STAT Stitch Deep Dive Podcast Beyond The Bedside

STAT Stitch Deep Dive Podcast Beyond The Bedside

by Regular Guy

Courses Life Sciences

Season 19

ACLS | Acute Coronary Syndrome

🔥 ACLS Deep Dive: High-Yield Crash Summary 🔥 1️⃣ Chain of Survival – Keep It Simple Recognize 🚨 → Activate EMS 🚑 → Rapid transport + prearrival notice → ED/cath lab diagnosis → Reperfusion 💥. STEMI survival depends on speed. Every second = muscle saved. 2️⃣ Shockable vs Nonshockable – Know the Split 💥 VFib & pulseless VT = shock now. 🫀 Asystole & PEA = compress & give epi. Defib/cardioversion breaks lethal rhythms; compressions buy time. 3️⃣ Key Meds & Timing ⏱️ • Aspirin: 162–325 mg, chewed, ASAP — blocks thromboxane A₂ to stop clot growth. • Nitroglycerin: Sublingual/translingual; repeat ×3 if SBP ≥ 90 mm Hg and no RV infarct. • Morphine: Only if pain persists after NTG. 🚫 Avoid if hypotensive. • Oxygen: Give only if SpO₂ < 90% or patient is dyspneic/hypoxemic. • Immediate priorities (<10 min): ABCs, IV access, ECG, labs, call cath team. 4️⃣ Brady vs Tachy – Pulse Present ⚡ Unstable bradycardia → pace. Unstable tachycardia → cardioversion. Unstable = hypotension, altered LOC, shock, chest pain, or pulmonary edema. 5️⃣ Cardiac Arrest Core Logic 🧠 • VF/pVT: Shock → CPR 2 min → shock → epi 1 mg q3–5 min → amio 300 mg bolus (then 150 mg). • Asystole/PEA: CPR + epi; no shock until rhythm changes. Keep compressions ≥ 2 in deep, rate 100–120/min, minimize interruptions. 6️⃣ Nursing Priorities 🩺 🚨 Call Rapid Response if HR < 40 / > 140, RR < 6 / > 30, SBP < 90, seizure, ↓LOC, or oliguria. 💡 When to Shock vs Compress: Shock for VF/pVT; compress for asystole/PEA. 💨 Airway: Manage ABCs first — secure airway, ventilate, oxygenate. 📊 Post-ROSC: Target ETCO₂ 35–40 mm Hg, O₂ 94–99%, maintain SBP > 90 mm Hg. 7️⃣ Contraindications & Traps ⚠️ • NTG/Morphine: Never in hypotension or RV infarct. • NSAIDs (except ASA): 🚫 During STEMI — ↑ risk of death, reinfarction, rupture. • Aspirin: Must be chewed (not enteric-coated). • Delay of Therapy = Death: 1️⃣ Diagnosis delay 2️⃣ Decision delay 3️⃣ Door-to-balloon delay 4️⃣ Door-to-departure delay 8️⃣ Reperfusion Goals ⏰ • PCI (door-to-balloon): ≤ 90 min from first medical contact. • Fibrinolysis (door-to-needle): ≤ 30 min of ED arrival. Miss these → ↑ mortality. 9️⃣ Rapid 2-Min Recall 🧩 1️⃣ RRT: HR < 40/>140, RR < 6/>30, SBP < 90. 2️⃣ ACS < 10 min: ABCs, IV, ECG, ASA, NTG, O₂ < 90%. 3️⃣ ASA 162–325 mg chewed. 4️⃣ NTG/Morphine 🚫 if hypotension or RV infarct. 5️⃣ PCI ≤ 90 min, Fibrinolysis ≤ 30 min. 6️⃣ No NSAIDs (except ASA). Bottom line 💀: Stay calm, think algorithmically, don’t delay shocks, and hit those reperfusion windows like your patient’s life depends on it — because it does.

ACLS | Stroke

🧠 ACLS Deep Dive: Stroke Edition (High-Yield & Real-World) 🚨 1️⃣ Stroke Chain of Survival — “Time = Brain” Recognize ➡️ Call 9-1-1 🚑 ➡️ EMS alerts hospital ➡️ Rapid diagnosis ➡️ Treatment (thrombolytics or EVT). Goal: minimize brain injury, maximize recovery. Every minute = 1.9 million neurons lost. ⏱️ 2️⃣ Critical Drug — Alteplase (tPA) 💉 • Window: ≤3 hr from symptom onset (extend to 4.5 hr in select pts). • EVT (mechanical thrombectomy): up to 24 hr for large-vessel occlusion (LVO). • Dose: 0.9 mg/kg (10% bolus 1 min → 90% infuse 60 min; max 90 mg). • BP goal: ≤185/110 mm Hg before tPA and ≤180/105 mm Hg for 24 hr after. • Absolute no-go: any intracranial hemorrhage on CT/MRI 🚫. • Watch glucose: correct hypo and avoid >180 mg/dL. 3️⃣ Airway & ABCs 🫁 Assess airway → oxygen if SpO₂ ≤ 94% or unknown. Stroke pts risk aspiration and hypoventilation — keep suction ready and watch for airway obstruction. 4️⃣ Rapid Algorithm (What to Know Cold) 1️⃣ Activate Stroke Team immediately upon EMS notification. 2️⃣ General + Neuro assessment within 10 min of arrival. 3️⃣ CT/MRI ≤ 20 min (best practice: direct to scanner). 4️⃣ Interpret ≤ 45 min → if hemorrhage = NO tPA. 5️⃣ If no bleed → administer tPA (if eligible). 6️⃣ Door-to-Needle: ≤ 60 min (Goal: 85% meet this). 7️⃣ EVT: Door-to-device ≤ 90 min (direct) / ≤ 60 min (transfer). 5️⃣ Nursing Priorities & Critical Thinking 🩺 🚨 Activate stroke system immediately when symptoms recognized. 💉 Start IVs early (but don’t delay CT). 💨 Maintain airway + O₂ ≥ 94%. 🩸 Monitor BP closely during and after tPA. 🧾 Document last known well time — it defines eligibility. ⚡ Do NOT delay CT for ECG or labs — “Time is Brain.” 6️⃣ Key Contraindications / Exam Traps ⚠️ • Hemorrhage on imaging = NO tPA. • BP >185/110 mm Hg = NO tPA until controlled. • Do not delay CT/MRI for Atropine or Adenosine (if brady/tachy). • Uncontrolled HTN, active bleeding, or recent surgery = 🚫. • Treating stroke mimics w/ tPA can cause ICH — consult stroke expert. 7️⃣ Critical Times You Must Memorize ⏰ • General assessment ≤ 10 min • CT/MRI obtained ≤ 20 min • CT interpreted ≤ 45 min • Door-to-needle ≤ 60 min • Door-to-device (Thrombectomy) ≤ 90 min 8️⃣ “Gotcha” Moments 🧩 💡 Never give tPA before imaging rules out bleed. 💡 Never “wait for labs” before CT unless they directly affect tPA eligibility (e.g., coags). 💡 Aggressive BP lowering before CT can mask stroke severity — treat only if >220/120 and no tPA planned. 9️⃣ 2-Min Quick Recall 🔥 1️⃣ Ischemic = 87% of strokes 🧠 2️⃣ CT/MRI ≤ 20 min → NO BLEED = candidate for tPA 3️⃣ Door-to-Needle ≤ 60 min 4️⃣ Alteplase 0.9 mg/kg (max 90 mg) — 10% bolus, 90% infuse 60 min 5️⃣ BP < 185/110 before tPA; maintain < 180/105 after 6️⃣ O₂ ≤ 94% → supplement 7️⃣ “Time is Brain” — act fast or neurons die.

ACLS | Respiratory Arrest

💨 ACLS Deep Dive: Respiratory Arrest (With a Pulse) 🫁 1️⃣ BLS Foundation — Keep It Basic, Keep It Alive Scene safe ✅ → Check responsiveness → Shout for help 📣 → Activate emergency response 🚑 → Check breathing + pulse simultaneously (≤10 sec). 💤 If no breathing but pulse present → Respiratory Arrest. 👉 Deliver 1 breath every 6 seconds (10/min) via BVM or advanced airway. 👉 Recheck pulse every 2 minutes (5–10 sec). 👉 If pulse disappears → start CPR immediately. 2️⃣ Airway Priorities — The ABCs Still Rule 🫀 Open the airway: Most common obstruction = tongue fall-back. Use head-tilt chin-lift (no trauma) or jaw-thrust (suspected trauma). 💨 Ventilation: 1 breath q6 sec (10/min) with visible chest rise. Tidal volume ≈ 500–600 mL (6–7 mL/kg). Avoid hyperventilation — it kills perfusion. 🧩 Adjuncts: OPA: Only in unresponsive pts w/out gag/cough reflex. NPA: Use if conscious, semi-conscious, or intact gag reflex. 🚫 Wrong size → gastric inflation or esophageal placement → ↓ventilation & ↑aspiration risk. 🧠 If opioid overdose suspected: Administer Naloxone per protocol. 3️⃣ Ventilation Traps — “Less is More” ⚠️ Overventilation is deadly: 🚫 ↑ Intrathoracic pressure → ↓ venous return. 🚫 ↓ Cardiac output → ↓ perfusion → ↓ survival. 🚫 Cerebral vasoconstriction → ↓ brain blood flow. 🚫 Gastric inflation → aspiration risk. 🎯 Goal: Just enough air to see chest rise — no more. 4️⃣ Algorithm Snapshot 🧩 If Respiratory Arrest (Pulse Present): 1️⃣ Open airway (head-tilt or jaw-thrust). 2️⃣ Use OPA/NPA if needed. 3️⃣ Ventilate 1 breath q6 sec w/ 100% O₂. 4️⃣ Avoid excessive ventilation. 5️⃣ Check pulse every 2 min. 6️⃣ If no pulse → switch to CPR. 🧾 Use waveform capnography for ET tube placement & ventilation quality monitoring. 5️⃣ Meds & Extras 💉 Epi, Amio, Adenosine = not indicated here. Only drug of note: Naloxone for suspected opioid overdose. Some settings may initiate RSI (rapid sequence intubation) if trained and equipped. 6️⃣ Nursing Priorities 🩺 ✅ Maintain airway patency. ✅ Ensure effective ventilations (visible chest rise, SpO₂ monitoring). ✅ Avoid gastric inflation — slow, gentle breaths. ✅ Reassess pulse + airway every 2 min. ✅ Use ETCO₂ to confirm airway placement + monitor ventilation quality. ✅ Activate additional help early if ventilation difficult or ineffective. 7️⃣ “Gotcha” Exam Traps 🎯 🚫 Never use OPA in any patient w/ gag or cough reflex. 🚫 Don’t hyperventilate — it reduces cardiac output. 🚫 Don’t skip the pulse check before starting compressions. 🚫 Don’t forget airway adjuncts — tongue obstruction is #1 cause. 8️⃣ 2-Min Quick Recall 🔥 1️⃣ 1 breath every 6 sec (10/min). 2️⃣ 500–600 mL or just enough for visible chest rise. 3️⃣ Avoid excessive ventilation — kills perfusion. 4️⃣ OPA = only if no gag; NPA = okay if gag present. 5️⃣ Check pulse q2 min; if absent → CPR. 6️⃣ Use capnography to confirm airway & monitor effectiveness.

ACLS | Brady/Tachycardia

⚡ ACLS Deep Dive: Rhythms with a Pulse (Brady & Tachy) ⚡ 1️⃣ Core Concepts — When to Shock, When to Chill 💥 Synchronized Cardioversion: For unstable rhythms with a pulse — unstable SVT, AFib, flutter, or monomorphic VT. Sedate if possible. ⚡ Unsynchronized (Defibrillation): For pulseless VT/VF or unstable polymorphic VT (if rhythm can’t be timed safely). 🧠 Rule: If they have a pulse but are tanking → cardiovert. No pulse → shock. 2️⃣ Bradycardia Algorithm 🫀 (HR < 50 + symptoms) 1️⃣ Atropine 1 mg IV bolus, repeat q3–5 min (max 3 mg). 2️⃣ If ineffective → TCP (Transcutaneous Pacing) or Epinephrine 2–10 mcg/min / Dopamine 5–20 mcg/kg/min. 3️⃣ Don’t delay pacing for ECG — treat first. 🚫 Atropine traps: – Doesn’t work in Mobitz II or 3° AV block w/ wide QRS — pace instead. – Ineffective in heart transplant pts. – <0.5 mg may paradoxically slow HR. 3️⃣ Tachycardia Algorithm 🔥 (HR > 150) 💣 If Unstable (shock, hypotension, chest pain, AMS, HF): → Immediate synchronized cardioversion (follow device energy levels). 💤 Sedate if conscious unless rapidly deteriorating. 📈 If Stable: Narrow QRS, Regular (SVT): Vagal maneuvers → Adenosine 6 mg rapid IV push, then 12 mg if needed. Wide QRS, Regular/Monomorphic: Expert consult → Amiodarone 150 mg IV over 10 min, or Procainamide/Sotalol if available. ⚠️ Avoid AV nodal blockers (Adenosine, CCBs, β-blockers) in irregular wide-complex rhythms (e.g., pre-excited AFib/WPW) — can cause VF! 4️⃣ High-Yield Meds 💊 • Atropine: 1 mg IV q3–5 min (max 3 mg). Avoid in advanced blocks/transplants. • Epinephrine (infusion): 2–10 mcg/min for bradycardia after atropine fails. • Dopamine: 5–20 mcg/kg/min if epi unavailable. • Adenosine: 6 mg → 12 mg IV push for regular narrow tachycardia. 🚫 Never for irregular wide-complex rhythms. • Amiodarone: 150 mg IV over 10 min for stable wide monomorphic VT → 1 mg/min x 6 hr → 0.5 mg/min. 5️⃣ Airway & Oxygen 🫁 Maintain patent airway; assist ventilation if needed. Give O₂ only if hypoxemic. Monitor continuously. 6️⃣ Nursing Priorities & Real-World Moves 🩺 ✅ If unstable → act fast: Atropine, pacing, or cardioversion. Don’t wait for 12-lead. ✅ Confirm mechanical capture with TCP (check femoral pulse — not carotid). ✅ Sedate before cardioversion if conscious. ✅ Get expert consult for stable wide-complex tachycardias. 📞 Call for help early if instability persists or rhythm unclear. 7️⃣ Exam Traps & Common Mistakes ⚠️ 🚫 Giving Atropine in 3° block w/ wide QRS — it won’t work. Go straight to pacing or Epi/Dopa. 🚫 Using AV nodal blockers (Adenosine, β-blockers, CCBs) in pre-excited AFib → can cause VF. 🚫 Delaying cardioversion for an unstable tachycardia — act first. 🚫 Forgetting sedation for conscious cardiovert patients. 🚫 Mistaking electrical twitch for a pulse during pacing — always confirm mechanical capture. 8️⃣ 2-Min Quick Recall 🔥 1️⃣ Brady: Atropine 1 mg → TCP → Epi 2–10 mcg/min / Dopa 5–20 mcg/kg/min. 2️⃣ Don’t rely on Atropine for Mobitz II, 3° AV block, or transplant pts. 3️⃣ Unstable tachy = cardiovert NOW. 4️⃣ Stable SVT = vagal → Adenosine 6 → 12 mg. 5️⃣ Stable monomorphic VT = Amio 150 mg/10 min. 6️⃣ Never Adenosine or AV blockers in irregular wide-complex. 7️⃣ Always confirm mechanical capture after pacing.

ACLS | Cardiac Arrest and More

🫀 Why Patients Die (and How ACLS Saves Them) Cardiac arrest = no effective circulation → global ischemia. Survival hinges on CPP (aortic diastolic − RA pressure). • High-quality CPR (≥2 in/5 cm, 100–120/min, full recoil, CCF ≥80%) maintains CPP; every pause tanks CPP. • Defibrillation for VF/pVT stuns chaotic myocardium → pacemakers can resume an organized rhythm (ROSC). Shock early. Rhythms & Management 🔹 Shockable: VF / pVT ECG: VF = chaotic; pVT = fast wide-QRS + no pulse. Algorithm (cycle): Start CPR, attach defib. Shock (biphasic 120–200 J per device; mono 360 J). CPR 2 min → rhythm check. Gain IV/IO. If still shockable → Shock → Epi 1 mg IV/IO q3–5 min (give after the next rhythm check/shock). Next cycle if shockable → Shock → Amio 300 mg IV/IO, then 150 mg (or Lido 1–1.5 mg/kg, then 0.5–0.75 mg/kg; max 3 mg/kg). Treat H’s & T’s, monitor ETCO₂. Rotate compressors q2 min. Nursing: Have antiarrhythmic drawn before shock; “All clear—shocking.” 🔹 Nonshockable: Asystole / PEA (mechanical/perfusion problem) ECG: Asystole = flat line (check leads/gain). PEA = organized rhythm without a pulse. Algorithm: • CPR 2 min, Epi 1 mg IV/IO q3–5 min ASAP. • No defib. H’s & T’s hunt: Hypovolemia, Hypoxia, H+ (acidosis), Hypo/Hyper-K, Hypothermia; Tension pneumo, Tamponade, Toxins, Thrombosis (pulm/coronary). Nursing: Do not interrupt CPR >10 s; assign someone to etiology search (history + ultrasound). Meds Epinephrine (α-vasoconstrictor → ↑aortic diastolic → ↑CPP) • Arrest dose: 1 mg IV/IO q3–5 min (VF/pVT & Asys/PEA). No arrest contraindication. • Do not stop CPR to push meds; flush 20 mL + elevate limb 10–20 s. Amiodarone (Class III; stabilizes myocardium) • VF/pVT refractory: 300 mg, then 150 mg IV/IO. • Post-bolus hypotension/brady can occur (less relevant during arrest). Lidocaine (Class Ib; ↓automaticity) • VF/pVT alt: 1–1.5 mg/kg, then 0.5–0.75 mg/kg (max 3 mg/kg). Magnesium sulfate (torsades) • 1–2 g IV/IO diluted (~10 mL) over ~20 min (use if torsades present). During arrest • No advanced airway: 30:2. • Advanced airway: 10 breaths/min (q6 s) with continuous compressions. • Avoid hyperventilation. Post-ROSC targets • Ventilation: start 10/min; SpO₂ 92–98%; PaCO₂ 35–45 mmHg (avoid hyperoxia/hyperventilation). • Hemodynamics: SBP ≥90 or MAP ≥65. – Fluids 1–2 L NS/LR → if needed: NE 0.1–0.5 μg/kg/min, Epi 2–10 μg/min, or Dopa 5–20 μg/kg/min. • TTM: comatose after ROSC → 32–36°C for ≥24 h (don’t delay PCI for STEMI). • Confirm ET tube with capnography.

ACLS | ACLS Combined Material

🫀 Core Concepts Cardiac arrest = electrical failure (VF/pVT) or mechanical/perfusion failure (Asystole/PEA). On the floor/ICU, arrests are often preceded by resp failure or hypovolemia → RR <6 or >30, HR <40 or >140, SBP <90 → activate Rapid Response. ACS pathway: plaque → rupture → thrombus → ischemia/MI. STEMI = full occlusion, NSTE-ACS = partial; ischemia makes myocardium irritable → VF. ACLS boosts chances of ROSC + neuro recovery. 🧷 Chain of Survival (STEMI) Recognize → EMS/transport + prearrival notice → ED/cath dx → reperfusion. Goals: PCI ≤90 min from first medical contact; fibrinolysis ≤30 min from ED arrival. Your job: zero delays. 🔄 Rhythms & Management ⚡ Shockable: VF / pVT Patho/ECG: VF = chaotic, no QRS; pVT = wide, fast, pulseless. Do: CPR → Shock (biphasic 120–200 J; mono 360 J) → 2 min CPR → rhythm check. If still shockable: Shock → Epi 1 mg IV/IO q3–5 min. Next cycle: Shock → Amio 300 mg (then 150 mg) or Lido 1–1.5 mg/kg, then 0.5–0.75 mg/kg (max 3 mg/kg). Treat H’s/T’s; rotate compressors q2 min; minimize pauses. 🧠 Why: Defib ends electrical chaos so native pacemakers can resume. 🫢 Nonshockable: Asystole / PEA Patho/ECG: Asystole = flat (check leads/gain); PEA = rhythm, no pulse (severe preload/mechanical problem). Do: CPR → Epi 1 mg IV/IO q3–5 min ASAP → NO shock → relentless H’s/T’s search (Hypovolemia, Hypoxia, H+, Hypo/Hyper-K, Hypothermia; Tension pneumo, Tamponade, Toxins, Thrombosis pulm/coronary). 🧠 Why: Vasoconstriction ↑ aortic diastolic P → ↑ CPP during CPR; fixing the cause is the win. 🐢 Bradycardia (symptomatic, HR <50) Airway/O₂/monitor/IV/12-lead. Atropine 1 mg IV q3–5 min (max 3 mg). If ineffective: TCP, Dopamine 5–20 mcg/kg/min or Epi 2–10 mcg/min. ⚠️ Often ineffective in Mobitz II/3° block w/ wide QRS and transplant → pace early. Sedate for TCP if conscious. 🚀 Tachycardia (HR >150) Unstable: Synchronized cardioversion NOW (sedate if possible). Stable narrow regular (SVT): vagal → Adenosine 6 mg, then 12 mg rapid IV push. Stable wide regular: consider Amio 150 mg over 10 min (or procainamide). ⚠️ Never AV nodal blockers (Adenosine/BB/CCB) in irregular wide-complex (likely pre-excited AF) → can provoke VF. 💊 Meds (adult highlights) Epinephrine: Arrest 1 mg IV/IO q3–5 min; Brady 2–10 mcg/min. Flush 20 mL + elevate limb. Amiodarone: VF/pVT refractory 300 mg, then 150 mg; maint 1 mg/min ×6 h. Lidocaine: 1–1.5 mg/kg, then 0.5–0.75 mg/kg (max 3 mg/kg). Magnesium: 1–2 g for torsades. Atropine: 1 mg IV (max 3 mg). Adenosine: 6 mg → 12 mg rapid push + flush.

Season 20

Podcast Subject Breakdown

This episode CONTAINS NO EDUCATIONAL MATERIAL. This episode details how the subjects are set up. Season 1= Health Assessment Season 2- Medical Surgical Season 3- Pharmacology

PALS | Management of Pedi Arrhythmias

PALS | Management of Pedi Arrhythmias

PALS | Cardiac Arrest

the recognition and management of Pedi cardiac Arrest

PALS | Systemic Approach to Critically Ill Child Extended

The PALS Systematic Approach provides a structured framework to quickly evaluate, identify, and treat life-threatening conditions in pediatric cases[1]. Applying the 80/20 principle, clinical priorities focus on rapidly recognizing respiratory failure and shock before cardiac arrest occurs[1][2]. 1. Initial Impression (Pediatric Assessment Triangle) Formed within seconds "from the doorway" without touching the child[1][3]: Appearance: Evaluates consciousness, interactiveness, tone, and consolability via TICLS[3]. Work of Breathing: Identifies respiratory distress via effort (retractions, nasal flaring), position (tripod), and audible sounds (stridor, grunting, wheezing)[3][4]. Circulation: Assesses systemic perfusion using skin color (pallor, mottling, cyanosis)[3][4]. 2. Immediate Life-Threatening Interventions Unresponsive, No Breathing/Gasping, No Pulse: Shout for help, activate emergency response, and begin CPR (C-A-B)[5][6]. Pulse Present, No Breathing: Provide rescue breathing (1 breath every 3-5 seconds; 12-20 breaths/min)[6]. Pulse <60/min with Poor Perfusion (despite oxygenation): Start chest compressions[5][6]. 3. Evaluate-Identify-Intervene Sequence Care is a continuous loop: Evaluate -> Identify -> Intervene, repeated after every intervention or change in clinical condition[7][8]. 4. Primary Assessment (ABCDE Framework) Rapid hands-on evaluation of vital physiologic functions[7][8]: Airway (A): Assess patency (Clear, Maintainable via head tilt-chin lift/jaw thrust/OPA, or Unmaintainable requiring advanced airway)[9]. Breathing (B): Assess rate (warning: <10 or >60/min)[11], effort, chest expansion (tidal volume 5-7 mL/kg)[12], breath sounds, and SpO2 (hypoxemia: <94%)[13]. Bradypnea and grunting signal impending arrest[14][15]. Circulation (C): Assess HR (bradycardia is hypoxia-driven)[16], central vs peripheral pulses[17], capillary refill (<=2s)[18], skin color/temp[19], blood pressure (hypotension: infant <70, child 1-10 yrs <70 + 2xage, >10 yrs <90 mmHg)[20], and urine output (infants 1.5-2, children 1 mL/kg/h)[20]. Hypotension signals decompensated shock[20]. Disability (D): Rapid neuro assessment using AVPU[21] or Pediatric GCS (<=8 indicates severe injury)[22][23], pupil response (PERRL)[24], and blood glucose (hypoglycemia: <=45 mg/dL in neonates, <=60 mg/dL in children)[24]. Exposure (E): Undress to evaluate trauma, hemorrhage, or petechiae/purpura (indicative of septic shock), preventing hypothermia[24]. 5. Secondary Assessment & Diagnostics SAMPLE History: Focused history: Signs/symptoms, Allergies, Medications, Past history, Last meal, and Events leading to illness[25]. Diagnostic Assessments: ABG/VBG (PaO2, PaCO2, pH <7.35 acidosis)[26], blood lactate (tissue ischemia)[27], ScvO2 (normal 70-75%)[28], ECG, and CXR[29].

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