Chapter 22 Practical procedres: circlation

Question 1

What is the landmark for intraosseous access of the femur?

Answer 1

Anterolateal surface 3cm above the lateral condyle

Question 2

How much must a child weigh before using the proximal humerus as an intraosseous access site?

Answer 2

> 40kg

Question 3

EZ-IO needles are all the same gauge, what gauge are they?

Answer 3

15 gauge

Question 4

If you cannot aspirate marrow after intraosseous access, does this mean the insertion has failed?

Answer 4

No

Question 5

How long can intraosseous access remain in site?

Answer 5

24 hours

Question 6

How much lignocaine can you infiltrate to reduce pain from IO infusion?

Answer 6

1mg/kg 1%
0.5mg/kg 2%

Question 7

What are signs of failed intraosseous access?

Answer 7

Failure of fluids to flow
Swelling around insertion site

Question 8

An intraosseous access has failed, there is swelling around the site of insertion and you have removed the needle. Can you use the same limb for access?

Answer 8

No. Need to wait 72 hours before using the same limb again

Question 9

What are complications from intraosseous access?

Answer 9

Compartment syndrome
Infection
Fracture

Question 10

You want to use the external juguar vein for venous access, how to you position the child’s head?

Answer 10

15-30 degree head down. Can place padding under shoulder to help

Question 11

In relation to the sternocleidomastoid, where is the external jugular vein?

Answer 11

Superficial to the SCM at the junction of the middle and lower third of the muscle belly

Question 12

You want to access the umibilical vein. There are three vessels seen. One at the cephalic end that is larger and open and two at the cuadal end that are small and contracted. Which one is the vein?

Answer 12

The larger dilated one. Insert catheter here.

Question 13

Do you position the head up 15 - 30 degree or head down 15 - 30 degree for internal jugular access?

Answer 13

Head down

Question 14

Why must you immediately occlude the needle when you remove the syringe while gaining access to the internal jugular vein?

Answer 14

To prevent air embolism

Question 15

You have occluded the extra ports for central access and have just threaded the catheter over the wire and then removed the wire through the one remaining open port. Why must you immediately occlude hte free port?

Answer 15

To prevent air embolism

Question 16

When using the external jugular vein for central venous access, there may be resistance as the J wire is advanced, what is this resistance?

Answer 16

Valves

Question 17

Where is the puncture site for the subclavian vein?

Answer 17

1cm below midpoint of clavicle

Question 18

Should a child be positions head up or head down to access the subclavian vein?

Answer 18

Head down 15 - 30 degrees

Question 19

Radial artery cannulas come in 4 sizes, 24, 22, 20 and 18. What age groups are these appropriate for?

Answer 19

Pre-term - 24 gauge
Infant-pre-school 22 guage
School aged 20 -22
Adolescent to adult 20 - 18

Question 20

What are the complications of arterial lines?

Answer 20

Arteriospasm
Haematoma
Thrombosis
Bacterial colonisation and sepsis

Question 21

If defibrillator electrode pads are closer than 2cm to each other, what can happen?

Answer 21

Arching

Question 22

At what age can adult defibrillator pads be used?

Answer 22

Age 8 and older

Question 23

What should you use to provide defibrillation to a neonate?

Answer 23

manual paddles

Question 24

In infants, where are the defibrillator pads placed?

Answer 24

Anteroposterior placement