Float Nurse

Answer the following questions. 1. What is the correct pediatric dose of magnesium for this rhythm? a. 1 – 2 grams/kg  IV/IO infused over 10 minutes b. 25 – 50 mg/kg IV/IO pushed c. 50 – 100 mg/kg IV/IO push d. .5 – 1 g/kg infused over 10 minutes 2. What is the recommend pediatric initial joule setting to defibrillate this rhythm? a. 0.5 J/kg b. 1 J/kg c. 2 J/kg d. 5 J/kg 3. A 4th shock is delivered to a 6 year old in cardiac arrest.  The post shock rhythm remains unchanged. What is the recommended initial dose of Amiodarone for this rhythm? a.  2 – 20 mcg/kg per minute b. 15 mg/kg IV/IO push c. 5 mg/kg IV/IO d. 1 mg/kg  IV/IO 4. A 10 year old is rushed into the ER by his parents following a fall from a tree.  The child has agonal breathing.  He is found to be pulseless.   CPR is initiated.  This is the initial rhythm....

Answer the following questions. 1.What is the correct second dose of Adenosine for a 6 year old (weight 25 kg) who was brought to the ER with dizziness, weakness, and palpitations?  The following rhythm is seen on the monitor. a. 1.0 mg b. 2.0 mg c. 5.0 mg d. 6.0 mg 2. What is the dose of amiodarone that can be used to treat this rhythm in a 6 year old (weight 20 kg) in cardiac arrest? a. 0.2 mg IV/IO every 3 - 5 minutes b. 40 units IV/IO push as a one time dose c. 100 mg IV/IO push, may repeat at 100 mg for refractory VF d. 20 mg IV/IO, may repeat at 10 mg IV if needed. 3. A 15 year old high school student is brought in to the ER with a palpitations, dizziness, restlessness, and weakness. She reports taking some "pills" over the last two days that her friend gave her to help her lose weight for the high school prom. The EKG shows her initial heart rhythm: NSR at 180 bpm, BP 188/ 101. Temp 102.2. Skin is hot and dry. She is extremel...

Answer the following questions: 1. A 6 year old patient (weight 25 kg) was brought in by EMS with an overdose of a beta blocker. The following rhythm is noted on the monitor.  He  fails to respond to an initial dose of atropine. A second dose is ordered by the MD before attempting transcutaneous pacing. What is the correct second dose for this patient? a. 0.25 mg b. 0.5 mg c. 0.75 mg d. 1 mg 2.This strip shows: a. Transcutaneous pacing with poor mechanical capture b. Transcutaneous pacing below the pacing threshold c. Transcutaneous pacing with good electrical capture d. Transcutaneous pacing with failure to capture 3.What is the correct joule setting for a second shock in order defibrillate a 7 year old (weight 20 kg) cardiac arrest victim with refractory ventricular fibrillation? a. 40 joules b. 60 joule c. 80 joules d. 100 joule 4.What is the recommended initial dose of Amio...

PALS Medications:  Match the dosage with the correct medication. First line drug in pediatric pulseless VF/VT a. Lidocaine b. Epinephrine c. Amiodarone d. Atropine This medication is used in pediatric shock and is given as a continuous infusion mcg/kg/min a. Lidocaine b. Dopamine c. Amiodarone d. Epinephrine Used to treat unstable bradycardia secondary to a heart block a. Lidocaine b. Epinephrine c. Amiodarone d. Atropine May be considered for wide complex tachycardia with uniform looking QRS complexes a. Adenosine b. Epinephrine c. Dopamine d. Atropine Used as a first line drug for symptomatic SVT in pediatric patients. a. Adenosine b. Epinephrine c. Amiodarone d. Lidocaine Answers 1.   b. Epinephrine 2.   b. Dopamine 3.   d. Atropine 4.   a. Adenosine 5.   a. Adenosine

PALS Medications:  Match the dosage with the correct medication. 1.  Second dose:  .04mg/kg a. Epinephrine b. Atropine c. Amiodarone d. Glucose 2.  Used in pediatric pulseless arrest and PEA a. Epinephrine b. Vasopressin c. Atropine d. Amiodarone 3.  Used as a first line drug for unstable bradycardia in pediatric patients a. Atropine b. Epinephrine c. Lidocaine d. Milrinone 4.  Used to treat Torsades de pointes in pediatric patient a. Atropine b. Milrinone c. Inamrinone d. Magnesium 5.. A second line drug used to treat refractory VT (with a pulse) a. Epinephrine b. Atropine c. Procainamide d. Norepinephrine Answers 1. 2. 3. 4. 5.

PALS Medications:  Match the dosage with the correct medication. 1. 5mg/kg IV/IO bolus a. Glucose b. Adenosine c. Sodium bicarbonate d. Amiodarone 2. 0.01mg/kg IV/IO a. Dopamine b. Epinephrine c. Inamrinone d. Lidocaine 3. 1mg/kg rapid IV/IO push a. Magnesium Sulfate b. Naloxone c. Sodium bicarbonate d. Lidocaine 4. 2 – 20 mcg/kg/min a. Dopamine b. Lidocaine c. Amiodarone d. Epinephrine 5. 25 – 50 mg/kg over 10 – 20 minute a. Milrinone b. Magnesium Sulfate c. Amiodarone d. Lidocaine Answers 1.  d.  Amiodarone 2.  b.  Epinephrine 3.  d.  Lidocaine 4.  a.   Dopamine 5.  b.  Magnesium Sulfate

PALS Medications:  Match the dosage with the correct medication. 1. 0.1mg/kg rapid IV push a. Amiodarone b. Adenosine c. Atropine d. Inamrinone 2. 0.5 – 1g/kg a. Magnesium b. Glucose c. Milrinone d. Lidocaine 3. 15mg/kg over 30 – 60 minutes a. Lidocaine b. Procainamide c. Norepinephrine d. Dopamine 4. 1mEq/kg a. Sodium Bicarbonate b. Adenosine c. Vasopressin d. Atropine 5. Second dose 0.2mg/kg a. Lidocaine b. Adenosine c. Milrinone d. Atropine Answers 1.  b. Adenosine 2.  b. Glucose 3.  b. Procainamide 4.  a. Sodium Bicarbonate 5.  b. Adenosine

Pediatric PEA E valuate Reversible Causes ·          Hypoxia ·          Hypovolemia ·          Hyper/hypokalemia ·          Hypothermia ·          Tension pneumothorax ·          Tamponade ·          Thromboembolism ·          Tables/toxins ·          Trauma Note:   Management of PEA is exactly the same as for asystole. Interventions for specific causes of PEA may lead to successful resuscitation. Appropriate measures may include a rapid fluid bolus for potential hypovolemia (20 mL/kg normal saline or lactated Ringer’s administered IV or IO), needle decompression for suspected tension pneumothorax, vent...

Pediatric PEA Length based color-coded tape. Medication Dose Calculation ·          Use the child’s weight if it is known ·          If the child’s weight is unknown, it is reasonable to use a body length tape ·          No data regarding the safety or efficacy of adjusting the doses for obese patients IV Access ·          Peripheral IV ·          Central line ·          Intraosseous ·           Endo tratracheal Peripheral IVs ·           Placement may be difficult in a critically ill child ·           Central venous placement requires procedure can be time consuming Central IV Drug Delivery ...

Pediatric PEA Secondary Survey ·          Intubate ·          Oxygenate ·          IV access ·          Treat reversible causes Note: Once the patient is intubated, continue CPR with asynchronous ventilations and chest compressions. Formula for Estimating Endotracheal tube size:  Uncuffed ET tube:  mm ID = (age in years/4) + 4 Cuffed ET tube:  mm ID = (age in years/4) + 3.5 Confirm ET tube placement n   Direct cord visualization n   End-tidal CO2 monitor n   Purple- problem n   Yellow- yes n   Tan- think about it n   Bilateral breath sounds n   CXR n   Continuous waveform capnography Note:  Continuous quantitative waveform capnography is now recommended for intubated patients throughout the periarrest period as a means of bot...

Pediatric PEA Rhythms Idioventricular rhythm Sinus bradycardia Sinus tachycardia with inverted T waves Agonal Rhythm PEA mnemonic:  Keep them ALIVE A ssess ABCs L isten for pulse using doppler I nitiate CPR V asoconstrictors E valuate reversable causes A ssess ABCs- Primary Survey ·          Assess responsiveness and pulse ·          Active EMS system ·          Call for defibrillator/monitor Note:  If a rhythm is present on the monitor but the pulse is absent (eg,PEA), CPR should be started immediately, beginning with chest compressions, and should continue for 2 minutes before the rhythm check is repeated. L isten for Pulse Using Doppler ·          A doppler will help distinguish between a pulseless state and profoundly weak cardiac contractions with...

Pediatric PEA Pediatric Non-profusing Rhythms ·          Pulseless electrical activity ·          Asystole ·          Agonal Rhythms ·          Ventricular tachycardia ·          Ventricular fibrillation Cardiac arrest in infants and children ·          Does not usually result from a primary cardiac cause ·          Terminal result of progressive respiratory failure or shock ·          Asphyxia begins ·          Period of systemic hypoxemia, hypercapnia, and acidosis ·          Progresses to bradycardia and hypotension ·        ...