Pediatric Advanced Life Support (PALS) Review and Pharmacology

Vocabulary practice flashcards covering pediatric resuscitation parameters, CPR ratios, pharmacology, airway management, and dysrhythmia treatment protocols.

Heart Rate-Dependent Cardiac Output

The physiological state in infants and young children ($1\text{--}3\,\text{years}$ of age) where systemic cardiac output is driven almost entirely by heart rate rather than changes in stroke volume.

Pediatric Cardiopulmonary Compromise (CPR Threshold)

A state indicated by poor perfusion and bradycardia with a heart rate below $60\,\text{beats/min}$ after providing $30\,\text{seconds}$ of positive pressure ventilation ($\text{PPV}$), necessitating the initiation of chest compressions.

Adult Pharmacodynamic Weight Cutoff

A pediatric patient threshold of $50\,\text{kg}$ or greater (or $60\,\text{kg}$) at which medications and management may be treated pharmacodynamically as an adult.

Sniffing Position

The neutral pediatric airway positioning that avoids neck flexion or hyperextension, preventing occlusion or pinching of the pliable pediatric trachea.

Two-Rescuer Pediatric CPR Ratio

A compression-to-ventilation ratio of $15:2$ performed at a rate of $100\text{--}120\,\text{compressions/min}$ for an infant or child when two healthcare providers are present.

Single-Rescuer Pediatric CPR Ratio

A compression-to-ventilation ratio of $30:2$ delivered at a rate of $100\text{--}120\,\text{compressions/min}$ for an infant or child when a single healthcare provider is present.

Newborn CPR Compression-to-Ventilation Ratio

A resuscitation ratio of $3:1$ delivered at a rate of $120\,\text{compressions/min}$, with reassessment occurring every $30\,\text{seconds}$.

Pediatric Compression Depth

Adequate chest compression depth in pediatric resuscitation, defined as at least one-third to one-half of the anterior-posterior ($\text{AP}$) diameter of the chest.

Chest Recoil (Upstroke)

The complete release of downward pressure on the chest between compressions, allowing the thoracic cavity to expand, ventricles to fill, and coronary arteries to perfuse.

Stone Heart

A sustained, irreversible freezing or contracture of the myocardial cells caused by administering intravenous calcium chloride too rapidly into the cardiovascular system.

Glucagon (Pediatric Beta-Blocker Toxicity)

A drug administered at an IV/IO push dose of $0.05\text{--}0.15\,\text{mg/kg}$ that binds dedicated glucagon receptors to upregulate calcium channels and elevate heart rate independently of beta-1 adrenergic receptors.

Calcium Chloride (Pediatric Dosing)

An inotropic agent given slow IV/IO at $20\,\text{mg/kg}$ ($0.2\,\text{mL/kg}$), primarily indicated for hyperkalemia, calcium channel blocker toxicity, or following glucagon in beta-blocker overdose.

Calcium Gluconate Potency Ratio

A calcium formulation that is one-third as potent as calcium chloride, requiring three times ($3\times$) the dose of calcium chloride to achieve therapeutic equivalence while being less irritating to peripheral veins.

Pediatric Transcutaneous Pacing Rate

A mechanical pacing intervention indicated only for non-asphyxial bradycardias (e.g., electrocution, drug overdose), initiated at a starting rate of $100\,\text{beats/min}$.

Pediatric Fluid Resuscitation Bolus

An isotonic crystalloid administration of $20\,\text{mL/kg}$ given IV/IO via rapid push-pull over $5\text{--}10\,\text{minutes}$, repeatable up to $3$ times while monitoring breath sounds.

4-2-1 Rule

The formula used to calculate maintenance fluid rates in non-shock pediatric patients: $4\,\text{mL/kg/hr}$ for the first $10\,\text{kg}$, $2\,\text{mL/kg/hr}$ for kilograms $11\text{--}20$, and $1\,\text{mL/kg/hr}$ for each kilogram above $20\,\text{kg}$.

Albuterol (Pediatric Dosing)

A selective beta-2 adrenergic agonist bronchodilator administered via nebulizer at a standard dose of $2.5\,\text{mg}$ ($2,500\,\mu\text{g}$) in $3\,\text{mL}$ of solution.

Ipratropium Bromide (Atrovent)

An anticholinergic bronchodilator given at $500\,\mu\text{g}$ ($0.5\,\text{mg}$) via nebulization to dry up bronchial secretions and reduce bronchospasm in pediatric asthma.

Intramuscular Epinephrine 1:1,000 (Asthma)

A concentrated adrenergic agonist administered intramuscularly ($\text{IM}$) at $0.01\,\text{mg/kg}$ ($0.01\,\text{mL/kg}$), with a standard maximum single dose of $0.3\,\text{mg}$ (absolute maximum $0.5\,\text{mg}$).

Magnesium Sulfate (Pediatric Asthma)

A smooth muscle relaxant and calcium antagonist administered at $25\text{--}50\,\text{mg/kg}$ IV diluted in fluid over $15\text{--}30\,\text{minutes}$ for severe bronchospasm refractory to epinephrine.

Dexamethasone (Pediatric Dosing)

A potent corticosteroid administered at a dose of $0.5\text{--}0.6\,\text{mg/kg}$ up to a maximum dose of $16\,\text{mg}$ to suppress lower and upper airway inflammation.

Methylprednisolone (Solu-Medrol)

An intermediate-acting corticosteroid administered at $2\,\text{mg/kg}$ IV/IO up to a maximum dose of $60\,\text{mg}$ for acute pediatric respiratory distress.

Diphenhydramine (Pediatric Dosing)

An antihistamine ($H_1$ receptor antagonist) given at $1\text{--}2\,\text{mg/kg}$ IV/IO/IM up to a maximum dose of $50\,\text{mg}$ to treat systemic allergic reactions.

Foreign Body Airway Obstruction (Conscious Child)

A complete upper airway blockage managed in a conscious child by delivering alternating cycles of $5$ back blows followed by $5$ abdominal thrusts.

Foreign Body Airway Obstruction (Conscious Infant)

A complete upper airway obstruction managed in an infant by delivering alternating series of $5$ back blows and $5$ chest thrusts with the head angled lower than the trunk.

Magill Forceps

Angled retrieval forceps used under direct laryngoscopic visualization to grasp and extract foreign objects lodged in the upper airway of an unconscious pediatric patient.

Neonatal Hypoglycemia Threshold

A blood glucose level of less than $45\,\text{mg/dL}$ in a neonate, defining symptomatic hypoglycemia that requires treatment with intravenous dextrose.

Dextrose 10% ($D_{10}$)

The preferred dextrose concentration for infants from birth to $2\,\text{months}$, administered at a volume of $5\,\text{mL/kg}$ IV/IO to treat hypoglycemia.

Supraventricular Tachycardia (SVT) Cutoff Rates

Sustained dysrhythmia thresholds lacking beat-to-beat variability, characterized by a heart rate $>220\,\text{beats/min}$ in infants and $>180\,\text{beats/min}$ in children.

Infant Vagal Maneuver

A physical intervention to slow AV nodal conduction by placing an ice bag or cold compress across the face and over the eyes for $5\text{--}10\,\text{seconds}$.

Adenosine (Pediatric Dosing)

An antiarrhythmic given as a rapid IV/IO push at an initial dose of $0.1\,\text{mg/kg}$ (max $6\,\text{mg}$) followed by a second dose of $0.2\,\text{mg/kg}$ (max $12\,\text{mg}$), each followed by a rapid saline flush.

Pediatric Synchronized Cardioversion

Delivering an electrical shock synchronized to the R-wave, initiated at $0.5\text{--}1\,\text{J/kg}$ and increasing to $2\,\text{J/kg}$ for unstable tachyarrhythmias with pulses.

Pediatric Defibrillation Energy Dosing

Unsynchronized countershocks for pulseless arrest (VF/pVT) dosed at $2\,\text{J/kg}$ for the first shock, $4\,\text{J/kg}$ for the second shock, and $\ge 4\,\text{J/kg}$ up to a maximum of $10\,\text{J/kg}$ for subsequent shocks.

Amiodarone (Pediatric Dosing)

An antiarrhythmic administered at $5\,\text{mg/kg}$ rapid IV/IO push for pulseless VF/pVT, or infused slowly over $20\text{--}60\,\text{minutes}$ for stable ventricular tachycardia with a pulse.

Lidocaine (Pediatric VT with Pulse)

An antiarrhythmic dosed at $1\,\text{mg/kg}$ IV/IO over $1\text{--}2\,\text{minutes}$, repeatable at $0.5\,\text{mg/kg}$ up to a cumulative maximum of $3\,\text{mg/kg}$, followed by a maintenance infusion of $20\text{--}50\,\mu\text{g/kg/min}$.

Sodium Bicarbonate (Pediatric Arrest)

A systemic alkalinizing agent dosed at $1\,\text{mEq/kg}$ IV/IO for documented hyperkalemia or prolonged arrest; diluted to $4.2\%$ concentration in neonates and young infants.

Sialorrhea

Excessive or uncontrolled drooling, noted as a hallmark clinical sign of epiglottitis resulting from painful dysphagia and supraglottic swelling.

Pediatric AED Dose Attenuator

A built-in resistor mechanism within pediatric AED pads that reduces the energy delivered from an adult-level shock by approximately $70\text{--}75\%$.

Commotio Cordis

Sudden cardiac arrest and ventricular fibrillation induced by a non-penetrating blunt impact directly over the heart during the upstroke of the T-wave (the R-on-T phenomenon).

Kussmaul Respirations

Deep, rapid, labored respirations that compensate for severe metabolic ketoacidosis by increasing carbon dioxide excretion from the pulmonary system.

Osmotic Diuresis

Excessive fluid loss through urination resulting from hyperosmolar tubular fluid when blood glucose exceeds the renal threshold of approximately $180\,\text{mg/dL}$.

Hydroxocobalamin (Cyanokit)

The specific antidote for smoke-inhalation cyanide toxicity, administered to pediatric patients at $70\,\text{mg/kg}$ IV infused over $15\,\text{minutes}$.