General Resus Flashcards
How is a chin lift/jaw thrust different in infants (3 months to 1 year)?
The head is kept in the neutral position, neither flexed nor extended
Which pulses should be palpated in APLS based on age range?
infant or younger: brachial and femoral (carotid difficult to palpate)
> 1yo: Brachial, femoral and carotid
What is the rate and initiation of compressions in APLS in children >1yo
2 initial rescue breaths
15 compressions:2 breaths
1/3rd way through the chest, 100bpm, lower half of the sternum, palms of hands
What is the rate and initiation of compressions in APLS in infants and younger?
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
What are the normal range of Heart Rates in children?
<1 year = 110 to 160
1-2 = 100 to 150
2-5 = 95 to 140
5-12 = 80 to 120
>12 = 60 to 100
What is the normal range of systolic BP in children?
<1 year = 60-100
1-2 = 65 - 110
2-5 = 70 - 115
5-12 = 75 - 120
>12 = 90 - 130
What are the duct dependent pulmonary circulation conditions in neonates?
Pulmonary stenosis
Pulmonary atresia
Tricuspid atresia
Triscuspid stenosis
What are the duct dependent systemic circulation conditions in neonates?
Critical Aortic stenosis
Transposition of the great vessels
Hypoplastic left heart
co-arctation of the aorta
What are the clinical signs of systemic duct dependent conditions?
Grey appearance
Inability to feed
breathlessness
Poor peripheral circulation
What are the clinical signs of pulmonary duct dependent conditions?
Increasing cyanosis unresponsive to supplemental 02
What are typical causes of seizures in paediatrics?
Febrile seizures
Epilepsy
Meningoencephalitis
Hypoglycaemia
Hypoxia
Head trauma
Deranged electrolytes
Brain tumours
What is paediatric status epilepticus?
Continuous seizure lasting >5mins, previously was 30mins
Or recurrent seizures (2 or more) without a return to normal consciousness in between
What are the sites available in paeds for IO insertion?
Distal Femur
Proximal Tibia
Distal Tibia
Humeral head
What are the contraindications to IO insertion?
- 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
What is the dose of High flow nasal prongs in paediatrics?
2L/Kg/min
What are features suggestive of paediatric epiglottitis
tripoding
drooling
Significantly altered voice
pain to neck out of proportion
un-immunized
How does wheeze affect the diagnosis of pneumonia in young children?
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)
What is the general approach to the sick neonate?
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!!!!
What is a mnemonic for the causes of the critically ill neonate?
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
What is the most sensitive exam finding for sepsis in neonates?
Persistent tachypnoea (>60) despite other factors being corrected (ie warming, feeding, correcting BSL)
What are the causes of arrest in young children that should be screened and treated?
4Hs + 4Ts
+ Hypoglycaemia
+ Sepsis
When calculating maintenance fluids how is calculating mls/hr different to calculating mls/day?
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
In summary how is daily maintenance fluids calculated in mls/hr and mls/day?
4/2/1 rule for mls/hr
mls/day
100mls/kg 1st 10kgs
50mls/kg 2nd 10kgs
20mls/kg every kg after
What is the dosing of IM adrenaline in anaphylaxis at different ages?
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
