ERC - Paeds Flashcards
define neonate, infant, child and adolescent
neonate <4 weeks
infant 4 weeks - 1 year
child 1 year - puberty
adolescent - >puberty
Airway management in paeds
Bag mask ventilation is first choice
if intubating use an uncuffed tracheal tube especially in neonates
what could cause a sudden deterioration in an intubated child
Displaced Obstruction Pulmonary disorder (pneumothorax, oedema, bronchospasm) Equipment failure Stomach (distention splinting diaphragm)
at what rate do you ventilate a child
a) during CPR
b) post ROSC
a) 10 breaths/min
b) at the age appropriate rate
volume of fluid bolus given in paeds
20ml/kg
how does procainamide work and when is it used
1a antiarrhythmic - slows intraatrial conduction
wide QRS
prolong QT
used as a last resort in SVT and VT
what often causes bradycardia in children and therefore how is it treated
hypoxia! acidosis, hypotension
oxygen and PPV
Management of broad complex tachycardia in paeds
(very rare in paeds)
synchronised electrical cardioversion
amiodarone
how is pulmonary hypertension managed in paeds
high inspired fiO2
hyperventilation (reduce pulmonary vascular resistance)
IV epoprostenol
post ROSC goals in paeds
normoxia
normocapnoea
normoglycaemia
temp between 32-37.5
you find an unresponsive child who is not breathing, now what
5 rescue breaths
compressions: ventilations 15:2
describe an effective cough and an innefective cough
effective: able to vocalise, breathe between coughs, crying
ineffective: silent, unable to breathe or vocalise, LOC, cyanosed
a child has an effective cough, what do you do
encourage them to continue coughing
a child has an ineffective cough but is still conscious, what do you do
5 back blows
5 abdominal thrusts
an infant has an ineffective cough but is still conscious, what do you do
5 back blows
5 chest thrusts
compare FBAO management in an infant vs a child
back blows are the same (in a child if you can’t lie them across your knee then encourage them to lean forward)
thrusts are done on the chest (same position as CPR) in infants rather than abdominally (between umbilicus and xiphisternum)
rate of compressions in paeds
100-120
which arrest rhythm is most common in paeds and why
non-shockable as commonest cause of arrest is hypoxia
management of a paediatric non-shockable rhythm
Ventilate and oxygenate
adrenaline ASAP then every other cycle eg 1st, 3rd, 5th
management of a paediatric shockable rhythm
Ventilate and oxygenate
adrenaline and amiodorone after 3rd and 5th shock then continue with adrenaline every other cycle
describe how electrode pad placement differs in paeds
<10kg use smaller pads (4-5cm)
>10kg use pads 8-12cm
if they are too close together there is danger of arcing electricity to place in AP position instead of sterno-apical
if you are a lone responder to a paediatric emergency, how long do you perform CPR for before calling help
1 minute
what is the energy used for shocking a paediatric patient in arrest
4J/kg
in which age group of paediatric patients do you not give oxygen
neonates
how often are you giving adrenaline in a paediatric patient
every 3-5 minutes
which drugs can effect capnograph value
adrenaline and other vasoconstrictors can lead to reduced ETCO2
sodium bicarb can lead to an increased ETCO2
to what depth should compressions be done to in infants and children
infants: 4cm
children: 5cm
What is the initial dose of energy to cardiovert a paediatric patient in SVT
1J/kg
When checking for a pulse in paediatrics, where should you feel
infants: femoral or brachial
children: femoral or carotid
tracheal tube size for neonates:
a) premature
b) full term
UNCUFFED
premature: gestational age in weeks/10
full term: 3.5
uncuffed tracheal tube size for
a) infants
b) 1-2
c) >2
a) 3.5-4
b) 4-4.5
c) age/4 + 4
cuffed tracheal tube size for
a) infants
b) 1-2
c) >2
a) 3-3.5
b) 3.5-4
c) age/4 + 3.5
what pressure should the cuff be inflated to in paediatric patients
25cm H2O
when is atropine given to paediatric patients
only when the bradycardia is due to increased vagal tone or cholinergic drug toxicity
Adrenaline is used for bradycardia normally
A child is bradycardic, how should they initially be managed
100% O2 and PPV
if they don’t respond to this start compressions and give adrenaline
How is a stable paediatric patient in SVT managed
vagal manoeuvres and adenosine
How should decompensated paeds patients with SVT be managed
1) synchronised electrical carioversion 1J/kg
2) synchronised electrical cardioversion 2J/kg
3) amiodarone or procainamide
4) 3rd attempt at electrical cardioversion
