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PALS
Chapter 2
| Question | Answer |
|---|---|
| Why is it necessary to use an organized, systematic method to evaluate a child? | Because in a child respiratory failure, respiratory arrest, and or shock can quickly deteriorate to cardiopulmonary failure or cardiac arrest. Rapid recognition and intervention are required. |
| What are the most common causes of cardiac arrest in infants and children? | progressive respiratory failure or shock or both |
| What is the less common cause of cardiac arrest in infants and children? | arrhythmias such as VT and VF |
| What are the percentages of survival for infants and children in cardiac arrest in hospital and out of hospital? | in hospital only 33% survive, out of hospital only 4-13% even with optimal resuscitation effort |
| What can we do to prevent infant and child progression to cardiac arrest? | be able to readily identify the signs of respiratory failure and shock and intervene promptly |
| What are the assessments made during the initial assessment? | consciousness, breathing, color |
| What are the types of consciousness that might be assessed during the initial impression? | alert, irritable, unresponsive |
| What are some possible causes of decreased level of consciousness? | inadequate oxygen, substrate delivery, or brain trauma/dysfunction |
| What are the signs of abnormal breathing? | increased work of breathing, use of accessory muscles, absent or decreased respiratory effort, extra breath sounds, irregular breathing patterns |
| What are the signs of abnormal color? | pale, mottled, pallor (bluish/gray skin), flushing |
| What could cause cyanosis, pallor, or mottling in an infant/child? | poor perfusion, poor oxygenation or both |
| What are two possible causes of flushing of the skin in an infant/child? | fever, toxin |
| What is the next course of action if you find an infant/child is unresponsive and not breathing or only gasping? | activate emergency response system and check pulse |
| What is the next course of action if you find that an infant/child is unresponsive, not breathing or gasping and there is no pulse? | start CPR and follow the PALS cardiac arrest algorithm |
| What is the next course of action if an infant/child is not breathing or only gasping but pulse is present? | provide rescue breathing |
| What is the next course of action if an infant/child, despite adequate oxygenation and ventilation has a heart rate less than 60 with signs of poor perfusion? | compressions and ventilations, proceed with Pediatric Cardiac Arrest algorithm |
| What is the three step sequence of action that is repeated until an infant/child is stable? | Evaluate-Identify-Intervene |
| What clinical assessment tools make up the Evaluate step of the Evaluate-Identify-Intervene sequence? | Primary assessment, Secondary assessment, diagnostic tests |
| What are the components of the primary assessment? | Rapid hands on assessment of respiratory, cardiac, neurologic function, vital signs and pulse oximetry using the ABCDE approach |
| What is the secondary assessment? | a focused medical history and focused physical exam |
| What do we mean by diagnostic tests? | labs, x-rays, us, etc |
| During the identify step of the Evaluate-Identify-Intervene sequence, what are the main areas of focus? | Type and severity of Respiratory or Circulatory disorders which can quickly lead to cardiopulmonary failure and or cardiac arrest |
| List the types and severities of respiratory problems that you will assess for. | types: upper airway obstruction, lower airway obstruction, lung tissue disease, or disordered control of breathing. Severity: respiratory distress, respiratory failure |
| List the types and severities of circulatory disorders that you will assess for. | types: hypovolemic, distributive, cardiogenic, or obstructive shock. Severity: compensated or hypotensive shock |
| Positioning for patent airway, activating emergency response, st CPR, attaching cardiac monitor and pulse ox, administering 02, supporting ventilation, starting medications or fluids are considered which step of the Evaluate- Identify-Intervene process? | intervention |
| What is the next course of action after every intervention or when the child’s condition changes or deteriorates? | reevaluate the child, start the Evaluate-Identify-Intervene sequence again if the problem is life threatening activate emergency response |
| List four signs that indicate Life threatening situations. | absent or agonal breathing, respiratory distress, cyanosis, decreased level of consciousness |
| What does ABCDE model stand for in the primary assessment? | Airway, Breathing, Circulation, Disability, Exposure |
| When assessing the Airway what determinations are we making? | is the upper airway open, if not is it maintainable or not maintainable |
| How do we assess the Airway? | look for movement of the chest or abdomen, listen for air movement and breath sounds |
| What signs suggest obstruction of the upper airway? | increased respiratory effort, retractions, abnormal inspiratory sounds (stridor, snoring), no airway or breath sounds despite inspiratory effort |
| What is the definition of a maintainable airway according to PALS? | can be maintained by simple measures such as head tilt-chin lift, NPA, OPA |
| What do you do if you suspect a foreign-body airway obstruction? | If the child is still responsive and has complete airway obstruction <1 year =5 back slaps and 5 chest thrusts, >1 year = abdominal thrust |
| What are the possible advanced interventions for airway patency? | ET tube, CPAP, Removal of foreign body (may require visualization via larngoscopy), cricothyrotomy (a surgical opening into the trachea below the vocal chords) |
| What assessments are necessary to evaluate breathing? | respiratory rate and effort, chest expansion and air movement, lung and airway sounds, O2 sats |
| What are the normal respiratory rates for Infants (<1yr), toddlers (1-3), preschoolers (4-5), school age (6-12), and adolescents (13-18)? | infant 30-60, toddler 24-40, preschool 22-34, school age 18-30, adolescent 12-16 |
| What consistent respiratory rates, low and high, in a child should sound an alarm if assessed in a child of any age? | less than 10 or greater than 60 |
| How would you expect conditions that raise the metabolic demand such as fever, excitement, anxiety, exercise, pain to affect a child’s respiratory rate? | would expect respiratory rate to be higher than normal |
| What irregularity in breathing pattern during sleep is normal for infants? | periodic breathing with pauses lasting as long as 10-15 seconds |
| When is a return to a more regular rate of breathing in a child a good sign? A bad sign? | good when the child shows signs of improvement such as improving LOC, reduced work of breathing and reduced signs of air hunger, bad when LOC continues to deteriorate |
| Define quiet tachypnea. | compensatory rapid breathing that does not produce signs of increased respiratory effort often related to the compensation to increase PH by moving CO2 out of the lungs and decreasing levels in the blood |
| What are some nonpulmonary causes of quiet tachypnea? | fever, pain, metabolic acidosis, dehydration, DKA, sepsis, CHF (early), anemia, congenital heart defect like transposition of the great vessels |
| Define apnea. | cessation of breathing for >20 seconds or less than 20 seconds with bradycardia, pallor or cyanosis |
| What are some possible causes of bradypnea? | respiratory muscle fatigue, central nervous system infection or injury, hypothermia, or medications that suppress respiratory drive |
| What concern is related to bradypnea or an irregular respiratory rate in an acutely ill infant or child? | bradypnea/irregular respiratory rate is an ominous sign often signaling impending arrest |
| Increase respiratory effort often results from pulmonary conditions that increase resistance to airflow. Name some pulmonary conditions that would increase resistance to airflow. | asthma, bronchiolitis, pneumonia, pulmonary edema, pleural effusion |
| Name some non-pulmonary conditions that can result in acidosis and compensatory increased rate and work of breathing. | DKA, Salicylate ingestion, congenital metabolic disorders |
| What signs indicate increased work of breathing? | nasal flaring, retractions, head bobbing, seesaw respirations, prolonged inspiratory or expiratory times, open mouth breathing, gasping, use of accessory muscles, grunting |
| Where are retractions noted if breathing difficulty is mild to moderate? | subcostal –retraction of the abdomen just below rib cage, substernal-retraction of abdomen at the base of the sternum, and intercostals- between the ribs |
| Where are retractions noted if breathing difficulty is severe? | supraclavicular – in the neck, suprasternal – just above the breastbone, sternal – sternum toward the spine |
| Head bobbing or seesawing in a child is often an indication of what? | increased risk for deterioration |
| Define seesaw breathing. | chest retracts and abdomen expands during inspiration and the reverse for expiration |
| Seesaw breathing is an inefficient form and of ventilation and quickly leads to _________. | fatigue |
| What are some possible causes of seesaw breathing? | upper airway obstruction, severe lower airway obstruction, lung tissue disease, disordered control of breathing, characteristic of infants and children with neuromuscular weakness |
| Seesaw breathing is characteristic of children and infants with what type of condition? | neuromuscular weakness |
| Retraction and what suggest upper airway obstruction? | stridor or inspiratory snoring sound |
| Retractions and what is suggestive of lower airway obstruction (asthma, brochiolitis)? | expiratory wheezing |
| Retractions and what is suggestive of lung tissue disease? | grunting or labored respirations |
Created by:
persevereandovercome