BLS/ALS - VF/VT and drowning Flashcards
What are the first steps in BLS
What are the initial aspects of opening an infants airway
Stabilise head
Neutral position of neck
Lift chin
If a chin lift is not effective what do you do with an infants airway
Jaw thrust
Note neck remains in neutral position
What is the main difference between the initial approach to an infants and a childs airway
Infant - neutral position
Child - Sniffing position
What comes after DRSA in BLS
Breathing - look, listen and feel
-> If the child is not breathing within 10 seconds, give two rescue breaths.
How does the delivery of rescue breaths given to an infant vary with that of a child
Infant - head neutral position
-Give breaths coving nose and mouth of infant when delivering
Child - sniffing position
What comes after breathing in BLS
If the child is unresponsive and is apnoeic or has abnormal breathing, cardiac compressions should commence unless a pulse can definitely be palpated in less than 10 seconds.
Where do you check for a pulse in a child? Infant?
Child - carotid, femoral or brachial
Infant - Femoral or brachial
[neck short and carotid can be difficult to palpate]
Compression to breath ratio in child?
Where is the hand?
How deep to press?
How fast?
Infant?
15:2 -
Heel of palm on lower half of childs sternum
Press 1/3 of chest deep
100-120bpm
15:2
2 fingers
1/3 diameter
100-120bpm
PALS with VF / VT on the monitor
When do you do the first shock?
What strength of shock?
What drugs are used? Dose? When?
Immediately
4j/kg
Adrenaline 10mcg/kg after 2nd shock then every 2 minutes
Amiodarone after 3rd shock 5mg/kg - only once
What are the 4Hs and Ts
Hypoxia -> 100% oxygen
Hypothermia ->
Hypovolaemia -> consider bolus 20mls/kg
Hyper/hypokalaemia
Tension pneumothorax
Tamponade
Thromboembolism
Toxins - expecially TCA -> sodium bicarbonate
Shock strength for VF/VT
Biphasic current is delivered at a dose of 4 joules per kg (and round up) - Max 200J
Where do you put pads on kids / infants
Kids - normal
Small/ infant - AP
11kg child with VF what shock strength
4 joules per kg rounded up to the closest setting on the defibrillator.
11kg, round up to 50 joules
60kg in VF shock strength?
60kg, we still use our 4 J/kg rule but only deliver a shock of 200 joules
how much adrenaline in arrest for a 25kg child?
Amio?
Adrenaline 25kg = (10mcg/kg) = 2.5mls of 1 in 10,000
Amiodarone = 5mg/kg = 125mg
When charging a defib who stands away who carry on
Chest compressions continue while charging
Everyone else moves away
Timings of adrenaline and amiodarone in APLS VF / pulseless VT
Adrenaline 10mcg/kg after 2nd shock then every second loop
Amiodarone 5mg/kg Once after 3rd shock
Do you synchronise when defibrillating pulsless VT or VF?
NO
[The defibrillator is NOT synchronised for pulseless VT or ventricular fibrillation. Attempting to synchronise in these states will delay defibrillation or the defibrillator may be unable to synchronise]
2 times where sodium bicarbonate is used in ALS
tricyclic anti-depressant overdose
or severe hyperkalemia
Which compression technique is better in infants?
The encircling finger technique is more effective than the two finger technique in infants
How often should you switch the person doing chest compressions
Ideally the rescuer should be rotated every 2 minutes (1 cycle) with minimal interruptions
How to work out ETT size for kids
(Age/4) + 4
Have half size up and below
What is the most common rhythm in a paediatric arrest?
Asystole
Management of non-shockable rhythms in PALS algorithm?
Which drugs? How often?
Adrenaline - 10mcg/kg immediately then every second cycle
In an infant how do you insert a OPA ?
Measure from tip of the incisors to the angle of jaw
Under vision Eg with a tongue depressor / laryngoscope
-insert in correct orientation (ie you don’t flip it in infant)
How big a BVM do you want for infant?
What other things are important
Over bridge of nose and under lower lip
(not over chin)
Neutral position
finger under Jaw (not over soft tissues under chin)
Some pressure on mask
BVM a child?
What else is important?
Over bridge of nose and below lower lip
Sniffing position
Fingers can come under chin to pull jaw up into mask
What are the aspects of the preparation for intubation?
Team, Patient, IV drugs, monitoring, equipment
Hypothermic arrest following drowning. Name 4 ways to aid re warming
Remove wet clothes
Blankets
Bair hugger
Direct heat packs eg over groin/axilla
Warmed IV fluids - 39 degrees
warmed vent 42 degrees
Warmed fluid into stomach/bladder
Extracorporeal blood warming
Poor prognosis when downing
immersion >10mins
Delay in effective CPR
ED arrival - asystole, CPR, GCS<5
First respiratory effort after > 40mins
Need for vasoactive drugs
Gold standard for confirming intubation
Capnography
How is an infants airway anatomy different? What can you do?
The larynx is high and anterior and the epiglottis is relatively large.
External laryngeal manipulation and use of a straight laryngoscope may assist intubation
If the radius of an infant’s airway is narrowed by half, the resistance to airflow past this obstruction will …?
increase 16 times!
[Infants are very prone to upper and lower airway obstruction due to small airway size. Airway resistance is inversely proportional to radius to the power of 4.]
SVT algorithm + doses
Shock initial 1J/kg
Then 2J/kg
Adenosine 100mcg/kg then 200mcg/kg Then 300
Bradycardia algorithm
Newborn life support algorithm
Newborn life support algorithm
Which vagal maneuvers in kids
Ice bath
Blow on straw
Hand stand
NOT CAROTID MASSAGE
