163. Peds resus

Question 1

most common pathway of peds arrest

Answer 1

resp fail > shock > brady > arrest

Question 2

2 alternative spots to look for pulse

Answer 2

1. brachial

2. fem

Question 3

4 worrisome vital signs in peds

Answer 3

1. BP
   - SBP < 70 + (2xage)
2. RR
   - > 60
   - declining previous tachypnea
3. fever
   - each 1C increases HR by 10
4. EtCO2
   - progressive increase or decrease

Question 4

Infant and child CPR

Answer 4

1. Infant
   - two thumbs around chest
   - 1.5 inches
   - 15:2 ratio
2. Children
   - 2 hands
   - 2 inches
   - 15:2

Question 5

PALS arrest meds doses

Answer 5

Epi (0.01mg/kg)
Amio (5mg/kg bolus)
Lido (1mg/kg)

Question 6

PALS defib doses

Answer 6

first shock - 2J/kg

2nd shock - 4J/kg

Question 7

2 differences heart location in peds

Answer 7

inferior

lower third

Question 8

2 issues for IO in peds

Answer 8

1. aim away from growth plate

2. best success in tibia

Question 9

4 steps in post arrest care

Answer 9

1. Tx underlying cause
2. minimize brain injury
3. prevent hypoT
   - pressors
4. Temp mgmt
   - 32-36

Question 10

5 targets and goals post arrest

Answer 10

1. O2
   - 94-98%
2. Vent
   - CO2 35-40
3. CV support
   - avoid hypoT
   - pressors and fluids
4. Temp
   - antipyretics and cooling
   - 32-36
5. Glucose
   - maintain euglycemia

Question 11

6 associations of poor survivial

Answer 11

o	length of resus
o	unwitnessed
o	initial rhythms
o	multiple dose of epi
o	atropine
o	ETCOs <10

Question 12

pathophys of shock

Answer 12

• endothelial damage, cap leak, microcirc shutdown

- vasodilation, myocardial depression, complement activation, DIC

Question 13

3 keys to manage sepsis

Answer 13

o timely IV access
o rapid fluids
o ABx

Question 14

how to give peds fluids

Answer 14

• push-pull syringe
• 20ml/kg over 5-15 min
• continue until better vitals
• if still shock after >60ml/kg or signs of fluid over load, should give pressors

Question 15

3 indications for steroids in septic shock

Answer 15

o HPA problem
o Recent steroids
o Chronic illness

Question 16

Define acute life threatening event (ATLE)

Answer 16

• “episode that is frightening to the observer”
• combo of color change, apnea, chocking, gagging, change in tone
• usually under 1 and most common 2-4 months
• hard to find cause
  o most common are GERD, seizure or resp illness

Question 17

9 RFs for dangerous cause of ATLE

Answer 17

PMH
- premature
- comorbidities
- <1 month old
- prior ATLE
Hx
- color to blue
> 1 event / 24 hours
- no choking
- no URI Sx
PHx
- any abnormal findings

Question 18

3 indications to DC ATLE

Answer 18

1. first episode
2. assoc with feeding
3. observe in ED 3-4 hours