A case-based update: 2010 paediatric basic and advanced life-support guidelines Flashcards
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?
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
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?
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
What is the ratio for chest compressions to breathes
2 people - 30:2
1 person - 15:2
What is the rate of good chest compressions?
100 compressions/min
How would you define good quality compressions?
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
What is the rate of rescue breathes?
8-10 ventilations/minute
How long should pulse checks be?
What oxygen saturation do we aim for and why?
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)
What oxygen saturation do we aim for and why?
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)
What is the ratio for chest compressions to breathes
2 people - 30:2
1 person - 15:2
What is the rate of good chest compressions?
100 compressions/min
How would you define good quality compressions?
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
What is the rate of rescue breathes?
8-10 ventilations/minute
How long should pulse checks be?
less than 10 seconds
Can an AED be used in infants?
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
What oxygen saturation do we aim for and why?
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)
What do you think of therapeutic hypothermia?
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
In a stable wide complex tachycardia, what do you try first? And who would you not give this to?
Adenosine
Kids with WPW
What is the defibrillation shock dose?
2-4 J/kg for first attempt
Max 10J/Kg
Why do we not use etomidate?
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
How do we determine the right ETT size (cuffed and uncuffed)?
Cuffed: 3.5 + (age/4)
Uncuffed + 0.5cm
Should we use cricoid pressure?
Nope. Insufficient evidence to prevent aspiration. The worry is that it interferes with the speed and ease of intubation
What is the main cause of cardiac arrest in an admitted patient?
asphyxia
