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Paediatrics > General Resus > Flashcards

General Resus Flashcards

1
Q

How is a chin lift/jaw thrust different in infants (3 months to 1 year)?

A

The head is kept in the neutral position, neither flexed nor extended

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2
Q

Which pulses should be palpated in APLS based on age range?

A

infant or younger: brachial and femoral (carotid difficult to palpate)
> 1yo: Brachial, femoral and carotid

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3
Q

What is the rate and initiation of compressions in APLS in children >1yo

A

2 initial rescue breaths
15 compressions:2 breaths
1/3rd way through the chest, 100bpm, lower half of the sternum, palms of hands

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4
Q

What is the rate and initiation of compressions in APLS in infants and younger?

A

2 initial rescue breaths
15:2 compressions to breaths
1/3rd the way of the chest, 100/120bpm
lower half of the sternum, but using either thumbs or 2 fingers

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5
Q

What are the normal range of Heart Rates in children?

A

<1 year = 110 to 160
1-2 = 100 to 150
2-5 = 95 to 140
5-12 = 80 to 120
>12 = 60 to 100

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6
Q

What is the normal range of systolic BP in children?

A

<1 year = 60-100
1-2 = 65 - 110
2-5 = 70 - 115
5-12 = 75 - 120
>12 = 90 - 130

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7
Q

What are the duct dependent pulmonary circulation conditions in neonates?

A

Pulmonary stenosis
Pulmonary atresia
Tricuspid atresia
Triscuspid stenosis

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8
Q

What are the duct dependent systemic circulation conditions in neonates?

A

Critical Aortic stenosis
Transposition of the great vessels
Hypoplastic left heart
co-arctation of the aorta

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9
Q

What are the clinical signs of systemic duct dependent conditions?

A

Grey appearance
Inability to feed
breathlessness
Poor peripheral circulation

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10
Q

What are the clinical signs of pulmonary duct dependent conditions?

A

Increasing cyanosis unresponsive to supplemental 02

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11
Q

What are typical causes of seizures in paediatrics?

A

Febrile seizures
Epilepsy
Meningoencephalitis
Hypoglycaemia
Hypoxia
Head trauma
Deranged electrolytes
Brain tumours

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12
Q

What is paediatric status epilepticus?

A

Continuous seizure lasting >5mins, previously was 30mins
Or recurrent seizures (2 or more) without a return to normal consciousness in between

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13
Q

What are the sites available in paeds for IO insertion?

A

Distal Femur
Proximal Tibia
Distal Tibia
Humeral head

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14
Q

What are the contraindications to IO insertion?

A
  • Overlying infection to the site
  • Previous significant orthopaedic procedure to the site
  • IO to the target bone in last 48hrs
  • Fracture to the bone, or in significant trauma suspected pelvic fracture/SVC injury for lower limb sites
  • Unable to determine landmarks
  • Significant overlying soft tissue
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15
Q

What is the dose of High flow nasal prongs in paediatrics?

A

2L/Kg/min

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16
Q

What are features suggestive of paediatric epiglottitis

A

tripoding
drooling
Significantly altered voice
pain to neck out of proportion
un-immunized

17
Q

How does wheeze affect the diagnosis of pneumonia in young children?

A

The presence of global wheeze (as opposed to focal area) has a 90% negative predictive value for pneumonia (very unusual to have wheeze with pneumonia in young kids)

18
Q

What is the general approach to the sick neonate?

A

establish access (IV/IO/UV)
10-20ml/kg bolus
Supplemental 02 +/- airway support
resuscitaire
Control templ
seek and treat BSL
ABx
Prostaglandin
Call for help!!!!

19
Q

What is a mnemonic for the causes of the critically ill neonate?

A

THE MISFITS

Trauma
Heart (consider PGE1!)
Endocrine (CAH, consider steroids)
Metabolic (electrolytes, low BSL)
Inborn errors (hyperammonaemia, HAGMA on gas, give sugar)
Sepsis
Formula errors (ie dilution, hypoNa+)
Intestinal catastrophe (NEC, volvulus…)
Toxins (one pill kills, NAI)
Seizures

20
Q

What is the most sensitive exam finding for sepsis in neonates?

A

Persistent tachypnoea (>60) despite other factors being corrected (ie warming, feeding, correcting BSL)

21
Q

What are the causes of arrest in young children that should be screened and treated?

A

4Hs + 4Ts
+ Hypoglycaemia
+ Sepsis

22
Q

When calculating maintenance fluids how is calculating mls/hr different to calculating mls/day?

A

For some reason different formulas

4/2/1 rule applies for mls/hr

mls/day is different for weight range
3-10kgs= 100x weight ie 3kgs = 300ml
10-20kg= 1000 + (50x [weight - 10]) ie 15kgs = 1250mls/day
20-60kg= 1500 + (20x[weight - 20]) ie 30ks = 1700mls/day
>60kg = 2400mls/day

Alternative daily formula
100mls/kg for 1st 10kgs
50mls/kg for 2nd 10kgs
20mls/kg thereafter

4/2/1 rule for 30kgs gives 70mls/hr = 1680mls
daily mls rule = 1500 + (20x[30-20]) = 1700mls
Thus marginal difference

23
Q

In summary how is daily maintenance fluids calculated in mls/hr and mls/day?

A

4/2/1 rule for mls/hr

mls/day
100mls/kg 1st 10kgs
50mls/kg 2nd 10kgs
20mls/kg every kg after

24
Q

What is the dosing of IM adrenaline in anaphylaxis at different ages?

A

Birth to 2yrs = 100mcg
2-3 = 150mcg
4-5 = 180mcg
5-6= 200mcg
7-10 = 300mcg
10-12 = 400mcg
>12 = 500mcg

Or if accurate ideal body weight known then 10mcg/kg

25
Q

What are the anatomical differences between adult and paediatric airways?

A
26
Q

When should the neonatal resuscitation algorithm be changed to the infant algorithm?

A

Neonates use the infant algorithm when it has been >6hrs post birth
- Neonatal algorithm specifically aimed at post birth resus and causes of arrest

27
Q

What are the advantages and disadvantages of having parents present during a major resuscitation?

A

Advantages
- Parents can see all the efforts
- Helps with acceptance of death and dealing with grief
- Reduces risk of litigation
- Improves professional behaviour of staff
- Opportunity to say goodbye

Disadvantages
- Need designated staff member to support the family
- Potential for parental interference
- Increased stress for staff
- Distress for parents seeing invasive interventions being performed

28
Q

What bedside tests can be done to differentiate between cardiac and respiratory causes of refractory low sats in neonates/infants?

A
  • Pre and post ductal saturations
  • 4 limb blood pressure
  • 10min hyperoxia test ie give 100% 02 for 10mins, cardiac babies wont change (shunt) but resp will improve
29
Q

How should the death of a child in the emergency department be handled?

A
30
Q

What is an example of initial ventilator settings for a child?

A

Paediatrics (21 decks)

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