Intro Flashcards
Most common primary arrest rhythm in children (2)
VF, pulseless VT
Every 1 minute delay in fibrillation of primary child arrest increases mortality by?
10%
Primary or secondary cardiac arrest more common in children and most common cause? (2)
Secondary
Hypoxia
Most common arrest rhythms with hypoxia? (2)
Asystole/ PEA
Rate of successful CPR for secondary oohca
4-12%
In hospital cardiac arrest successful cpr for secondary CA + discharge survival
60-80%
54%
Can epiglottis stimulation lead to vagal response
Yes
Larynx in children vrs adult
Higher
Ellipsoid in shape - cylindrical anterior-posterior diameter but cone shaped in the transverse diameter with vocal cords at the apex of the cone.
Air-alveolar surface area for gas exchange at birth vrs adult and what increase in number of small airways
3m2 vrs 70m2
10 fold increase
Main muscle of breathing in infants
Diaphragm
Normal respiratory rates in less than 1, 1-2, 2-5, 5-12, >12
30-40
26-34
24-30
20-24
12-20
Heart rate mean 0-3mth, 3mth - 2 year, 2-10, >10
140
130
80
75
Bp mean map for 1mth, 1 year, 5, 10, 15
55, 70, 75, 75, 80
Cardiac output relative to weight at birth vrs adult
300ml/kg/min vrs 70-80
Neonatal leading cause of death (3)
Congenital -> perinatal -> sudden infant death syndrome
Most common causes of death in infancy (2)
Congenital, resp/cvs,
Most common causes of death 1-4 (4)
Malignancy, trauma, congenital, CNS
Most common causes of death 5-9 (3)
Malignancy
Trauma
CNS
Most common teenager
Trauma, suicide, risk taking behaviour
Difference between primary, secondary and tertiary prevention of death
Primary - prevention of the accident
Secondary - reduction of severity
Tertiary - diminishing the consequences of event
Age cut off when chest wall recession is more significant
5 years old
What is grunting
The result of exhaling against a partially closed glottis in an attempt to create PEEP
Starting threshold of o2 therapy in infants or children with chronic lung issues
3% below known baseline
Peripheral cyanosis and central cut offs
<85%
<80%
5 types of shock
Hypovolaemic
Distributive
Cardiogenic
Obstructive
Dissociative
% blood loss before hypotension in children
Up to 40%
Sizing bp cuff
Cuff width >80% of the child’s upper arm length and bladder should cover more than 40#’circumference
Threshold urine output in infant
2ml/kg/hr
Cardiorespiratory failure immediate intervention signs
Coma
Exhaustion
Cyanosis
RR > 60
HR < 100 for newborn
HR > 180 or < 80 before 1 year cpr at 60
Hr > 160 after 1 year
Seizure
Cushing’s triad
Bradycardia, hypertension, abnormal breathing
See saw respiration meaning and cause
Abdomen protrudes markedly and chest is drawn inwards paradoxically reducing lung volume. Airway obstruction.
Max suction pressure in infants
120mmhg
NPA sizing length
Nostril to tragus of ear
HFNO2 flow rate/kg
2L/kg/min up to 12kg plus 0.5L/kg/min
Eg 20kg = 28L 32kg = 34L
ETT placement in 7 situations
Ineffective bmv
Deformity of anatomy
Aspiration protection
High pressures
Mechanical ventilation
Suctioning
Transfer
ETT sizing - pre term, term, six month, 1 year, then older
2.5-3, 3-3.5, 3.5, 4 (uncuffed) age/4 + 4
Length at month, nose
Age/2 + 12, 15
Sudden deterioration of the intubated patient causes acronym
DOPES
Displacement
Obstruction
Pneumothorax
Equipment
Stomach
Rate and depth of chest compressions
100-120/min
1/3rd on the chest depth ~ 4cm in infant, 5cm in child (6cm adult)
Timeframe removal of IO
Within 24hrs
Common locations to insert IO including cm
Proximal tibia (1cm below and medial to tuberosity in infants and 2-3cm in older children)
Distal tibia (1-2cm proximal to mm in infants and 3cm in older) and distal femur (less than 6y - 1-2cm above and medial to patella) as alternatives
Proximal humerus in older children (place their hand on abdo 1-2cm above surgical neck (hand over shoulder anterior feels like a ball where it should be inserted)
IO sizing vrs age
18g 0-6mnth
16g 6-18mnth
14g for children > 18minths
EZ-IO are all 15 gauge
15mm, 25, 45 for different ages
Other IO equipment
Wipe
Consider local
Primed three way tap extension
Syringe for aspiration bone marrow
Meds/ fluid
Rough upper limit of fluid resuscitation in hypovolaemic child and septic child and fluid used (3)
40-60ml/kg
60-80ml/kg
Balance crystaloid (nacl as an alternative)
Percentage chance of head injury with child with multi trauma
70-80%
Percentage chance of head injury with child with multi trauma
70-80%
Percentage chance of head injury with child with multi trauma
70-80%
Absolute cut off for massive haemorrhage protocol
> 40ml/kg
