Chapter 20 Management of cardiac arrest

Question 1

What is the most common cause of PEA arrest in children?

Answer 1

Hypovolaemia
Hypoxia

Question 2

What is the dose of adrenaline in cardiac arrest?

Answer 2

10 mcg/kg IV or IO

Question 3

What size is the bolus of saline following drug administration in cardiac arrest?

Answer 3

2-5 ml

Question 4

What is the ventilation rate for a child in cardiac arrest once a secure airway is obtained?

Answer 4

10-12 breaths per minute

Question 5

What rate are chest compressions given in cardiac arrest for a child?

Answer 5

100 -120
(though interruptions to give breaths, rhythm check mean actually compressions delivered is not 100-120 BPM)

Question 6

When should an ETT be inserted in cardiac arrest of a child?

Answer 6

As soon as possible, most likely cause of arrest is hypoxia

Question 7

What should you do with the defibrilator pads & leads if you see asytole?

Answer 7

Check they in the right position

Question 8

What should you do with the ventilation rate once you achieve ROSC?

Answer 8

Increased to 12 - 24 depending on age

Question 9

Should you check for a pulse if there is organised electrical activity seen during a rhythm check?

Answer 9

Note routinely, it takes too long. Check for ROSC by looking from normal breathing and responsiveness. Checking for a pulse may be more important in a sedated/paralysed patient

Question 10

When adrenaline is given every 2nd rhythm check, about how many minute does this work out to be?

Answer 10

Every 4 minutes

Question 11

In what situations is calcium given during cardiac arrest?

Answer 11

Hypocalcaemia
Hyperkalaemia
Calcium channel blocker overdose

Question 12

How common are thromboembolic events in children?

Answer 12

Rare.
Coronary or pulmonary artery occlusion is rare cause of cardiac arrest in a child

Question 13

What are the 4 H’s

Answer 13

Hypoxia
Hypovolaemia
Hypo/hyper electrolytes
Hypothermia

Question 14

What are the 4 T’s

Answer 14

Tension pneumothorax
Tamponade
Toxins
Thrombosis (rare)

Question 15

How does acidosis affect adrenaline and other catecholamines?

Answer 15

Makes them less effective

Question 16

When would you give sodium bicarbonate in a cardiac arrest?

Answer 16

Consider in prolonged cardiac arrest, hyperkalaemia and TCA overdose

Question 17

In cardiac arrest how well does arterial pH correlate with tissue pH

Answer 17

Very poorly.
Don’t use arterial pH to guide alkalising therapy.

Question 18

what is the dose of sodium bicarbonate should you choice to use it in a cardiac arrest?

Answer 18

1mmol/kg

Question 19

What happens if you give sodium bicarbonate through the same IVC that you gave calcium through

Answer 19

You make chalk.
Give at separate sites

Question 20

How common is VT/VF in children? What tends to cause it in this age group?

Answer 20

Rare. Generally due to congenital heart disease, TCA overdose, hypothermia

Question 21

How many J/kg for shockable rhythms do you give?

Answer 21

4J/kg

Question 22

What is the dose of amiodarone in cardiac arrest?

Answer 22

5mg/kg

Question 23

Is amiodarone helpful in VT/VF caused by arrhythmogenic drug overdose?

Answer 23

May do more harm than good. Discuss with poisons center first

Question 24

In an AED (the type found in shopping centers), what age do you start using the adult pads?

Answer 24

> 8 years old

Question 25

What should end tidal CO2 be during CPR

Answer 25

Aim for > 15mmHg, less than this check effectiveness of chest compressions

Question 26

What does hyperoxia do once you achieve ROSC? Is it harmful?

Answer 26

Yes, increases reperfusion injury. Titrate O2 down as tolerated

Question 27

Why shoulder hyperthermia be avoided on getting ROSC?

Answer 27

Increases metabolic demand

Question 28

After how many minutes should you consider stopping CRP? What circumstances would you go longer?

Answer 28

After 20 minutes.
Consider longer attempts if due to overdose or hypothermia