AHA PALS EXAM QUESTIONS AND ANSWERS WIT COMPLETE SOLUTIONS VERIFIED
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AHA PALS
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AHA PALS
AHA PALS EXAM QUESTIONS AND ANSWERS WIT COMPLETE SOLUTIONS VERIFIED
Capillary refill
Capillary refill time is the time it takes for blood to return to tissue blanched by pressure. It increases as skin perfusion decreases. Note that normal capillary refill time is 2 seconds or less, and a prolon...
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AHA PALS EXAM QUESTIONS AND ANSWERS WIT
COMPLETE SOLUTIONS VERIFIED
Capillary refill
Capillary refill time is the time it takes for blood to return to tissue blanched by pressure.
It increases as skin perfusion decreases. Note that normal capillary refill time is 2
seconds or less, and a prolonged capillary refill time may indicate low cardiac output
Evaluate capillary refill in a neutral thermal environment (ie, room temperature) by
• Lifting the extremity slightly above the level of the heart
• Pressing on the skin
• Rapidly releasing the pressure
BGL in pediatrics
Hypoglycemia refers to blood glucose 45 mg/dL or less in the newly born and 60 mg/dL
or less in a child. It may result in brain injury if not recognized and effectively treated.
Base treatment decisions on patient symptoms, and potentially include oral glucose.
Monitor the blood glucose concentration of any seriously ill infant or child. A low blood
glucose concentration may cause altered level of consciousness or even brain injury if it
is not quickly identified and adequately treated. Measure the blood glucose
concentration with a point-of-care glucose test.
Important factors associated with increased work of breathing:
• Increased airway resistance (upper and lower)
• Decreased lung compliance
,• Use of accessory muscles of respiration
• Disordered central nervous system control of breathing
Airway resistance
• Airway resistance, or the impedance to airflow within the airways, is primarily
increased by reducing the size of the conducting airways, either by airway constriction
or inflammation. Turbulent airflow also causes increased airway resistance. Airflow may
become turbulent when the flow rate increases, even if the airway size remains
unchanged. When airway resistance increases, work of breathing increases in an
attempt to maintain airflow despite the increase in airway resistance.
• Larger airways provide lower resistance to airflow than smaller. Airway resistance
decreases as lung volume increases (inflation) because airway dilation accompanies
lung inflation.
• Conditions such as edema, bronchoconstriction, secretions, mucus, or a mediastinal
mass impinging on large or small airways can decrease airway size, thereby increasing
airway resistance.
• Resistance in the upper airway, particularly in the nasal or nasopharyngeal passages,
can represent a significant portion of tot
Lung compliance
• Compliance refers to the distensibility of the lung, chest wall, or both. Specifically, lung
compliance is defined as the change in lung volume produced by a change in driving
pressure across the lung. When lung compliance is high, the lungs easily inflate, a large
change in volume produced by a slight change in driving pressure.
• The lungs are stiffer in a child with low lung compliance, so it takes more effort to
,inflate them. To create a significant pressure gradient to produce air flow into the stiff
lung, the diaphragm contracts more forcefully, increasing intrathoracic volume and
reducing intrathoracic pressure. Poorly compliant lungs will also lead to increased work
of breathing. During mechanical ventilation, increased positive airway pressure is
needed to achieve adequate ventilation when lung compliance decreases.
Decreased lung compliance
• The chest wall in infants and young children is compliant. Therefore, relatively small
pressure changes can move the chest wall. During normal breathing, diaphragm
contraction in infants pulls the lower ribs slightly inward but does not cause significant
chest retraction. However, forcefully contracting the diaphragm results in a large drop in
pressure within the chest, pulling the chest inward (ie, retracting it) during inspiration.
• When lung compliance is reduced, maximum inspiratory effort may not produce
adequate tidal volume because marked retractions of the chest wall limit lung expansion
during inspiration.
Breathing is controlled by complex mechanisms involving...
• Brainstem respiratory centers
• Central and peripheral chemoreceptors
• Voluntary control
Respiratory center
A group of respiratory centers located in the brainstem controls spontaneous breathing.
Voluntary control from the cerebral cortex, such as breath holding, panting, and sighing,
can also override breathing. Conditions like infection of the central nervous system,
, traumatic brain injury, and drug overdose can impair respiratory drive, resulting in
hypoventilation or even apnea.
Chemoreceptors
Note that central chemoreceptors respond to changes in the hydrogen ion concentration
of cerebrospinal fluid, which is largely determined by the arterial CO2 tension (Paco,).
Peripheral chemoreceptors (eg, the carotid body) respond primarily to a decrease in
arterial oxygen (Pa02); some receptors also respond to an increase in Paco2
Healthcare providers often deliver excessive ventilation during CPR, which is
harmful because it...
• Increases intrathoracic pressure and impedes venous return, thus decreasing filling of
the heart between compressions, reducing blood flow generated by the next
compression, and reducing coronary perfusion and cerebral blood flow
• Causes air trapping and barotrauma in children with small airway obstruction
• Increases the risk of regurgitation and aspiration in children without an advanced
airway
Awareness of Lung Compliance
• When performing bag-mask ventilation, be aware of the child's lung compliance. A
poorly compliant lung is "stiff" or difficult to inflate. A sudden increase in lung stiffness
during ventilation with a bag may indicate airway obstruction, decreased lung
compliance, or development of a pneumothorax.
• Lung distention from excessive inflating pressures, positive end-expiratory pressure, or
rapid assisted respiratory rates with short exhalation time may also cause the feel of
"stiff lungs" during ventilation.
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