9. Management of cardioresp arrest

Question 1

What mnemonic is used to manage an in hospital cardiorespiratory arrest?

Answer 1

SSSABC
Safety
Stimulate
Shout for help
Airway
Breathing
Circulation

Question 2

How do you assess the second ‘S’ (stimulate) and what are the possible outcomes?

Answer 2

Test if the child is responsive by shouting their name/pulling hair

Responsive -> follow A to E approach

Unresponsive -> follow BLS

Question 3

Talk through a paeds SSSABC approach up to the point of rhythm check

Answer 3

A - open airway, use suction as needed, head tilt chin lift or jaw thrust. In-line position if infant, sniffing the morning air in children

B - look listen feel for up to 10 seconds, deliver 5 rescue breaths with bag valve mask and oxygen

C - high quality chest compressions at rate of 100-120 for infants and children. 15 compressions to 2 ventilations. Correct depth, allow recoil. Attach ECG monitoring and defib when available.

Continue CPR while pads being applied and follow instruction of the AED. May require a brief pause for rhythm recognition.

Question 4

Are shockable or non-shockable rhythms more common in children?

Answer 4

Non-shockable

Question 5

If a child has adequate respiratory and ventilatory support, but their HR drops to <60, what should you do?

Answer 5

Start CPR

Question 6

When are VF and pVT more likely to occur?

Answer 6

When child has underlying congenital/acquired cardiac disease

Question 7

If you have started CPR, defib does a rhythm check and tells you it is PEA what should you do?

Answer 7

Resume CPR
Administer adrenaline 1:10,000 IV (10 micrograms per kilogram) as soon as possible, and then every 3-5 minutes following this

Question 8

If you have started CPR, defib does a rhythm check and tells you it is asystole what should you do?

Answer 8

Resume CPR
Administer adrenaline 1:10,000 IV (10 micrograms per kilogram) as soon as possible, and then every 3-5 minutes following this

Question 9

If you have started CPR, defib does a rhythm check and tells you it is VF what should you do?

Answer 9

Administer 1 shock (asynchronous) at 4 joules per kilogram and then immediately resume CPR

After 3 shocks have been given give:
- adrenaline (1:10,000 IV/IO 10 micrograms per kg) after the 3rd shock and then on alternate cycles thereafter
- amiodarone (IV/IO 5 MILLIGRAMS per kg) after this 3rd shock and then once more after 5th shock

Question 10

If you have started CPR, defib does a rhythm check and tells you it is VT what should you do?

Answer 10

Check it is pulseless!

Administer 1 shock (asynchronous) at 4 joules per kilogram and then immediately resume CPR

After 3 shocks have been given give:
- adrenaline (1:10,000 IV/IO 10 micrograms per kg) after the 3rd shock and then on alternate cycles thereafter
- amiodarone (IV/IO 5 MILLIGRAMS per kg) after this 3rd shock and then once more after 5th shock

Question 11

What are the reversible causes of cardiorespiratory arrest in children?

Answer 11

HHHHTTTT
hypoxia
hypothermia
hyperkalaemia/magnesaemia/calcaemia or hypoglycaemia
hypovolaemia

Toxins
Tamponade
Thrombus
Tension pneumoThorax

Question 12

Where should you check for a pulse during cardiorespiratory arrest?

Answer 12

ONLY WHEN NO CPR ONGOING

In children - feel for carotid in neck
In infants - feel for brachial pulse on inner aspect of upper arm

Question 13

If going through the H/T’s and you think hypovolaemia is the problem how will you fix it?

Answer 13

give 10 ml per kg bolus of 0.9%NaCl

Question 14

In what conditions might you prolong resuscitation attempts to over 30 mins?

Answer 14

Toxins (poisoning)
Thrombus
Hypothermia
Persistent VF/pVT