PEARS Exam

What are the three locations to listen in the lungs?

Bronchioles

Bronchovesicular

Vesicular

What are Abnormal CONTINUOUS Lung Sounds? (3)

*Extra sound lasts 0.2sec w/full RESPIRATION

High-pitched Polyphonic WhEeze - expiration/inspiration - many sounds

Low-Pitched Monophonic WhEeze - expiration/inspiration - low-pitched whistle w/one sound quality

StrIdor - Inspiration - HIGH pitched or Croup w/harsh quality; airway obstructed (rocking chair) - Upper airway

Define Hoarseness breathing

UPPER airway obstruction caused by infection or airway swelling. This results from swelling of vocal cords that interferes with normal vocal sounds.

What are Abnormal DISCONTINUOUS Lung Sounds?

*Extra sound lasts < 0.2sec

COARSE Crackles (Rales) - Inspiration (extend to expiration); wet/bubbling low pitch

FINE Crackles (RALES) - Inspiration; highest pitch cracking sound (DO not clear with couch)

Pleural Friction Rub - Inspiration/Expiration; LOW pitch harsh sounds

How can we differentiate between pericardial rub and pleural rub?

Pericardial Rub continues while patient DOES NOT BREATH

Regular Heart Rate for: Awaken and Sleeping

Neonate (96 hours)

Infant (1 year old)

Toddler (1 to 2 years)

PreSchooler (3-5 years)

School-age (6 - 9)

Adolescent (12 -15)

Neonate (96 hours) ; (100 - 125) (90 - 160)

Infant (1-year-old) ; (100 - 180) (90 - 160)

Toddler (1 to 2 years) ; (98 - 140) (80 - 120)

PreSchooler (3-5 years) ; (80 - 120) (65 - 100)

School-age (6 - 9) ; (75 - 118) (58 - 90)

Adolescent (12 -15) : (60 - 100). (50 - 90)

Normal Respiratory Rates by Age (breaths per min):

Infant (<1yr)

Toddler (1-3yrs)

Preschooler (3-5yrs)

School-age (6-9yrs)

Adolescent (12-15yrs)

Tip when looking at breathing outside window ranges

Breaths per Min:

Infant. 30-53

Toddler 22-37

Preschoolers 20-28

School age 18-25

Adolescent 12-20

Consistent resp: x < 10 breaths/min x > 60 breaths/min in any child of any age is abnormal

What are we looking for in the Pediatric assessment Triangle?

3 define each

Appearance (degree of interactivity) - Tone, Interactiveness, Consolability, Look/Gaze, Speech (TICLS)

Breathing - Respiratory effort and Lung/airway sounds

Circulation (Color) - skin color or hemorrhage

What one need to do if HR:

Less than 60/min w/signs of poor perfusion despite adequate O2 and ventilation?

60/min of higher

Provide chest compression and ventilation. Proceed according to BSL

Continue ventilation as needed, and begin the "Eval-ID-Intervene.", one should check PULSE every 2 minutes

Relief techniques for foreign-body airway obstruction:

younger than one

older than one

younger than 1 - give 5 back slaps and 5 chest compressions

older than 1 - give abdominal thrusts/Heimlich maneuver

What intervention should one do if baby has:

X >94% when breathing room air

X < 94% (hypoxemia) when breathing room air

X < 90% severe hypoxemia when breathing room air

X >94% - adequate; validate by clinical assessment

X < 94% - give supplementary O2

X < 90% - Get HELP; additional interventions will be needed (bag-mask ventilation if the child's level of consciousness is decreasing)

Where can we find Central Pulses (4)

Which would be used for infants? (1)

Femoral

Brachial (in infants)

Carotid (in older children)

Axillary

Where can we find Peripheral Pulses (3)

Radial

Dorsalis Pedis

Posterior Tibial

What is cyanosis?

If Peripheral cyanosis, what are the location and the cause?

If Central cyanosis, what are the location and the cause?

Cyanosis is a bluish discoloration of the skin and mucous membranes

Hands and Feet: Low Blood flow

Mucous Membranes: Low oxygen saturation

Inspired Oxygen Concentration / Flow Rate

Low-Flow systems (2)

High-Flow System (1) and rate

Inspired Oxygen Concentration / Flow Rate

Nasal Cannula 22-60% 0.25 - 4 L/min

Simple O2 Mask 35-60% 6 - 10 L/min

Nonrebreathing mask w/reservoir

95% 10-15 L/min

What is compensated shock?

What is Hypotensive shock?

Signs of poor PERFUSION and NORMAL SYS BP

Sings of poor PERFUSION and LOW SYS BP (Hypotensive)

General management for Hypovolemic Shock? and Disruptive Shock?

Hypovolemic shock - 20 mL/kg NS/LR bolus (repeat PRN)

Control External Bleeding (if present)

Disruptive (septic, eg) Shock - 20 mL/kg NS/LR (repeat PRN)

What are the signs of Hypovolemic shock?

CHART

Concentrated urine [x > 1.03]/cyanosis, cap refill longer

Hypotension

Anxiety/altered LOC/altered heart rhythm

Rapid/weak pulse/respirations increase

Temp high/tachycardia

What are the signs of Disruptive shock?

*Excessive vasodilation - impaired blood flow distribution

some as hypovolemic shock

When using a Self-Inflating bag w/face mask, how much volume should be used for infants, young children, older children, or adolescents? (2)

Volume of at least 450 to 500 mL for Infants and Young children.

Older children, or adolescents you may need to use an adults self-inflating bag 1000 mL or larger

What steps are used to minimize Gastric Inflation during Ineffective ventilation?

Ventilate at a rate of 1 breath/3-5 sec (about 12 to 20 breaths/min)

Deliver each breath over about 1 second

deliver enough volume and pressure to produce a visible chest rise

What complications can occur from using suctioning devices? (5)

Hypoxemia

Vagal stimulation = bradycardia

Gagging = Vomiting

Tissue injury

Agitation