A case-based update: 2010 paediatric basic and advanced life-support guidelines

Question 1

As a lay person, when you see a patient who is likely in a cardiac arrest, what do you do first?
Is this different as a health professional?

Answer 1

start chest compression first.

Previously you were supposed to do ABC + check for breaths (look listen and feel). The emphasis has been changed to decrease delay for compression, so all you have to check is if the patient is responsive and are they breathing normally

As a HCP - you can check for a pulse first

Question 2

As a lay person, when you see a patient who is likely in a cardiac arrest, what do you do first?
Is this different as a health professional?

Answer 2

start chest compression first.

Previously you were supposed to do ABC + check for breaths (look listen and feel). The emphasis has been changed to decrease delay for compression, so all you have to check is if the patient is responsive and are they breathing normally

As a HCP - you can check for a pulse first

Question 3

What is the ratio for chest compressions to breathes

Answer 3

2 people - 30:2

1 person - 15:2

Question 4

What is the rate of good chest compressions?

Answer 4

100 compressions/min

Question 5

How would you define good quality compressions?

Answer 5

1/3 of the AP diameter of the chest, or 4 cm in infants and 5 cm in children
Rotate compressor every 2 minutes
full recoil

Question 6

What is the rate of rescue breathes?

Answer 6

8-10 ventilations/minute

Question 7

How long should pulse checks be?

Question 8

What oxygen saturation do we aim for and why?

Answer 8

92-99%
Too much oxygen can cause oxidative injury during reperfusion (following ischaemia)

if you have Sats at 100%, it is hard to know the PaO2 (could be anywhere from 80-500mmHg)

Question 9

What oxygen saturation do we aim for and why?

Answer 9

92-99%
Too much oxygen can cause oxidative injury during reperfusion (following ischaemia)

if you have Sats at 100%, it is hard to know the PaO2 (could be anywhere from 80-500mmHg)

Question 10

What is the ratio for chest compressions to breathes

Answer 10

2 people - 30:2

1 person - 15:2

Question 11

What is the rate of good chest compressions?

Answer 11

100 compressions/min

Question 12

How would you define good quality compressions?

Answer 12

1/3 of the AP diameter of the chest, or 4 cm in infants and 5 cm in children
Rotate compressor every 2 minutes
full recoil

Question 13

What is the rate of rescue breathes?

Answer 13

8-10 ventilations/minute

Question 14

How long should pulse checks be?

Answer 14

less than 10 seconds

Question 15

Can an AED be used in infants?

Answer 15

yes, they can be used but are not the first choice. First choice is manual defibrillation.
If AED is used - you can use pediatric dose attenuator for up to 25 kg or 8 years

Question 16

What oxygen saturation do we aim for and why?

Answer 16

92-99%
Too much oxygen can cause oxidative injury during reperfusion (following ischaemia)

if you have Sats at 100%, it is hard to know the PaO2 (could be anywhere from 80-500mmHg)

Question 17

What do you think of therapeutic hypothermia?

Answer 17

CPS: if the kid remains comatosed post resuscitation, you can consider keeping cold 32-34 degrees

NB no evidence and we do not do this

Question 18

In a stable wide complex tachycardia, what do you try first? And who would you not give this to?

Answer 18

Adenosine

Kids with WPW

Question 19

What is the defibrillation shock dose?

Answer 19

2-4 J/kg for first attempt

Max 10J/Kg

Question 20

Why do we not use etomidate?

Answer 20

People like it because there is minimal adverse hemodynamic effects
BUT in kids with aseptic shock it has been linked to adrenal suppression and higher mortality

Question 21

How do we determine the right ETT size (cuffed and uncuffed)?

Answer 21

Cuffed: 3.5 + (age/4)

Uncuffed + 0.5cm

Question 22

Should we use cricoid pressure?

Answer 22

Nope. Insufficient evidence to prevent aspiration. The worry is that it interferes with the speed and ease of intubation

Question 23

What is the main cause of cardiac arrest in an admitted patient?

Answer 23

asphyxia