Fleischer & Ludwig's

Question 1

Medikamente im Fluid refraktärem Shock

F&L

Answer 1

Cold:
dopamine 5-10ug/kg/min
+ adre 0.05-1ug/kg/min

Warm:
Dopa+ noradrenalin (Same dosages)

After 40ml/kg volumen über 1h

F&l table 5.4

Question 2

Kurzanamnese SAMPLE

Flch1

Answer 2

Signs
Allergies
Medication
Past history
Last meal
Events leading up to

Question 3

Is there evidence for albumin or colloids in Reanimation?

Flch1

Answer 3

No

Question 4

How many percents of motor vehicle failures are pediatric patients?
What age group has the most pedestrian victims?

Flch2

Answer 4

49%

5-9 y

Question 5

GCS points distribution

Flch2

Answer 5

Eye 4
Verbal 5
Motor 6

Question 6

What min. BP equals peripheral vs central perfusion.

Flch 2

Answer 6

Peripheral pulse (radial) = sbp > 80 mmHg
Central pulse = sbp > 50 mmHg

Question 7

Hemorrhage classes

Flch2

Answer 7

Class 1 < 15% (20ml/kg)

2: 15-30% (20-40ml/kg)
3: 30-40% -> shock, sbp sinkt
4: >= 40% -> shock, narrow pulse -> immediate transfusion

Question 8

Dilated neck veins + deceleration injury

Flch2

Answer 8

Cardiac tamponade

Question 9

How much cristalloid for 100ml of lost blood.

Flch2

Answer 9

300ml

Question 10

When to give FFP?

Flch2

Answer 10

FFP Not evaluated in children,

Adults 1:1 FFP & PRBC

Question 11

How to evaluate normovolemia post reanimation?

Flch2

Answer 11

Urine output best measure.
>1y: 1ml/kg/h
<1y: 2ml/kg/h

Question 12

How many patients with bowel perf have free air on abdominal CT?

Flch2

Answer 12

Only 25% have signs on CT

Question 13

What’s correct ET-tube cuff pressure?

Flch3

Answer 13

20-30mmH2O

Question 14

Rule of thumb for cuffed tube size/uncuffed

Flch3

Answer 14

Uncuffed: 4+age/4 (cuffed: -0,5)

Question 15

What is the narrowest point of the airway at a child.

Flch3

Answer 15

Cricoid cartilage

Question 16

RSI medication sedation

Flch3

Answer 16

Etomidate 0,3mg/kg not for septic shock due to adrenal suppression
Propofol 1-4mg/kg; hypotension!
Ketamine 1-3mg/kg; nicht für SHT, erhöht SVR und BP, Bronchidilatation

Question 17

RSI medication paralyzing

Flch3

Answer 17

Succinylcholine 1-2mg/kg 30-60s inset, 3-8’ duration
CAVE myopathie da depolarisoiend (K+ release)

Alternative roccuronoium 0,6-1,2 mg/kg

Question 18

Role of atropine in intubation

Flch3

Answer 18

Reduziert vagusstimulus und Sekretionen

Nur bei <1y systematisch

Question 19

Percentage of primary cardiac arrests adult vs led

Flch4

Answer 19

13% in ped compared to 72% in adults

Question 20

Measure for oropharyngeal airway (güdel)

Flch4

Answer 20

Corner of mouth to madibule

Question 21

Measure for nasopharyngeal airway (Wendel)

Flch4

Answer 21

Nares to Targus

Question 22

% of O2 delivered via different devices

Flch4

Answer 22

Nasal cannula 30-40%
Simple mask 35-60%
Partially rebreathing mask 50-60%
Non-rebreathing mask 95%

Question 23

Defibrillation voltage

Flch4

Answer 23

2j/kg subsequent 4j/kg

Question 24

When to deliver synchronous shocks (cardoversion)? And voltage

Answer 24

Stable perfusing ventricular or Supra ventricular tachycardia
Cardio version on R
0,5-1J/kg max 2j/kg. CAVE: conscious patient! Sedation and analgesia!

Question 25

Approach to bradycardia

Answer 25

1. Airway (o2 mangel)
2. Erhöhter vagus tonus? => atropin
   Heart block? => pacing?
3. Sonst: Adrenalin

Question 26

Refractory VT/VF ohne Puls

Lfch4

Answer 26

Amiodarone: 5mg/kg max 3x IV rapid push

Question 27

Torsade de pointe approach:

Flch4

Answer 27

Magnesium iv to be considered, 25-50mg/kg iv push if pulseless, over 10-20min if with pulse

Question 28

Reversible causes of ACR

Flch4

Answer 28

Hypovolemia
Hypoxia
Hydrogen ion excess (acidosis)
Hypoglycemia
Hypokalemia
Hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade – Cardiac
Toxins
Thrombosis (pulmonary embolus)
Thrombosis (myocardial infarction)

Question 29

SVT Approach

Flch4

Answer 29

Unstable: adenosine 0,1mg/kg rapid push followed by 0,2mg/kg rapid push if ineffective or synchronized cardioversion
Stable: vagal stimulus