PALS Skills Study Guide

  • IO insertion allows for direct administration of medications and fluids into bone marrow.
  • Indications: Understand situations requiring IO insertion.
  • Performance Steps: Familiarize with steps for successful IO insertion.
  • Insertion Sites: Learn about sites like anterior tibia, distal femur, medial malleolus, and anterior-superior iliac spine.
  • Contraindications: Conditions preventing IO placement include fractures, previous insertion attempts, and infections.
  • IO Catheter Insertion: Learn safe insertion methods.
  • Confirming and Securing: Understand how to confirm correct positioning and secure the catheter.
  • Attaching IV Line: Learn to attach an IV line and give an IO fluid bolus.
  • Drug Doses: Learn to determine correct drug doses using resources like color-coded length-based tape.
  • Establishing IV Access: Understand the procedure for establishing IV access.

Oxygen Delivery Systems and Airway Management PALS Skills Study Guide

High-Flow vs Low-Flow Oxygen Delivery Systems

  • High-flow: O2 flow exceeds patient inspiratory flow, preventing entrainment of room air if the system is tight-fitting. It delivers nearly 1.00 FiO2. Examples include nonrebreathing mask with reservoir, high-flow nasal cannula.
  • Low-flow (≤10L/min): Patient inspiratory flow exceeds O2 flow, allowing entrainment of room air. It delivers 0.22 to 0.60 FiO2. Examples include standard nasal cannula, simple O2 mask.

Nasal Cannula Flow Rate

  • The maximum flow rate for a standard nasal cannula is 4 L/min.

Airway Opening Techniques PALS Skills Study Guide

  • Use the head tilt–chin lift maneuver while keeping the mouth open.
  • Use the jaw thrust for trauma victims.

Indications for Oropharyngeal Airway (OPA) and Nasopharyngeal Airway (NPA)

  • OPA: Only for unconscious victims without a gag reflex.
  • NPA: For conscious or semi-conscious victims.

Selecting and Inserting an Airway PALS Skills Study Guide

  • Measure the correct size of the OPA from the corner of the mouth to the angle of the mandible.
  • Insert the OPA correctly.

Assessment After OPA Insertion

  • Verbalize how to assess for adequate breathing after the insertion of an OPA.

Mask Selection for Ventilation

  • Select the correct mask size for ventilation.

Suctioning with OPA

  • Suction with the OPA in place. Suctioning should not exceed 10 seconds.

Assembling Bag-Mask Device

  • Assemble the bag-mask device, open the airway, and create a seal using the E-C clamp technique.

Application 3 ECG lead PALS Skills Study Guide

• Negative(white)lead:to right shoulder
• Positive(red)lead:toleftlowerribs
• Ground(black,green,brown)lead:to left shoulder

AED Pad placement pediatric PALS Skills Study Guide

Electrical therapy for cardiac disturbances

  • Synchronized cardioversion for unstable->SVT,VT with pulses
    • 0.5-1 Joules/Kg 1st Attempt
    • Charges, clears, delivers current
  • Defibrillation for pulseless->VT,VF
    • 2-4 Joules/Kg 1st attempt
    • Charges, clears, delivers current
  • Airway-maintain open airway
  • Breathing-increased rate/effort breathing, Stridor (typically inspiratory), Air movement decreased
  • Circulation
    • Tachycardia (early); bradycardia (late)
    • Skin Pallor, cool skin (early); cyanosis (late)
  • Disability
    • Anxiety, agitation (early); lethargy, unresponsiveness (late)
  • Exposure-Temperature variable
  • Management• Airway positioning • Suction as needed Oxygen
    • Pulse oximetry• ECG monitor as indicated • BLS as indicated
  • Croup-Nebulized epinephrine Corticosteroids
  • Anaphylaxis-IM epinephrine (or autoinjector), Albuterol, Antihistamine, Corticosteroids
  • Aspiration foreign body-Allow position of comfort • Specialty consultation
  • Airway-maintain open airway
  • Breathing
    • increased rate/effort breathing
    • Barking cough
    • Hoarseness
    • Wheezing (typically expiratory)
    • Prolonged expiratory phase
    • Air movement decreased
  • Circulation
    • Tachycardia (early); bradycardia (late)
    • Skin Pallor, cool skin (early); cyanosis (late)
  • Disability
    • Anxiety, agitation (early); lethargy, unresponsiveness (late)
  • Exposure-Temperature variable
  • Management• Airway positioning • Suction as needed Oxygen
    • Pulse oximetry• ECG monitor as indicated • BLS as indicated
  • Bronchiolitis
    • Nasal suctioning
    • Consider bronchodilator trial
  • Asthma
    • Albuterol ± ipratropium
    • Corticosteroids
    • Magnesium sulfate
    • IM epinephrine (if severe)
    • Terbutaline

Lung Tissue Disease (Pneumonia/pneumonitis, Pulmonary edema) PALS Skills Study Guide

  • Airway-maintain open airway
  • Breathing
    • Increased rate/effort breathing
    • Grunting
    • Crackles
    • Decreased breath sounds
  • Circulation
    • Tachycardia (early); bradycardia (late)
    • Skin Pallor, cool skin (early); cyanosis (late)
  • Disability
    • Anxiety, agitation (early); lethargy, unresponsiveness (late)
  • Exposure-Temperature variable
  • Management• Airway positioning • Suction as needed Oxygen
    • Pulse oximetry• ECG monitor as indicated • BLS as indicated

Pneumonia/pneumonitis Infectious, chemical, aspiration

    • Albuterol
    • Antibiotics (as indicated)
    • Consider noninvasive or invasive ventilatory support with PEEP

Pulmonary edema Cardiogenic or noncardiogenic (ARDS)

  • Consider noninvasive or invasive ventilatory support with PEE
  • Consider vasoactive support
  • Consider diuretic

Disordered control of breathing (Increased ICP, Poisoning/overdose, Neuromuscular disease) PALS Skills Study Guide

  • Airway-maintain open airway
  • Breathing
    • Variable rate/effort/movement
    • Normal breath sounds
  • Circulation
    • Tachycardia (early); bradycardia (late)
    • Skin Pallor, cool skin (early); cyanosis (late)
  • Disability
    • Anxiety, agitation (early); lethargy, unresponsiveness (late)
  • Exposure-Temperature variable
  • Management• Airway positioning • Suction as needed Oxygen
    • Pulse oximetry• ECG monitor as indicated • BLS as indicated

Neuromuscular disease

    • consider noninvasive or invasive ventilatory support

Poisoning/overdose

  • Reversal

Increased ICP

  • Avoid hypoxemia
  • Avoid hypercarbia
  • Avoid hyperthermia
  • Avoid hypotension

Shock (Hypovolemic, Obstructive, Cardiogenic, Distributive) PALS Skills Study Guide

Hypovolemic

  • Airway-maintain open airway
  • Breathing
    • Normal/Increased rate/effort breathing
    • Normal breath sounds
  • Circulation
    • Tachycardia
    • Skin Pallor, cool skin
    • Weak pulse
    • Delayed capillary refill
    • Decreased urine output
  • Disability
    • Irritable early, lethargic late

  • Exposure-Temperature variable
  • Management• Oxygen • IV/IO
    • Pulse oximetry• ECG monitor as indicated • BLS as indicated

Nonhemorrhagic

  • 20 mL/kg NS/LR bolus, repeat as needed • Consider colloid

Hemorrhagic

  • Control external bleeding
  • 20 mL/kg NS/LR bolus, repeat 2 or 3x as needed
  • Transfuse PRBCs as indicated

Distributive

  • Airway-maintain open airway
  • Breathing
    • Normal/Increased rate/effort breathing
    • Normal (± crackles)breath sounds
  • Circulation
    • Tachycardia
    • Skin Pallor, warm or cool skin
    • Bounding/weak pulse
    • Variable capillary refill
    • Decreased urine output
  • Disability
    • Irritable early, lethargic late

  • Exposure-Temperature variable
  • Management• Oxygen • IV/IO
    • Pulse oximetry• ECG monitor as indicated • BLS as indicated

Septic

  • 20 mL/kg NS/LR bolus, repeat as needed
  • Antibiotic within 1st hour of recognition
  • Blood/urine cultures

Anaphylactic

  • IM epinephrine (or autoinjector)
  • Fluid boluses (10-20 mL/kg NS/LR)
  • Albuterol
  • Antihistamines, corticosteroids
  • Epinephrine infusion

Neurogenic

  • 20 mL/kg NS/LR bolus, repeat PRN, Vasopressor

Cardiogenic

  • Airway-maintain open airway
  • Breathing
    • Labored effort breathing
    • Grunting/crackles breath sounds
  • Circulation
    • Tachycardia
    • Skin Pallor, cool skin
    • Weak pulse
    • Delayed capillary refill
    • Decreased urine output
  • Disability
    • Irritable early, lethargic late

  • Exposure-Temperature variable
  • Management• Oxygen • IV/IO
    • Pulse oximetry• ECG monitor as indicated • BLS as indicated

CHD, myocarditis, cardiomyopathy, poisoning

  • 5 to 10 mL/kg NS/LR bolus, repeat PRN
  • Inotropic and/or vasoactive infusion
  • Consider expert consultation
  • Antidote for poisoning

Obstructive

  • Airway-maintain open airway
  • Breathing
    • Labored effort breathing
    • Grunting/crackles breath sounds
  • Circulation
    • Tachycardia
    • Skin Pallor, cool skin
    • Weak pulse
    • Delayed capillary refill
    • Decreased urine output
  • Disability
    • Irritable early, lethargic late

  • Exposure-Temperature variable
  • Management• Oxygen • IV/IO
    • Pulse oximetry• ECG monitor as indicated • BLS as indicated

Tension pneumothorax

  • Needle decompression
  • Tube thoracostomy

Cardiac tamponade

  • Pericardiocentesis
  • 20 mL/kg NS/LR bolus

Pulmonary embolism

  • 20 mL/kg NS/LR bolus, repeat PRN
  • Consider thrombolytics, anticoagulants
  • Expert consultation

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