Paediatric Emergencies (PALS) Flashcards

Neonatal resuscitation initial steps immediately after birth include:

Answer: Warmth, drying and stimulation, airway positioning — before checking heart rate

NRP initial steps: warmth (warm environment, drying), stimulation (rubbing the back and feet), airway positioning (slight neck extension, sniffing position), and suction if needed — prior to any assessment or intervention.

In neonatal resuscitation, positive pressure ventilation (PPV) is indicated when the heart rate is:

Answer: Below 100 bpm or the baby is apnoeic/gasping despite initial stimulation

PPV is initiated when the heart rate is <100 bpm or the newborn is apnoeic or gasping after initial steps; central cyanosis without breathing difficulty may respond to supplemental oxygen before PPV.

Chest compressions in neonatal resuscitation are started when heart rate remains below:

Answer: 60 bpm after 30 seconds of adequate PPV

NRP guidelines: begin chest compressions when HR is <60 bpm despite 30 seconds of adequate PPV; compressions are coordinated 3:1 with ventilation (90 compressions + 30 breaths per minute).

Paediatric hypotension (systolic BP below lower limit of normal) is estimated using the formula:

Answer: Lower limit SBP = 70 + (2 × age in years) for children 1-10 years

The formula 70 + (2 × age in years) estimates the lower limit of normal systolic BP for children aged 1-10; values below this indicate hypotension requiring urgent intervention.

A 2-year-old child presents with sudden onset stridor, drooling, and sitting forward in a tripod position with a muffled voice. The most likely diagnosis is:

Answer: Epiglottitis — do not examine the throat, keep child calm, prepare for surgical airway, transport urgently

The triad of sudden stridor, drooling, and tripod positioning with muffled voice in a young child suggests epiglottitis (though now rare due to vaccination); any examination or agitation risks complete airway obstruction.

In a paediatric patient, the earliest reliable sign of deteriorating haemodynamic status is:

Answer: Tachycardia and prolonged capillary refill time (CRT >2 seconds)

Tachycardia and prolonged CRT are the earliest measurable signs of compensated shock in children, preceding hypotension (a late sign) by a considerable margin — allowing earlier intervention if recognised.