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61.  Hypoglycemia is defined as have a blood glues level less than ____ in neonates and ____ in infants and children? 45mg/dl in neonates 60mg/dl in infants and children 62. What is the volume of blood that is transfused in a pediatric patient with hemorrhagic shock? 10-15ml/kg of PRBCs 63. What are the ECG characteristics of SVT? Heart rate > 220 for infants Heart rate > 180 for children P waves absent or abnormal PR interval absent QRS complex is usually narrow Rhythm is regular 64. What are some conditions that may predispose a patient to torsades de pointed Long QT syndrome Hypomagnesemia Antiarrhythmic drug toxicity Other drug toxicities phenothiazines, tricyclic antidepressants. calcium channel blockers 65. Name some examples of distributive shock.  Septic shock, neurogenic shock, and anaphylactic shock.

56. When treating a pediatric patient without a known underlying cardiac problem, what is the initial amount of fluid boluses that can be administered? 20ml/kg then reassess the patient 57.  What is the compression-ventilation ratio for two rescuer CPR? 15:2 58. During the treatment of pulseless VF/VT, what are the joule settings for the subsequent defibrillations? 2-4J/kg 59. During the treatment of SVT, what is the initial dose of adenosine? 0.1mg/kg IVorIO 60. When is transcutaneous pacing indicated during the treatment of pediatric bradycardia? It is used when the bradycardia is not corrected by oxygenation, medications, or when a primary cardiac problem has been recognized.

51.  Describe the ECG characteristics of ventricular tachcardia The rate is greater than 150 The QRS complexes are greater than .12 sec QRS complexes may be either uniform or multiform P waves are absent 52.  How does one verify asystole on the monitor? Increase the gain Check the rhythm in another lead Verify all electrical cords are connected Verify all electrodes are in place 53. What are four precautions that should be observed before applying the defibrillator pads to the patient? Make sure the skin surface is fry Avoid pacemakers and other devices Avoid letting the pads touch 54. What is the maximum cumulative dose of atropine in a child and an adolescent? 1mg for the child and 2mg for the adolescent 55. What is the dose of bicarbonate in a pediatric cardiac arrest? 1mEq/kg IVor IO

46. Describe four vagal maneuvers that can be used in the initial treatment of SVT. Valsalva maneuver Blowing through a straw Ice water to the face Coughing 47. When treating pediatric shock, what is the correct volume of fluid that should be administered to a pediatric patient with a suspected cardiac problem? 5-10ml/kg 48. During transcutaneous pacing, what is meant by mechanical capture and how would you assess for it? Mechanical capture refers to actual contraction of the myocardium and results in a palpable pulse 49. What is the initial dose of Amiodarone in pediatric pulseless VF/VT? 5mg/kg IV or IO 50.  During the treatment of PEA the aim of the treatment is to identify and treat the underlying cause of the rhythm?  True or False True

41.  What are two antiarrhythmics that are used in the treatment of pulseless VF/VT? Amiodarone and Lidocaine 42.  Describe the technique for giving Adenosine during the treatment of SVT. Fast-flush technique 43. Name the steps for using an AED. Power on AED Apply pads to patients chest Plug in cord Analyze heart rhythm 44. What is maximum cumulative dose of Lidocaine during the treatment of pulseless VF/VT? 3mg/kg 45. What is the correct dose and concentration of epinephrine that can be administered through the endotrachial tube? 0.1mg/kg of a 1:1000 solution

36. SVT typically produces heart rates greater than____ in children and ____ in infants? 180, 220 37.  What is the dosage of magnesium used in the treatment of torsades de pointe in pediatric patients? 25-50grams IV 38.  What is the maximum initial dosage of atropine in a child? 0.5mg 39.  Adenosine is indicated in the treatment of what dysthythmia? SVT 40.  After the initial defibrillation, what is the subsequent joule settings in the treatment of pulseless VF/VT? 4J/kg

31.  What is the minimum dosage of atropine that is recommended during the treatment of unstable bradycardia? 0.1mg 32.  What is meant by the term PEA? Pulseless electrical activity is when the monitor displays a rhythm but the patient does not gave a pulse. 33.  What is the initial joule setting when preparing to cardiovert pediatric SVT? 0.5-1J/kg 34. Amiodarone is used in the treatment of what two rhythms? Pulseless VF/VT and stable VT 35. What are 3 products that are used in fluid replacement therapy during pediatric shock? Crystaloids, colloids, blood products

26.  Pediatric pads are recommended for children weighing less than____? 15kg 27. What are five components of the primary survey during the treatment of pediatric cardiac arrest? Assess the patient Support ABCs CPR Attach defibrillator/monitor Assess the heart rhythm 28. Name the "T" reversible causes in the treatment of asystole. Tension pneumothorax Toxins/tablets Tamponade, cardiac Thrombosis coronary Trauma 29. What are 4 medications that can be administered through the ET tube? Narcan, epinephrine, atropine, lidocaine 30. What is the first vasoconstrictor that is administered during a pulseless arrest? Epinephrine 0.01mg/kg

21.  In the treatment of PEA the rescuer is asked to look for reversible causes- the Hs & Ts.  Name the Hs. Hypoxia, hypovolemia, hydrogen ions, hyperkalemia, hypokalemia, hypoglycemia, hypothermia 22. What are 5 signs and symptoms of shock or clinical instability? Hypotension, altered mental status, cold, clammy skin, delayed capillary refill, absent or weak, thready pulses 23.  What are four differences between defibrillation and cardioversion? Cardioversion delivers electrical current to the heart during a specific time during the cardiac cycle, treatment of choice for SVT Defibrillation does not need synchonized with the ECG, it uses higher energy levels, used in the treatment of pulseless vfib/vtach 24. What is the dosage of Lidocaine used in the treatment of pulseless VF/VT? 1mg/kg IV/IO 25. What is the dosage and method of administration of dopamine during unstable bradycardia? 2-20mcg/kg/min IV/IO as an infusion

16. Describe the location for placing the defibrillator pads Anterior/posterior Apex/right chest wall 17. AVPU describes what? Describes the patient's level of consciousness. Alert Responds to voice Responds to pain Unresponsive 18. What is meant by the term decompensated shock? When their are clinical signs of poor systemic perfusion accompanied by hypotension 19. Describe sinus tachcardia. Sinus tachycardia is a nonspecific clinical sign; often related to a specific cause: fever, pain, activity;  P aves are normal and present; heart rate below 180 for a child and 220 for an infant 20 What is the initial joule setting in the treatment of pediatric SVT? 0.5-1J/kg

11. Magnesium is the drug of choice in the treatment of what dysthythmia? Polymorphic Vtach or torsades de pointe 12. What is meant by the term compensated shock? When the patient exhibits signs of poor profusion but exhibits a normal blood pressure 13.  SVT in infants produces a heart rate greater than_____bpm? 220 14.  What is the dose of Procainamide used in the treatment of Vtach with a pulse? 15mg/kg over 30-60 minutes 15. Name three medications used in the treatment of unstable bradycardia? Atropine, epinephrine, dopamine

6.  What are four non-profusing heart rhythms in s pediatric patient? Asystole, PEA, pulseless VF, and pulseless VT 7. In the treatment of asystole, how often can epinephrine be repeated? Every 3-5 minutes 8. What is the dose of atropine used in the treatment of unstable bradycardia? 0.02mg/kg IV/IO 9. What is the primary treatment for ventricular fibrillation? Defibrillation 10. Name five ways in which you can positively confirm ET tube placement Direct cord visualization End-tidal CO2 Bilateral breath sounds CXR Continuous capnography

PALS review 1.  What's is the dose and concentration of epinephrine used in the treatment of PEA? 0.01mg/kg of a 1:10,000 solution IV or IO 2.  What is the maximum cummulative dose of Amiodarone in treating pulseless VF/VT? 15mg/kg 3. In a pediatric patient, Lidocaine is indicated in the treatment of what two cardiac problems? Pulseless VF/Vtach and VT with a pulse 4.  Name 5 causes of bradycardia in a pediatric patient. Hypoxia, hypothermia, heart blocks, head injury, heart medications, high vagal tone 5.  In a pediatric patient, what is indicated when the heart rate is less than 60 with accompanying and poor systemic perfusion? CPR

Identify the following rhythms: 1. 2. 3.   4.   5. Answers 1. Ventricular Demand Pacing.   The patient has an underlying atrial flutter. 2. Ventricular Demand Pacing Ventricular Demand Pacing.  The underlying rhythm looks like atrial flutter.  The pacer spikes are small and difficult to see on complexes 3, 4, 5, and 7.  My first thought about this rhythm was that the patient was having some ventricular escape beats.  But I learned that the patient had a pacemaker and that the 12 lead also showed a functioning pacemaker.  If the patient was having some escape beats then I would suspect a primary pacemaker failure.  3. Ventricular Paced Rhythm Ventricular Paced Rhythm.   The rhythm is regular.  The rate is 60. The PR interval is 20.  A pacer spike occurs before each QRS complex.   4. 100% ventricular paced with some demand atrial pacing. 5. Biventricular Pacing

Identify the following paced rhythms: 1. 2. 3. 4.  5. Answers 1. Demand Atrial Paced Demand Atrial Paced.   There are no pacemaker spikes on the second and fourth complexes.  The P waves are the patient's own native P waves.  But on the other complexes a pacer spike preceeds each of the P waves.   It is not possible to determine the exact kind of internal pacemaker a patient has based on the rhythm.   This could be an example of an AAI pacemaker in which the atria are paced.  But when the pacemaker senses a native P wave it is inhibited from producing a paced beat.     2. Biventricular Paced Biventricular Paced.   Two pacemaker spikes precede the QRS complex.   One pacemaker spike for each ventricle.  A PVC is also present.  3. Demand AV Paced Demand AV Paced.   On the 1st and 7th complexes there are very small atrial spikes present.  On all the other complexes there are native P waves present wit

Complications of Fibrinolytics ·          Symptomatic intracranial hemorrhage ·          Orolingual angioedema (1.5%) ·          Acute hypotension ·          Systemic bleeding Note:   Symptomatic intracranial hemorrhage occurred in 6.4% of the 312 patients treated in the NINDS trials and 4.6% of the 1135 patients treated in 60 Canadian centers Fibrinolytic Precautions ·          Care dose calculation ·          Removal of excess medication ·          Holding anticoagulants and anitplatelet medications for 24 hours until repeat CT scan shows no hemorrhage Note:   Removal of excess rtPA help prevent inadvertent administration of excess rtPA General Stroke Care ·          Prevention of hypoxia ·          Manage hypertension ·          Glycemic Control ·          Temperature Control ·          Nutritional support ·          Prevention complications (Pneumonia, DVT, UTI) ·          Initiation of secondary stroke prevention ·          Transfer to stoke unit or stroke center Prevent

CT Scan ·          Should be completed within 25 minutes of the patient's arrival ·          Should be interpreted within 45 minutes of ED arrival ·          More advanced neurologic imaging should not delay initiation of IV rtPA ·          During the first few hours noncontrast CT scan may not indicate signs of brain ischemia ·          If negative for intracerebral hemorrhage, the patient may be a candidate for fibrinolytic therapy Fibrinolytics Inclusion Criteria ·          Diagnosis of ischemic stroke causing measurable neurologic deficit ·          Onset of symptoms <3 hours before beginning treatment ·          Age ≥18 years Fibrinolytics Exclusion Criteria ·          Head trauma or prior stroke in previous 3 months ·          Symptoms suggest subarachnoid hemorrhage ·          Arterial puncture at noncompressible site in previous 7 days ·          History of previous intracranial hemorrhage ·          Elevated blood pressure (systolic >185 mm Hg or diastolic >

Critical EMS Assessments ·          Support ABCs: O 2 for oxygen saturation <94% ·          Perform CPSS assessment ·          Establish time of onset of symptoms ·          Triage to stoke center ·          Alert hospital ·          Check glucose Note:   If the patient wakes from sleep or is found with symptoms of a stroke, the time of onset of symptoms is defined as the last time the patient was observed to be normal. Unless the patient is hypotensive (systolic blood pressure <90 mm Hg), prehospital intervention for blood pressure is not recommended EMS systems should establish a stroke destination preplan to enable EMS providers to direct patients with acute stroke to appropriate facilities Circulation. 2010; 122: S818-S828 doi: 10.1161/​CIRCULATIONAHA.110.971044 In-hospital Assessment ·          Assess ABCs ·          Provide oxygen ·          Establish IV access and draw labs ·          Check blood glucose ·          Perform neurologic exam ·          Activate stroke

Warning Signs and Symptoms of Possible Stoke ·          Sudden onset of weakness ·          Sudden confusion ·          Trouble speaking or understanding ·          Sudden trouble seeing in one or both eyes ·          Sudden trouble walking ·          Dizziness or loss of balance or coordination ·          Sudden severe headache with no known cause Note :   Identifying clinical signs of possible stroke is important because recanalization strategies (intravenous [IV] fibrinolysis and intra-arterial/catheter-based approaches) must be provided within the first few hours from onset of symptoms Public Education ·          Public must be educated regarding the signs and symptoms of a stroke ·          Public must be educated to activate EMS as soon as symptoms of stroke are recognized ·          Currently half of all stoke patients are drive to the hospital by their family members Note:   Most strokes occur at home, and just over half of all victims of acute stroke use EMS for transpo