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Tips for exam PALS

1. Learn size endotracheal tube according to age (Age 4 = 5mm)


2. Why ppl do wrong in PALS
1. They forget to evaluate completely the child, and focus too much on the vital signs
2. They defibrillate instead oc cardiac synchroversion (pVT vs SVT)
3. They forget to do a full Primary Survey (ABCDE) and Secondary Survey (SAMPLE)
3. Distinguishes ACLS vs PALS
1. PALS = If you see no pulse in child, you need to do 2 min CPR before calling for help
i. ACLS = no pusle --> Call help first before CPR
2. PALS = Infant check brachial pulse for 10 sec (child and adult is carotid)
i. ACLS = Adult check carotid pulse for 10 sec
4. Assessment = ABC
1. Treatment = CAB = CPR --> Airway --> Breathing
i. When you get a heart attack, you call for a CAB (taxi) to go to the hospital =
Treatment
5. Primary assessment = ABCDE
1. D -> AVPU : Alert, Verbal, Pain, Unresponsive
2. E = Exposure
6. Secondary assessement = SAMPLE
1. Signs/Symptomes, Allergies, Medications, Past Med Hx, Last meal, Events leading to
situation
7. Practice pearls
1. Important to tell paramedics when they come = 1) Witness or Unwitness arrest, 2) # of
shocks, 3) When started and stopped CPR
2. When someone has a nipple percing = move the pads 2 cm away from that
8. If it is cardiogenic shock = give 10ml/kg, not 20ml/kg
1. If you realize it afterwards, say that you will reassess the treatment
2. Cardiogenic shock = Get it from History (EII --> ABCDE --> SAMPLE) + Physical Exam
(Hepatosplenomegaly, Crackles lungs bilateral)
3. Hypovolemic shock (cold extremities, tachycardia) vs Neurogenic shock (warm extremeties,
bradycardia)
i. Neurogenic shock = injury T6 and above, so you stop the sympathetic nervous
system, so no more taachycardia
9. Intra-osseus
1. Max 24h
2. All kind of fluid can be injected; Fluid has to be always under pressure; Pt can feel pain at
the infusion of fluids, that's why you should give lidocain push before.
3. 13 long bong options = distal and proximal tibia, distal femoral; Iliac crest
i. Iliac and radial = high chances of fracture
ii. Humeral on kids has chainces of fail
iii. Kids = tibia
4. 2 fingers of the patient bellow tibial tuberosity, 1 finger
10. ECG LEADS
1. Salt (Right), Peper (Left up), Red (lef bellow), brown (v2 or v4)
11. ECG
1. White is Right
2. Left = Smoke over fire
3. Right = Cloud (white) over grass (green)
4. Shit is in the middle
12. Heart block
1. 3rd degree = LARGE QRS
2. 2nd degree type 2 = Some P waves are conducting QRS, QRS is SHORT
3. 3rd degree Don't respond to Atropine
4. Atropine works Heart block 1st degree and 2nd degree type 1
13. Transcutaneous pacing
1. Put bpm to 70
2. Then increase the electrical capture so that every pacing is followed by QRS
3. Increase electrical capture by 10-20 to make sure to capture it.
4. Important = check the pulse of FEMORAL, because kid is shaking with every shock (moves
his arms)
5. Sedation with Ketamine
14. Side effect of Etomidate = Adrenal suppression
15. Epi
1. for the heart = 1:10 000 (there is 4 "0", there are 4 chambers of the heart)
2. For Anaphylaxis: 1:1000
3. For infusion = 1:100 000
16. For ETT tube drugs, just double the dose of the drug
17. "2, 4, 6, 8 is the doses to defibrilate"
18. For the exam:
1. For the paper exam
i. Read absolutely the chapter on Resp physiology and management (CNS vs Upper
resp vs Lower resp vs Parenchyma)
2. Stick with this strategy
i. Initial = PAT = Appearance, Breathing, Circulation
ii. Primary Survey = ABCDE
iii. Secondary survey = SAMPLE + Head to Toe + 6H & 6T
1. Don't forget Head-to-Toe!!!
3. Know Contraindication of meds
4. Cases
i. Assign roles beforehand
1. "MOVIE" = Monitor, Oxygene/Airway, Vitals, IV/IO,
ECG/Expose/Environement
2. 1) Recorder/Monitor, 2) IV/IO/Meds/Vitals; 3) Compressions, 3) Airway/O2 (3
and 4 swtich together)
ii. Encourage sharing information
iii. Resume case often
iv. Team leader talking in a friendly and confidence voice (don't yell)
v. Before shock, check pusles
vi. Brady <60 + Cyanotic + Altered LOC ---> Start CPR
5. Scenarios tips to not forget
i. Call for help!!
ii. Use Braslow tape!!! Up to heals
iii. Think blood product after 2nd bolus IV
iv. Blood transfusion rate of 10ml/kg
v. Check Glucose (Disability) + Temperature (Environment)
vi. Get SAMPLE + Head to toe (tenderness? Bruising? Body prominence?)
vii. Make sure to follow the process
viii. Manage Airway, problem airway = DOPE = Displacement, Obstruction,
Pneumothorax, Equipment failure
ix. Resum case!!!
x. Seizure = Think CNS = Think about Resp issue to manage!!!
xi. Think 6H + 6T systematically, in particular if you are in the non shockable rythm
pathway
xii. Pneumothorax in Peds = Decrease Breathing sound in one chest +/- Tracheal
deviation +/- high JVP
xiii. Post ROSC = Temperature management = 36 to 37.5 degrees x 5 d
xiv. Cardiac arrest (no pulse, even tho Rythm is HR<60) vs Brady --> Epi, atropine,
transcutanous pacing
xv. Everytime you check the rythm, you need to check the pulse (physical action)