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1
Q

Check first

A

Cogh

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2
Q

If no cough and unconsciousness

A

Open airway
Rescue breath

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3
Q

If no cough and conscious

A

Infant -5 back blow and chest trusts
Child -5 back blow and abdo thrusts

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4
Q

Back blows position

A

Head down and prone

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5
Q

Ratio of chest compression

A

15:20

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6
Q

Rate chest compression

A

100-120

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7
Q

Depth chest comp

A

4cm infants
5cm children

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8
Q

Sites of Io

A

Proximal tibia
Distal Tibia
Distal femur
Prix humerus

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9
Q

Fluid boils

A

10ml/kg

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10
Q

Glucose solution

A

2ml/kg of 10%
2.5ml/kg in newborn

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11
Q

When to consider blood replacement

A

2xgluid blouses

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12
Q

Adrenaline indications

A

Arrest
Hr<60
Dose 10mcg/kg of 1:10000
Septic shock
Anaphylaxis

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13
Q

Mechanism of adrenaline

A

Alfa and beta adrenergic

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14
Q

Avoid adrenaline with

A

Sodium bicarbonate

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15
Q

Half life of adrenaline

A

2m

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16
Q

Indications amiodarone

A

VF or pVT

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17
Q

Dose amiodaro e

A

5mg/kg

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18
Q

Side effect amiodaro me

A

Hypotension

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19
Q

Adenosine indication

A

SVT

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20
Q

Dose adenosine

A

Neonates to 11 months -150mcg/kg max doe 300/500
1-11yrs- 100mcg/kg max 500
12-17yts- 3mg then 6 then 12

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21
Q

Sodium bicarbonate indication

A

Acidaemia
Consider if prolonged arrests

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22
Q

Sodium bicarbonate dose

A

1mg/kg

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23
Q

Administration of calcium associated with

A

Increased mortality

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24
Q

Dose for naloxone

A

Under 5 100mcg/kg
Over 5 2mg
Every 3m

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25
Q

Indication of mag

A

Low mag
Torsade de pointes

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26
Q

Mechanism of salbutamol

A

Beta 2 agosnit

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27
Q

Fise of IV salbutamol

A

1-23 month 5mcr/kg
2-17 yrs 15mcg/kg

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28
Q

Indication for atropine

A

Bradycardia

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29
Q

Bradycardia and tachycardia <1

A

80
180

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30
Q

Bradycardia and tachycardia <1

A

80
180

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31
Q

Bradycardia and tachycardia >1

A

60
160

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32
Q

First thing to do in Brady child

A

Airway opening
100% oxygen

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33
Q

Cardioversion energy level

A

1J/kg
2J/kg second shock
Increase to 4 under specialist advice and consider amiodarone if second shock fails

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34
Q

Adenosine side effects

A

Bronchospasm

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35
Q

Hr rate difference in Tachycardia and SVT

A

Infant tachycardia <220
Child tachycardia <180
SVT will be above these

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36
Q

Incidence of shockable rhythm in in hospital arrests

A

27%

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37
Q

Positions of pads

A

Bracket the heart

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38
Q

Position of pads in infant

A

Anterior posterior
Lower half of chest and between scapulae

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39
Q

Energy dose in defibrillation

A

4J/kg for all shocks
Consider escalation after 6th shock
Dose up to 8J/kg

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40
Q

Most common rhythms in children

A

Non shockable PEA, asystole, profound bradycardia

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41
Q

Most common rhythms in children

A

Non shockable PEA, asystole, profound bradycardia

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42
Q

Shockable rhythms common in children with

A

Underlying heart disease

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43
Q

Where to feel pulses

A

Infant brachial
Child carotid (>1yr)
Both femoral

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44
Q

Dose of adrenaline and amiodarone in arrest

A

10mcr/kg
5mg/kg

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45
Q

How often to give adrenaline

A

Ever 3/5m (every other cycle)

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46
Q

How often to give adrenaline

A

Ever 3/5m (every other cycle)

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47
Q

How often give amiodarone

A

3rd and 5th shocks

48
Q

If using AES in child <8 give attenuated shock of

A

50-75J if possible

49
Q

4H and T

A

Hypovolaemia
Hypoglycaemia
Hypothermia
Hypoxia
Toxins
Tension
Tamponade
Thrombus

50
Q

Complication of BMV

A

Gastric distention
Manage with gastric tube

51
Q

Causes of sudden deterioration in intubated patient

A

DOPES
Displacement of tube
Obstruction
Pneumothorax
Equipment failure
Stomach distention

52
Q

Urine output target

A

> 1ml/kg/h in child
2ml/kg/h in infant

53
Q

Hb target

A

> 70

54
Q

Clinical features of croup

A

Inspiratore stridor
Barking cough
Hoarseness
Resp distress

55
Q

Common pathogen of croup

A

Parainfluenza
RSV
Adenovirus

56
Q

Management of croup

A

Oral dexamethasone one to two doses
Neb adrenaline (3-5ml of 1:1000) if resp distress
Neb steroid as budesonide if unable to take oral
Intubation can be required if exhaustion

57
Q

Causes of epiglottitis

A

Haemophilus influenzae B

58
Q

CF of epiglottitis

A

Drooling lethargic
High fever and pale

59
Q

When to consider bacterial tracheitis

A

Upper airway obstruction not responsive to croup management

60
Q

Management of tracheitis

A

Abx for staph and strep

61
Q

Cause of bronchiolitis

A

RSV 75%
Parainfluenza
Influenza
Adenoviruses

62
Q

CF of bronchiolitis

A

1/3 days of cough
High RR
Wheeze
Crackles

63
Q

When does bronchiolitis occur

A

Autumn and winter

64
Q

Common age of bronchiolitis

A

1-9months 90%
Rare after 1 year

65
Q

RF for severe bronchiolitis

A

Congenital heart disease
Premature
Less than 3m
Chronic lung disease
Immunodeficiency

66
Q

Management bronchiolitis

A

Supportive
NIV required if resp failure

67
Q

Indication of hospital admission

A

Poor oral fluid intake (50-75%)
Apnoea
Oxygen sta <92 ORA
Resp distress - gruntin, chest recession, RR >70

68
Q

How often is mechanical ventilation required in bronchiolitis

A

3%

69
Q

Dose of neb salbutamol in asthma

A

2.5-5mg every 20m

70
Q

Dose of ipratropium

A

250mcg

71
Q

Oral steroid dose pred

A

20mg for 2-5
30/40mg for >5

72
Q

What to consider in asthma if no response to bronchodilators and steroid

A

Magn and aminophylline

73
Q

What steroid to give in asthma if vomiting and dose

A

Hydrocortisone 4mg/kg every 4hrs

74
Q

Adrenaline IM anaphylaxis doses

A

<6m 100-150mcg 1:1000 (0.1-0.15ml of 1mg ml)
6m-6yr 150mcg (0.15ml of 1mg ml)
6-12yt 300mcg (0.3ml of 1mg ml)
>12 500mcg (0.5ml of 1mg ml)

75
Q

How often given adrenaline

A

Every 5m if no resolution

76
Q

How to keep open PDA

A

Prostaglandin infusion

77
Q

Dose of antiepileptic

A

Lorazepam 0.1mg/kg IV/IO
Midazolam 0.15 mg/kgIV/IO
Midaz 0.3 mg/kg buccal or intranasal

78
Q

Side effect of rapid phenytoin

A

Bradycardia or asystole

79
Q

5% degree of dehydration

A

Ph 7.2-7.29 or bicarbonate <15 = mild DKA
Ph 7.1-7.19 or bicarbonate <10 = moderate DKA

80
Q

10% degree of dehydration

A

Ph <7.1 or bicarbonate <5 = severe DKA

81
Q

Calculate fluid deficient

A

Degree of dehydration x weight x 10

82
Q

Fluid requirement over 48hr

A

Maintenance fluid for 48hr + (fluid deficit-initial fluid given)

83
Q

Maintenance fluid calculation

A

4ml/kg/hr for first 10
2ml/kg/hr for second 20 (11-20)
1ml/kg/hr for each kg above 20 up to 75kg max

84
Q

Main cause of hyponatraemia in children

A

SIADH

85
Q

Dose of sodium for replacement

A

3ml/kg of 3% sodium chloride over 20m
Rate of change no more than 0.5mmol/l/h

86
Q

Management of hyperkalaemia

A

Calcium gluconate or chloride IV
Insuline dextrose infusion and salbutamol never
Diuretics
Calcium resonium (slow)

87
Q

Management high calcium

A

Fluids: twice calculate basic daily fluid requirement

88
Q

Percentage of blunt trauma in UK

A

80%
2/3 of life threatening due to brain injury

89
Q

Triad that increases mortality in trauma

A

Acidosis
Hyperthermia
Coagulopathy

90
Q

What is SCIWORA

A

Spinal cord injury without radiological abnormalities

91
Q

How to assess for internal bleeding

A

USS evidence of free fluid
Contrast Ct

92
Q

Total circulating volume in child

A

70ml/kg

93
Q

At what point does BP drop

A

> 40% loss
Not useful to initiate or guide treatment

94
Q

Tranexamic acids dose

A

15mg/kg loading
2mg/kg/h infusion

95
Q

Unilateral dilated pupil

A

Intracranial bleeding or raised ICP

96
Q

Percentage of brain injury responsible for death

A

70%

97
Q

Signs of tension pneumothorax

A

Hypoxia
Absent or decreased breath sounds
Resonant to percussion
Neck vein distention
Tracheal deviation away from side

98
Q

Management of tension

A

Needle thiracicentesis - cannula in 2nd intercostal space mid clavicular line
Chest drain

99
Q

Traumatic diaphragmatic hernia most common which side

A

Left

100
Q

Landmark for chest drain insertion

A

4/5th intercostal in mid axillary line

101
Q

Imaging for spinal injury

A

MRI especially is SCIWORA suspected

102
Q

Epidermal burn

A

Pain with erythema and no blister
Heal in 7 days

103
Q

Superficial partial thickness

A

Epidermis and superficial dermis
Blister and pale pink
Very painful
Heal in 2/3 wks

104
Q

Deep partial thickness

A

Epidermis and dermis
Dry/moist skin
Blothciness with blisters
Decreased CRT
May or not be painful
Heals >3wks

105
Q

Full thickness burns

A

Epidermis dermis and subcutaneous tissues and structures
White in appearance with no CRT
Manage with surgical debridement and grafting

106
Q

Calculate burn area

A

Child’s palm = 1%

107
Q

Burns of 10% or more require fluid through Parkland formula

A

% burn x body weight x 4ml/day
Half in first 8hr
Half in next 16hrs

108
Q

Drowning management

A

Open airway
Rescue breath
Chest compressions

109
Q

Hypothermia

A

Temp <35
High risk due to high body surface to weight ratio

110
Q

What to do with newborn baby

A

Delay clamping cord if possible
Keep WARM
Assess- color, tone, breathing, HR

111
Q

How long should you wait to clamp cord

A

60s at least

112
Q

Heart rate morning in newborn

A

<100 without effective breathing = immediate inertvention with assessment every 30s

113
Q

Acceptable says in newborn

A

2m 65
5m 85
10m 90

114
Q

Signs of significant hypoxia in newborn

A

Apnoea
Low or absent HR
Pallor
Floppy

115
Q

Newborn baby should be put in which position for airway management

A

Neutral
Jaw thrust can be done

116
Q

Ho to perform inflation breaths

A

5 slow breaths over 2/3 sec in air
Check HT after 5 breaths to see increase >100

117
Q

What to do after first 5 inflation

A

If HR raising and breathing = continue at 30/m until regular breathing
If no HT raise = give other 5 and check after, if ongoing nil response give oxygen and chest compressions after 30s of ventilation breaths

EPALS (2 decks)

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