PALS Helpful Hints Nov 2011
The PALS exam is a 33 question exam. Passing score is 84% or you may miss 5 questions. For those persons taking PALS for the first time or renewing with a current card, exam remediation is permitted should you miss more than 5 questions on the exam. Viewing the books ahead of time with the accompanying student web site www.heart.org/eccstudent located on page ii of the PALS provider manual is very helpful. This site has a pretest and other helpful tools. This document contains information on the PALS 2010 Guidelines.
Basic Dysrhythmias knowledge is required in relation to asystole, ventricular fibrillation, tachycardias in general and bradycardias in general. You do not need to know the ins and outs of each and every one. Tachycardias need to differentiate wide complex (ventricular tachycardia) and narrow complex (supraventricular tachycardia or SVT).
The course is a series of video segments then skills. The course materials well prepare you for the exam.
▪ AED – infant – if pediatric pads are unavailable it is acceptable to use adult pads ▪ AED – no pulse, CPR initiated – use AED when it arrives ▪ Airway – Intubated, oxygen saturation decreases. Breath sounds only on right – verify tube placement. ▪ BP – 2 year old 55/40 – hypotensive
▪ Bradycardia – vagal maneuver for infant – ice to the face ▪ CPR – child – 15:2 compression to ventilation
▪ Defibrillation - Ventricular fibrillation – defibrillation 2 Joules/kg shock after CPR ▪ Drug – epinephrine 0.01 mg/kg IV or IO. If dose ordered not correct, ask team leader to clarify. ▪ Drug - PEA – Pulseless electrical activity - epinephrine 0.01 mg/kg IV or IO ▪ Drug – Pulseless, breathless – epinephrine 0.01 mg/kg IV or IO ▪ IV – best method for immediate vascular access – intraosseous ▪ IV for Shock – IV fluids 20 ml/kg of isotonic crystalloid over 5 to 10 minutes ▪ IV with hypovolemic shock – 20 mL/kg normal saline ▪ Lab – vomiting, diarrhea, lethargic – check glucose ▪ Oxygen – with suctioning heart rate from tachycardia to sinus rhythm – administer oxygen and ensure adequate ventilation. ▪ Oxygen Saturation – If reading is normal and respiratory assessment shows the patient is not doing well, the Sp02 is unreliable and oxygen should be administered. ▪ Oxygen Saturation – target range 94% to 99%
▪ PEA – looks like a sinus rhythm, or any other rhythm that should support a pulse, but no pulse ▪ Pulse check – infant – brachial location
▪ Pulse check – no more than 10 seconds before starting CPR ▪ Rescue breaths child – 12 to 20 per minute
▪ Respiratory – allergy – epinephrine I.M.is the initial medication ▪ Respiratory – increased work of breathing, color pink, respiratory rate 30 – respiratory distress ▪ Respiratory – lung tissue disease most likely to have decreased oxygen saturation ▪ Respiratory – no breath sounds on left, trachea deviated to the right – needle decompression on the left chest ▪ Respiratory – seizures with respiratory distress most likely disordered control of breathing ▪ Respiratory – stridor, barking cough – nebulized epinephrine ▪ Respiratory – wheezing is lower airway obstruction ▪ Respiratory failure – inadequate oxygen and/or ventilation ▪ Shock – compensated if blood pressure is ok
▪ Shock – lethargy, fever, on chemo – septic shock ▪ SVT – no major symptoms – first attempt vagal maneuvers ▪ SVT narrow complex tachycardia – symptomatic – synchronized shock 0.5 to 1 J/kg
Systematic Approach to Pediatric Assessment
Evaluate – Identify - Intervene
A continuous sequence.
**Determine if problem is life threatening.
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