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PALS

Terms in this set (62)

If there is no pulse..
start CPR (CAB)
If pulse is present..
Open airway & begin ventilation (rescue breathing) & oxygen therapy
Flushed appearance suggests..
fever or presence of a toxin
If child is unresponsive & not breathing or only gasping..
shout for help, activate emergency response system, check pulse, If no pulse- start CPR; If pulse is present- perform rescue breathing
Primary Assessment
rapid, hands on ABCDE approach to evaluate respiratory, cardiac, neurologic fuction, vital signs, and pulse ox
Secondary Assessment
Focused medical history & focused physical exam
Always assess the..
scene before you evaluate a child if outside hospital
Primary Assessment, ABCDE
Airway, Breathng, Circulation, Disability, Exposure
S&S of Obstructed Upper Airway
increased inspiratory effort with retractions, abnormal inspiratory sound such as snoring, high pitched stridor
Simple Measures to Open & Maintain Patent Upper Airway
Allow child to assume comfortable position to improve airway patency, use head tilt chin lift or jaw thrust to open airway
Use head tilt chin lift UNLESS you suspect..
a cervical spine injury
Avoid overextending head/neck of infant because..
it may occlude airway; Suction the nose and oropharynx
If you suspect cervical spine injury..
open the airway by using a jaw thrust without neck extension; If this does not open the aiway, use the head tilt chin lift or jaw thrust with neck extension because opening the airway is priority.
During CPR, stabilize the head and neck..
manually rather than with immobilization devices
Jaw thrust may be used in..
children without trauma as well
Perform foreign-body airway obstruction (FBAO) relief techniques if you suspect that the child has..
aspirated a foreign body, has complete airway obstruction, unable to make any sounds, and is still responsive.
Foreign-Body Airway Obstruction, FBAO
<1 year of age: Give 5 back slaps and 5 chest thrusts; > 1 year of age: give abdominal thrusts
Use airway adjuncts such as nasopharyngeal airway, or oropharyngeal airway to..
keep the tongue from falling back and obstructing the airway
Advanced interventions to maintain airway patency may include..
Endotrachel intubation or placement of a laryngeal mask airway, application of continuous positive airway pressure, CPAP, removal of foreign body, cricothyrotomy- needle puncture or surgical opening through the skin and cricothyroid membrane and into the trachea below the vocal cords
Assessment of breathing includes evaluation of:
respiratory rate, effort, chest expansion, air movement, lung and airway sounds, 02 sat by pulse ox
Normal respiratory rate for infant <1yr old
30-60
Normal respiratory rate for Toddler, 1-3 yrs of age
24-40
Normal respiratory rate for Preschooler, 4-5 ysr of age
22-34
Normal respiratory rate for School age, 6-12 yrs of age
18-30
Normal respiratory rate for Adolescent, 13-18 yrs of age
12-16
If the child has any condition that causes an increase in metabolic demand such as excitement, anxiety, exercise, pain, fever) it is appropriate for respiratory rate to be..
HIGHER than normal
Determine the respiratory rate by..
counting the number of times the chest rises in 30 seconds and multiplying by 2
Be aware that normal sleeping infants may have..
irregular, periodic, breathing with puases lasting up to 10 or even 15 seconds
A consistent respiratory rate of less than..
10 or more than 60 breaths/min in a child of any age is abnormal and suggests the presence of a potentially serious problem
Tachypnea is often the first sign of..
respiratory distress in infants; tachypnea can also be an appropriate response to stress
Tachypnea with respiratory distress is, by definition, associated with..
other signs of increased respiratory effort
Quiet tachypnea
term used if tachypnea is present without signs of increased respiratory effort, without respiratory distress; this often results from an attempt to maintain near-normal blood pH by increasing the amount of air movement in and out of the lungs; this decreases C02 levels in the blood and increases blood pH
Quiet tachypnea results from
nonpulmonary problems including high fever, pain, mild metabolic acidiosis assocaited with dehydration or DKA, sepsis without pneumonia, CHF, severe anemia, some cyanotic congenital heart defects
Bradypnea
frequently breathing is both slow and irregular; possible causes are respiratory muscle fatigue, central nervous system injury or infection, hypothermia, or medications that depression RR.
Apnea
cessation of breathing for 20 seconds or cessation for less than 20 seconds if accompanied by bradycardia, cyanosis, or pallor
Agonal gasps
are common in adults after sudden cardiac arrest and may be confused with normal breathing. Agonal breaths will not produce effective oxygenation and ventilation
Increased respiratory effort results from
conditions that increase resistance to airflow such as asthma, bronchiolitis, or that cause lungs to be stiffer and difficult to inflate such as pneumonia, pulmonary edema, or pleural effusion
Nonpulmonary conditions that result in severe metabolic acidosis are
DKA, salicylate ingestion, inborn errors of metabolism, can also cause increased respiratory effort. Signs of increased respiratory effort reflect the child's attempt to improve oxygenation, ventilation, or both.
Signs of increased respiratory effort include
nasal flaring, retractions, head bobbing or seesaw respirations, prolonged inspiratory or expiratory times, open-mouth breathing, gasping, and use of accessory muscles
Grunting is a serious sign and may indicate
respiratory distress or respiratory failure
Bradypnea in an acutely ill infant or child is an ominous clinical sign and often signals..
cardiac arrest
Apnea is classified into 3 types:
central apnea, obstructive apnea, mixed apnea
Central Apnea
There is no respiratory effort because of an anbormality or suppression of the brain or spinal cord
Obstructive Apnea
There is inspiratory effort without airflow, airflow is partially or completely blocked
Mixed Apnea
Periods of obstructive apnea & periods of central apnea
Nasal flaring
is most commonly observed in infants and younger children and is usually a sign of respiratory distress
Retractions
inward movements of the chest wall or tissues, neck, or sternum during inspiration; chest retractions are a sign that the child is trying to move air into the lungs by using the chest muscles, but air movement is impaired by increased airway resistance or stiff lungs; they may occur in several areas of the chest
Subcostal retractions
retraction of the abdomen, just below the rib cage
Substernal retractions
retraction of the abdomen at the bottom of the breastbone
Intercostal retractions
Retraction between the ribs
Supraclavicular Retractions- Severe
Retraction in the neck, just above the collarbone
Suprasternal Retractions- Severe
Retraction in the chest, just above the breastbone
Sternal Retractions- Severe
Retraction of the sternum toward the spine
Head bobbing or Seesaw Respirations
often indicate that the child has increased risk for deterioration
Head Bobbing
is caused by the use of neck muscles to assist breathing, child lifts the chin and extends the neck during inspiration and allows the chin to fall forward during expiration; most frequently seen in infants and can be a sign of respiratory failure
Seesaw Respirations
Present when the chest retracts and the abdomen expands during inspiration, during expiration the movement reverses; the chest expeands and the abdomen moves inward; usually indicate an upper airway obstruction, also may be observed in severe lower airway obstruction, lung tissue disease, and disordered control of breathing
Seesaw respirations are characteristics of
infants and children with neuromuscular weakness, this inefficient form of ventilation can quickly lead to fatigue
Seesaw Respirations usually indicate
upper airway obstruction
Retrations accompanied by stridor or an inspiratory snoring sound suggest
upper airway obstruction
Retractions accompanied by expiratory wheezing suggest
marked lower airway obstruction such as asthma or bronchiolitis, causing obstruction during both inspiration and expiration
Retractions accompanied by grunting or labored respirations suggest
lung tissue disease
The cause of seesaw breathing in most children with neuromuscular disease is
weakness of the abdominal and chest wall muscles, it is caused by strong contraction of the diaphragm that dominates the weaker abdominal and chest wall muscles; the result is retraction of the chest and expansion of the abdomen during inspiration
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