug, foreign body aspiration

The most common cause of low stroke volume

Inadequate preload, therefore low cardiac output. Ex: Hemmorrhage, sever dehydration, vasodilation, results in hypovolemic shock.

Describe distributive shock

Inappropriate distribution of blood volume with inadequate tissue and organ perfusion. Common forms are septic, anaphylactic, neurgenic.

What are signs of upper airway obstruction?

Increased Inspiratory effor with retractions, Abnormal inspiratory sounds (snoring), Episodes where no airrway or breath sounds are present.

Common compensatory mechanisms

Increased heart rate, increased SVR (cold, pale skin, delayed cap refill, weak peripheral pulses), increased renal and splanchnic vascular resistance (oliguria-decreased urine output, vomiting, ileus)

Signs of obstructive shock

Indistinquishable from hypovolemic shock at first, then signs of increased resp effort, cyanosis, and vascular congestion become more apparent.

Common signs and symptoms of SVT:

Irritability, poor feeding, rapid breathing, unusual sleepiness, vomiting and pale, mottled, gray, or cyanotic. HR >220/min in infants and HR>180 min in children

Describe compensated shock

Is systolic blood pressure is within normal range but there are signs of inadequate tissure perfusion, the child is in compensated shock.

Cardiovascular system post resuscitation management

Monitor HR, Blood pressure, Spo2, urine output, central venous pressure, Monitor end organ function. Watch lab test (hgb, hct, glucose) perform chest xray, ECG. Possible fluid bolus

Assessment of Renal system post ROSC

Monitor UO, Examine for distended bladder, examine for hypovolemia, Asses renal function ( BUN/ Creatinine) ABG, serum glucose, anion gap.

Hypovolemic shock

Most common cause of shock in children. Results from fluid loss from Diarrhea, vomiting, hemorrhage, inadequate fluid intake, DKA< third space loss, large burns. Depletion of most intravascular and extravascular fluid volume.

Primary assessment: Airway

Look for movement of chest and status.1. Clear (airway is open and unobstructed) 2. Maintainable (Airway is obstructed but can be maintained by siimple measure (head tilt chin lift) 3. Not maintainable (airway is obstructed and cannot be maintained without advanced interventions (intubation)

ABG result of hypoxemia

Low PaO2

Causes of central cyanosis

Low ambient o2 tension (high altitude), alveolar hyoventilation (TBI, drug overdose), Diffusion defect (pneumonia),Ventilation/ perfusion imblanace (asthma, bronchiolitis), Intracardiac shunt (cyanotic congenital heart disease)

Hypoxemia

Low arterial O2 tension (pao2) that is associated with low O2 saturation assessed by Puulse oximiety (Spo2)

Atrial flutter

Narrow complet tachyarrythmia. Sawtooth appearance.

Name Vasodilators

Nitroglycerin, Nitroprusside- Decrease SVR an dvenous tone

Different types of vasoactive therapy during septic shock based on symptoms:

Normotensive: Dopamine Hypotensive (vasodilated )(warm)- Norepinephrine Hypotensive (vasoconstricted) (cold)- Epinephrine rather than norepinephrine

Cardiac tampanode- type of shock, patho

Obstructive shock, caused by an accumulation of fluid, blood or air int he pericardial space. Causing increased intraperiocardial perssure and compression of the heart impeding systemic venous and pulmonary venous return. Can result in Pulseless electrical acitivity.

Signs of Mild croup and interventions

Occasional barky cough, little or no stridor Intervention: Consider Dexamethasone

Upper Airway Obstruction: Causes and signs

Occur in nose, pharynx, larnx Causes: foriegn body aspiration, anaphylasix, croup, epiglottis, tumors or mass. Signs: (often occur during Inspiration) Tachypnea, Retractions, nasal flare, hoarseness, stridor, poor chest rise, poor air entry

Lower airway Obstruction:Causes and signs

Occur in trachea, bronchi, or bronchioles Cuases: Asthma, bronchiolitis Signs: (occur during expiration) tachypnea, wheezing, retractions, nasal flare, Prolonged expiratory phase, cough

Management of bronchiolitis

Perform oral/nasal suction, consider lab tests such as viral studies, chest xray, abg

Causes of decreased level of consciousnes:

Poor cerebral perfusion, traumati brain injury, encephalitis, hypoglycemia, drugs, hypoxemia, hypercarbia

General management of shock

Positions (most comfortable), Airway and breathing (high concentration), Vascular access, Fluid resuscitation (Isotonic, 20 ml/kg), monitoring, Frequent reassessment, Lab studies, Medication therapy.

What are the steps of evaluate?

Primary assessment, secondary assessment, and diagnostic tests

You come upon a patient who is unresponsive, they DO have a pulse, what is your next action

Provide rescue breathing

Name several peripheral pulses

Radial, dorsalis pedis, posterior tibial

Improving volume and distribution of cardiac output and *Hypovolemic shock

Rapid administration of isotonis crystalloid fluids

Pao2: how does it work

Reflects o2 dissolved in plasma. If hgb is low, pao2 will benormal or high. Low hgb is inadequate to deliver o2 to tissues though pulse ox reads 100%.

Signs of Hemodynamic instability associated with tachycardia.

Resp distress/ failure, signs of shock, altered mental status , sudden collapse with rapid, weak pulse

Breathing assessment includes eval of what?

Resp rate, resp effort, chest expansion, Lung and airway sounds, o2 saturations

Secondary bradycardia

Result from non cardiac conditions that alter the normal function of the heart of the heart. Causes included: Hypoxia, acidosis, hypotension, hypothermia, drug effects

Primary bradycardia

Result of congenital or acquired heart conditions that slow the spontaneous depolarization rate of the hearts normal pacemaker cells. Causes include: Congenital abnormalities, surgical injury, cardiomyopthay, myocardities

How do you treat Septic shock?

Results from host responding to infections, and releasing inflammatory responses. Primary goals to: Restore hemodynamic stability, ID and control infection. 1. Give 02, support ventilation, hr, bp, temp. 2.initiate aggresive isotonic bolus fluids administration, treat fluid refractory septic shock with vasoactie agents, anticipate adrenal insufficiency and administer stressdose hydrocortisone and does not react to vasoactive medications

Cardiogenic shock and pathy

Results from inadequate tissue perfusion secondary to myocardial dysfunction. Common causes: congenital heart disease, myocarditis, arrhythmias, sepsis, myocardial injury. Marked by tachycardia, high SVR, and decreased Cardiac output.

Shockable rhythm vs non shockable

Shockable: VF/ VT Non Shock: Asystole/ PEA

Grunting

Short, low pitched sound hearing during expiration. Child uses in attempt to optimize oxygenation and ventilation. Sign of small airway collapse, alveolar collapse, pneumonia, pulmonatry contusion, ARDS.

Whats used to buffer metabolic acidosis

Sodium bicarbinate- works by combining the hydrogen isons to procude carbon dioxide and water, carbon dioxide with then eliminated through increased alveolar ventilation. *should not use in hypovolemic shock,

Sequence to take with shockable rhythm.

Start CPR----> Shock-->CPR 2 min (establish IV/IO access)--->Check Pulse---->If shockable rhythm Shock again---> begin CPR and administer Epi every 3-5 min (vasopressor)----> Check Rhythm--->If shockable rhythm Shock again and adminster Amiodarone or LIdocaine if Amiodarone not available(Antiarrhythmic)

How do you treat hemorrhagic shock?

Start with isotonic crystalloids, Because these are distributed through extracellular space it may be necessary to give up to three bolus of 20 ml/kg. approximately 3 ml of crystalloid is needed for every 1 ml of blood lost.

Tachycardia is a normal repsonse to what?

Stress or fever, pain, tissue hypoxia, hypovolemia, shock, metabolic distress, injury, anemia

Equation for cardiac output:

Stroke volume x heart rate. If one decreases the other has to increase.

Name some mild to moderate types of retractions:

Subcostal ( Adbomen, below the rib cage) Substernal (Abdomen, bottom of breast bone) Intercostal (retraction between ribs)

Improving volume and distribution of cardiac output and *Distributive shock

Suspect when there is a low SVR and maldistribution of blood flow. Rapidly restore intravasular volume. Consider vasopressors if hypotension persists,

Improving volume and distribution of cardiac output and *Cardiogenic shock

Suspect with signs of shock when there are signs of poor perfusion, and pulmonary or systemic venous COngestion. (increased work of breathing, grunting). Use positive pressure ventilation, consider *slow infusion of IV fluid using 5 - 10mg/ks over 10-20 min. Select inotropic and vasodilator therapy.

Signs of tissue hypoxia

Tachycardia, Tachypnea, nasal flaring, retractions, agitation, pallar, cyanosis (late), bradypnea (late) Bradycardia (late)

Lung tissue disease: Causes and signs

Term iven to heterogeneous group of clinical conditions at level where gas exchange occurs. Causes: Pneumnoia, pulm edema, CHF, ARDS, pulmonary contusion, toxins signs: tachypnea, inc resp effort, grunting, crackles, diminished breath sounds, tachycardia

Pathophysiology of shock

The major function of cardiopulmonary system is to deliver 02 to body tissue and remove metabolic waste (CO2). when o2 deliever is inadequate to meet tissue deman cells use anaerobic metabolism to produce energy and creates lactic acid by product

Define oxygen saturation

The percentage of hemoglobin that becomes bound to 02

Signs of Tension Pneumothorax

Tracheal deviation towards contralateral side, Resp distress, *Hyperresonance of affected side, hyperexpansion of affected side, *diminished breath sounds on affected side, distended neck veins, pulsus paradoxus,

Levels of consciousness

Unresponsive, irritable, alert

Types of respiratory issues and severity.

Upper airway obstruction, lower airway obstruction, lung tissue disease, disordered control of breathing. Severity: Resp distress vs resp failure

When is dopamine used with septic shock?

When child presents with imparied perfusion but adequate blood pressure. At low dose this impairs renal and splanchnic blood flow. At high doses SVR is increased. If perfusion does not get better with dopamine go ahead with epinephrine and norepinephrine.

Ventricular Tachycardia

Wide complex tachyarrythmia, generated within ventricles.Compromises vent filling, stroke volume and cardiac output and can detriate unto pulseless VT.

What is the purpose of the evaluate- identify- intervene sequence?

Will help you determine the best treatment or intervention at anny point.

Management of mod to sever asthma

administer high o2, albuterol (possible continuous), administer ipratropium bromide by nebulizer, Administer IV corticosteroids, Consider mag sulfate continuous, Perform diagonstic tests.

Signs of anaphylactic shock

anxiety, agitation, hives (urticaria) angioedema (swelling of face, lips), resp distress, hypotension, tachycardia

impending respiraotry failuer

barking cough, audible stridor, retractions, lethargy or decreased LOC, pallor, cyanosis. Interventions: adminster high concentration of 02, assist ventilation, dexamethasone, intubate.

Obstructive shock

cardiac output is imparied by a physical obustrction of blood flow. Causes include: Cardiac tamponade, tension pneumothorax, ductal-dependent congential heart disease, massive pulmonary embolism. The obstruction causes low cardiac output, inadequate tissue perfusion and compensatory increase in SVR.

Patho of distributive shock

cardiac output may be increased, normal or decreased. Stroke volume can be adequate. Hypoxic tissue generates lactic acid, leading to metabolic acidosis. Early on shows "warm shock" bounding pulses and warm extremities. Has high cardiac output and low SVR (different than every other shock). Later will have signs of "cold shock" Low cardiac output and high SVR.

Alveolar hypoventilation and hypoxemia

causes: CNS infection, traumatic brain injury, drug overdose, apnea treatment: Restore normal ventilation supplementory O2

Cardiopulmonary failure is:

combination of respiratory failure and shock. Characterized by inadequate oxygenation, ventilation, tissue perfusion. May indicate to only be minutes away from cardiac arrest.

Signs of poor perfusion

decreased responsiveness, weak peripheral pulses, cool mottled skin.

What could a flushed appearance suggest>

fever or presence of toxin

Sign of moderate croup and interventions

frequent barking cough, easily audible stridor at rest, retractions at rest, little or no agitiation Intervention: administered o2, give nothing by mouth, observe for at least 2 hours after nebulized epinephrine, administer dexamethasone, consider heliox.

severe croup signs and inverventions

frequent barking cough, prominent inspiratory and occasional expiratory stridor, marked retractions, significant agitation, decreased air entry by auscultation Intervention: administered o2, give nothing by mouth, observe for at least 2 hours after nebulized epinephrine, administer dexamethasone, consider heliox.

ABG result of hypercarbia

high PaCO2

Quiet tachypnea results from:

high fever, pain, DKA, sepsis, CHF, Severe anemia

If ventilation is not effective what do you do?

reposition/ open airwa, verify mask size and tight seal, suction airway, chest o2 source, check the ventilation bag and mask, treat gastric inflation

In children most cardiac arrest results from what

progressive respiratory failure, shock or both

You come upon a patient who is unrepsonsive, they have no pulse what is your next action?

start CPR, beginning with chest compressions, Proceed to pediatric cardiac arrest algorithm

Name severe retractions

supraclavicular (retract in neck, above collar bone) suprasternal (retraction in chest, above the breast bone) Sternal (retraction of sternum toward spine)

Signs of cadiac tampanode

tachycardia, poor peripheral pulses, MUFFLED or DIMINISHED HEART SOUNDS, narrowed pulses, PULSUS PARADOXUS (decrease in systolic blood pressure during inspiration) distended neck veins.

Signs of cardiogenic shock

tachypnea, increased resp effort (retractions, nasal flaring, grunting), tachycardia, weak/ absent peripheral pulse, normal/ weak central pulse, signs of congestive heart failure (pulmonary edema, hepatomegalic, JVD) Cyanosis, cold, pale mottled,

Definition of cardiac arrest

the cessation of blood circulation resulting from absent or ineffective cardiac mech activity. No detectable pulse.

Leading cause of bradycardia in children

tissue hypoxia