Emergency circulatory access, fluid resus and medication

Question 1

When should IO access be used?

Answer 1

Should be first line when child is in cardiac arrest or if severely compromised (do not use if they still have their pain response)

Question 2

What are the IO insertion sites?

Answer 2

2-3cm below the anteromedial tuberosity in tibia is the main choice

Lower end of tibia 2-3cm above medial malleolus

Distal femur 1-2cm above patella

Question 3

When is IO contraindicated?

Answer 3

Haemophilia
Brittle bone disease
Other coagulopathy

Question 4

What are complications of IO access?

Answer 4

Bleed
Clot
Infection
Skin necrosis
Fracture
Extravasation

Question 5

How should weight be estimated in children?

Answer 5

1) Use actual weight if possible
2) Use body length and pre-calculated drug doses
3) Paediatric emergency chart
4) Age based weight calculation- age in years p[lus 4 and multiplied by 2

Question 6

How much fluid should be given in hypotension?

Answer 6

10ml per kg

Question 7

How much fluid should be given in cardiac failure?

Answer 7

5-10ml/kg

Question 8

How much fluid should be given in trauma?

Answer 8

10ml/kg

Question 9

How much adrenaline should be given in arrest situation?

Answer 9

Pre made syringe
either 0.1ml per kg or 10mcg per kg

Question 10

How much adrenaline should be given in anaphylaxis?

Answer 10

<6 months 100-150mcg IM
6 months-6 years 150mcg
6-12 years 300mcg (0.3ml)
12 years + 500mcg