Knowledge Bank Flashcards
What are the indications for the insertion of an OPA?
- Unconscious pt needing active airway management by displacing the tongue anteriorly
- Bite block to support ETT
What are the contraindications for the insertion of an OPA?
- Trismus
- Intact gag reflex
- Suspected neurological injury out of concern for inducing gag response
What are the indications for insertion of a NPA?
- Unconscious pt with trismus (where OPA can’t be inserted)
What are the contraindications of insertion of a NPA?
- Middle third facial fractures (possible intrusion into brain tissue)
- Significant nasal trauma (may induce gag)
- TBI and neurological even where airway patent and tidal volume adequate despite trismus (undesirable gag)
What are the precautions for insertion of a NPA?
- Basal skull fractures
- CSF in nares or ears
- May need to be removed during intubation as can interrupt view of glottis
How does triple airway manoeuvre enhance assessment of airway?
- Displaces tongue and soft tissue away from back of throat
Outline the difference between neutral and sniffing position
- Neutral position achieve by placing 2-5cm towel under occiput and aims to open airway
- Sniffing position requires more padding and maximises view of vocal cords
Why is it important to avoid hyperextension of the head?
- It can flatten the trachea
Why should head positioning be varied when assessing the airway or a small child compared to a medium child?
- Small children have a relatively larger occiput and don’t need their head elevated in the same fashion
- Medium children are best managed with head and body on same plane
How would you position an infant’s and small child’s airway?
- Small pad (2cm) beneath shoulders
In the setting of a cardiac arrest, when is a carotid pulse check required?
- In presence of a potentially perfusing rhythm at the end of a CPR cycle
In accordance with AV CPG’s, what are the correctable causes of PEA?
- Hypoxia
- Exsanguination
- Asthma
- Tension pneumothorax
- Anaphylaxis
- Upper airway obstruction
In accordance with AV CPG’s, how does the management of a hypothermic pt in cardiac arrest vary from that of a normothermic pt in cardiac arrest?
- 30C or more = standard
- <30C = double interval for adrenaline administration
- Primary goal of managing moderate-severe hypothermia should be prevention of further heat loss prior to ROSC or transport. Significant improvement in temperature from prehospital intervention is unlikely
- Greater than 3 shocks is unlikely to be successful while pt remains severely hypothermic
- If hypothermia is clear cause for cardiac arrest, mechanical CPR to hospital may be appropriate in consultation with clinician and hospital
What circumstances should compressions be performed in a paediatric pt?
- No palpable pulse
- HR<60bpm (infants)
- HR <40bpm (children)
What actions need to be performed when ROSC is achieved?
- 12 lead ECG - consider PHT
- VF/VT arrest OR suspected cardiac cause OR post PHT:
- transport to 24hr PCI facility
- consider AAV - Suspected non-cardiac cause:
- transport to closest appropriate hospital with notification
How does the technique of compressions differ for the infant, small child and medium child?
- Infant:
- 2 finger or 2 thumb technique
- hands encircle chest and thumbs compress sternum - Small child:
- one handed technique otherwise similar to that for adults - Medium child:
- two handed technique similar to that for adults
What are the compression and ventilation rates for infants? (No ETT/SGA)
- Two rescuers - 15:2, one rescuer - 30:2
- Aim for 100-120 compressions per minute
- Pause for ventilations
What are compression and ventilation rates for children? (ETT/SGA insitu)
- Aim for 100-120 compressions per minute
- 10 ventilations per minute
- No pause for ventilations
What are the five criteria used to determine a newborn’s APGAR score?
- Appearance
- Pulse
- Grimace
- Activity
- Respiratory effort
What are the compression ventilation rates for a newborn?
- 3:1
- Aim for 90 compressions and 30 ventilations per minute (120 per minute or 2 per second)
- 0.5 second pause for ventilation. No pause for ventilation post intubation
What are the 5 ECG rhythm criteria for VF?
- Ventricular rate: nil discernible
- Ventricular rhythm: bizarre, chaotic, amplitude >0.1mV
- P waves: nil discernible
- PR interval: nil discernible
- QRS duration: nil discernible
In accordance with AV CPG’s, what are the common causes of paediatric cardiac arrest?
- Hypoxaemia
- Hypotension
- Trauma
- Drowning
- Septicaemia
- SIDS
- Asthma
- Upper airway obstruction
- Congenital heart abnormalities
In accordance with AV CPG’s, list the 6 clinical elements in determinants of death
- No palpable carotid pulse
- No heart sounds heard for 2 mins
- No breath sounds heard for 2 mins
- Fixed and dilated pupils
- No response to central stimulus
- No withdrawal or grimace from painful stimulus
- ECG strip showing 2 mins of asystole is an optional finding that may be included
As per the AV CPG pharmacology sheet, what are the side effects of adrenaline?
- Sinus tachycardia
- Supraventricular tachycardia
- Ventricular arrhythmias
- Hypertension
- Dilated pupils
- May increase size of AMI
- Anxiety
What are the benefits of administering adrenaline for cardiac arrest?
- Alpha effects:
- causes peripheral vasoconstriction
- increases peripheral vascular resistance
- increases venous return/cardiac output/coronary perfusion pressures
- along with effective CPR, aids in perfusing myocardium to provide a shockable rhythm - Beta effects:
- increases irritability of ventricles and myocardial contractility
