Float Nurse

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 ·        ...

1250:  A 10 year old boy is brought to the emergency room by EMS after he struck a tree with his three-wheeler.  On the scene he was conscious,  alert and oriented but in route he began to have increasing shortness of breath and was becoming more lethargic.  The EMTs initiated positive pressure ventilations in route to the hospital.    He is on a spinal board with a C collar in place.   When he is transferred from the EMS stretcher to the hospital stretcher is found to be unresponsive and he no longer has spontaneous respirations.  1252:  No pulse is detected.  A pediatric code is called and CPR is initiated.  He is placed on the monitor and this is his initial rhythm.  PEA rhythm 1255: CPR is continued.   A #20 IV is started in his right antecubtial fossa.  Epinephrine 1mg IV is given and and a fluid bolus of 20ml/kg is also started.  Because there is difficulty with providing p...

Pediatric SVT A 2 year old child weighing 10 Kg is brought to the emergency room with dizziness, palpitations  and shortness of breath.  VS  98.2-216-28  82/54  Oxygen saturation 92% on 2 L/min via nasal cannula.