Circulation

Question 1

What would you check when doing a cardiac assessment

Answer 1

Heart rate
Heart rhythm
Pulse volume
Blood pressure
Capillary refill
Temperature
Urine output
Evidence of any major haemorrhage

Question 2

How do you asses heart rate?

Answer 2

Feel for a pulse / palpate both centrally and peripherally and count for 60 seconds

Question 3

By landmarking, where do you check heart rate?

Answer 3

Both centrally (carotid) and peripherally (radial/brachial)

Question 4

When assessing heart rhythm, what are you feeling for?

Answer 4

Whether the heart rate regular or irregular

Question 5

When feeling the heart rate, what should you also check?

Answer 5

Pulse volume

Question 6

When assessing pulse volume, what words would you use describe pulses?

Answer 6

Is their bounding, normal, thready, weak or absent?

Question 7

What are the normal heart rate parameters for a child aged 1-2 years?

Answer 7

100-150

Question 8

What are the normal heart rate parameters for a child aged 2-5 years?

Answer 8

95-140

Question 9

What are the normal heart rate parameters for a child aged 5-12 years?

Answer 9

80-120

Question 10

What are the normal blood pressure parameters for an infant?

Answer 10

75-80

Question 11

What are the normal blood pressure parameters for a child aged 1-10 years?

Answer 11

(Age x 2) + 85

Question 12

What are the normal blood pressure parameters for a child aged 10+ years?

Answer 12

Age + 100

Question 13

What are the normal blood pressure parameters for a child in septic shock?

Answer 13

(Age x 2) + 90

Question 14

How do you assess capillary refill time?

Answer 14

Hold for 5 seconds, and assess how long it takes for the skin colour to return

Question 15

What should capillary refill time?

Answer 15

Capillary refill should return within 2 seconds

Question 16

How and where should you check temperature?

Answer 16

Centrally with a tempadot or digitally (oral, axillary, tympanic) and peripherally (hands and feet)

Question 17

What should you also assess when checking peripheral temperature?

Answer 17

At what point, going up and down the arms/legs, does the temperature change?

Question 18

What are the normal urine output parameters for an infant?

Answer 18

0.5ml/kg/hr

Question 19

What are the normal urine output parameters for a child?

Answer 19

1ml/kg/hr

Question 20

What are the normal urine output parameters for a teenager?

Answer 20

2mls/kg/hr

Question 21

What questions can you ask to asses urine output?

Answer 21

• When was the last time they passed urine?
• How much urine have they passed in the last 24 hours?

Question 22

What is oliguria?

Answer 22

Inadequate urine output

Question 23

What is evidence of haemorrhage?

Answer 23

Any major fluid/blood loss

Question 24

At what point would you insert an IV?

Answer 24

Presenting with tachycardia, thready pulse volume, low BP, cool peripheries, prolonged CRT, pale, and reduced urine output.

Question 25

What fluid bolus would be given for a low blood pressure?

Answer 25

10mls/kg delivered over 5-10 minutes (maximum 500mls)

Question 26

What fluids would you give in a fluid bolus?

Answer 26

Plasmalyte, Hartman’s or sodium chloride 0.9%

Question 27

What should you do after each fluid bolus?

Answer 27

Reassess after each bolus - monitor for signs of fluid overload, dilution of clotting factors and U&E’s

Question 28

At what point of continuous fluid bolus’ should you consider further intervention?

Answer 28

After 40-60 mls/kg, consider intubation and inotropes

Question 29

What interventions would be made for a child with sepsis?

Answer 29

Fluid bolus, administer paracetamol, prescribe anti-biotics