1. Signs of poor perfusion 2. Adult pads on the AED 3. Initial impression assessment Temperature, AMS, Pulses, Skin (pale, mottling, and cyanosis) Use
... [Show More] adult pads on victims 8 years of age and older Appearance: LOC, interactiveness, consolability, look/gaze/stare/ and speech/cry circulation: Skin color, petechiae or purport or visible bleeding wounds work of breathing: including position, and any audible breath sounds, respiratory effort 4. Evaluate If no life-threatening condition is present, evaluate the child's condition by using the clinical assessment tool Primary Assessment: ABCDE including vital signs 5. Primary Assess- ment Airway Breathing Circulation Disability Exposure 6. Evaluate Airway To assess the airway, determine if is is patent: Look for movement of the chest of abdomen, listen for air move- ment and breath sounds, feel for movement of air at the nose and mouth 7. S/S Upper Airway obstruction Increased inspiratory effort with retractions Abnormal inspiratory sounds (snoring or high-pitches stri- dor) Episodes where no airway or breath sounds are present despite respiratory effort (Complete upper airway obstruc- tion* *If upper airway is obstructed, determine if you can open and maintain the airway with simple measures or if you need advanced interventions 8. Simple measures Positioning: For responsive child allow a position of com- to maintain the airway fort or elevate the head of the bed. For unresponsive child turn on side or use a head told chin lift Suctioning Relief techniques for foreign-body airway obstruction Airway Adjuncts: Oropharyngeal airway to keep the tongue from falling back and obstructing the airway Relief techniques for foreign body airway obstruction: Ab- dominal thrusts and back slaps 9. Advanced Airway Endotracheal intubation Interventions 10. Assessment of breathing 11. Normal respira- tory rate 12. Causes of bradypnea 13. Increased respi- ratory effort Laryngoscopy Cricothyrotomy Respiratory rate and pattern Respiratory effort Chest expansion and air movement Lung and airway sounds Oxygen saturation and pulse ox Infant: 30-53 Toddler: 22-37 Preschool:20-28 School-aged child: 18-25 Adolescent: 12-20 Respiratory muscle fatigue Central nervous system injury Severe hypoxia Severe shock Hypothermia Drugs that depress the respiratory drive Some muscle diseases that cause muscle weakness 14. Locations of re- tractions Nasal flaring Retractions Head bobbing or seesaw respirations Mild to moderate: subcostal, substernal, intercostal Severe: supraclavicular, suprasternal, sternal 15. Stridor a coarse, usually higher-pitched breathing sound typically heard on inspiration Sign of upper airway obstruction 16. Grunting typically a short, low-pitched sound heard during expira- tion. Attempt to optimize oxygenation and ventilation Often a sign of lung tissue disease resulting from small airway collapse, alveolar collapse, or both ** Typically a sign of severe respiratory distress or failure 17. Urine Output In- fant and young children 18. Urine Output old- er children and adolescents 1.5-2 mL/kg/hr 1 mL/kg/hr 19. AVPU Response Alert Verbal Painful Unresponsive 20. Focused history S/S Allergies Medications Past Medical History Last Meal Events 21. Advanced Airway Breath q 6 seconds 22. Epi dose 0.01mg/kg q 3-5 minutes 23. Amio 5mg/kg bolus can give x 3 24. Lidocaine 1mg/kg loading dose 20-50mcg/kg/min 25. Manual Defibril- lator 26. Magnesium sul- fate 27. Causes of Upper Airway Obstruc- tion 28. S/S Upper airway obstruction 29. S/S Lower Airway Obstruction 30. Causes Lower airway obstruc- tion 2-4J/kg 25-50mg/kg IV IO Max 2g Foreign body aspiration, swelling, thick secretions, mass, congenital airway abnormality **Stridor Increased rate and effort, increased inspiratory and respi- ratory effort (retractions, use of accessory muscles, nasal flaring), inspiratory stridor, change in voice, cry, barking cough, drooling, snoring, gurgling sound, poor chest rise, poor air entry on auscultation **Wheezing Increased rate and effort, decreased air movement on auscultation, prolonged expiratory phase, cough Asthma bronchiolitis 31. Lung Tissue Dis- ease Causes PNU Cariogenic and noncardiogenic pulmonary edema (CHF or ARDS) 32. S/S Lung tissue **Grunting and crackles disease -Increased rate, effort, decreased air movement, tachycar- dia, hypoemia 33. Disordered con- Neurological disorders, metabolic abnormalities, drug trol of breathing overdose causes 34. S/S disordered Variable or irregular respiratory rate and pattern, shallow control of breath- breathing with inadequate effort ing 35. Croup Manage- Dexamethasone ment Humidified O2 Nebulizer Epi 36. Anaphylaxis remove the offending agent oral antihistamine IM Epi q 10-15 minutes Methylpred Albuterol 37. Management of Oral and nasal suctioning pro bronchiolitis Keep sats .94% 38. Management of Humidified O2 asthma Albuterol MDI or Nebulizer Corticosteroids Mag Sulfate 39. Management of antibiotic therapy PNU Albuterol CPAP Reduce metabolic demands by reducing temperature 40. Cariogenic pul- monary edema provide ventilator support (PEEP) Diuretics 41. Nasal Cannula 0.25 - 4L Gives 22-60% O2 42. Simple O2 mask 6-10L 35 - 60% 43. Nonrebreather Up to 95% 10-15L 44. High flow nasal cannula 4-40L 45. Nebulizer Set gas flow 5-6L 46. Fluid Resuscita- tion 3mL isotonic fluid for every 1mL blood lost Reassess after every fluid bolus 47. Fluid Bolus 20mL/kg of isotonic fluid over 5-10minutes 48. Goals of shock therapy 49. Initial shock sta- bilization Improve mental status, normalize heart rate, temperature, and adequate bp ABC, heart rate, bp, pulse ox IV/IO access, Fluid resuscitate and broad spectrum antibi- otics 50. Drugs in shock Cold extremities, delayed capillary refill, low bp = epi, dopamine Warm extremities, flash capillary refill, low diastolic pres- sure = norepi 51. Anaphylactic shock IM epic by auto injector 2nd dose may be needed albuterol for bronchospasm antihistamines corticosteroids - methylprednisone 52. Neurogenic shock hypotension, bradycardia head down to improve venous return trial of fluid therapy hypotension --> vasopressors norepi, epic 53. Cardiogenic shock 5-10mL/kg over 10-20 minutes frequently assess for pulmonary edema milrinone therapy 54. Ductal Depen- dent LV Outflow Obstruction Prostaglandin E 55. Tension Pneumo Needle decompression, tube thoracostomy 56. Cardiac Tampon- ade Pericardiocentesis 20mL/kg NS or LR 57. Pulmonary em- bolism 20mL/kg Ns or LR bolus Thrombolytics, anticoagulants 58. IO access proximal tibia, position the leg with slight external rotation 1-3cm below the tibial tuberosity, leave the stylet in the needle Use a twisting motion with gentle but firm pressure When there is a sudden decrease in resistance, should stand easily without support Infuse saline. If no edema, in correctly. May not aspirate bone marrow Tape over flange/gauze 59. Symptomatic bradycardia 60. S/S SVT in in- fants 61. S/S SVT in older children 62. Bradycardia with pulse algorithm 63. Causes of brady- cardia heart rate slower than normal for child's age Cardiopulmonary compromise - hypotension, AMS, de- creased LOC, signs of shock irritability, poor feeding, rapid breathing, unusual sleepi- ness, pale, mottles skin palpitations, SOB, chest pain, light headed, fainting airway, oxygen, cardiac monitor, bp, pulse ox, IV/IO, 12 lead CPR if HR <60 with poor perfusion and ventilation Epi 0.01mg/kg q 3-5 minutes Atropine 0.02mg/kg max dose 0.5mg hypoxia, hydrogen ions, elevated potassium, hypother- mia, heart block, toxins/poisons/drugs, trauma (brady = increased ICP) 64. Vagal manuevers ice to face, valsalva maneuver, carotid sinus massage 65. Synchronized cardioversion hemodynamically unstable its with palpable pulses 0.5 - 1J/kg cardioversion 2nd shock 2J/kg 66. Adenosine 0.1mg/kg 2nd dose 0.2mg/kg max dose 12mg 67. Amiodarone 5mg/kg over 20-60 minutes max dose 300mg 68. Procainamide treat atrial and ventricular arrhythmia resistant to other drugs loading dose 15mg/kg ver 30-60 minutes [Show Less]