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Life support Flashcards

1
Q

If patients temp <30 degrees and in arrest/arrythmia/SBP <90 what should we do?

A

Transfer to ECMO centre

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2
Q

If temp <30 degrees what change should we make to the ALS algorithm? (2)

A
  1. Don’t give adrenaline
  2. If 3 shocks unsuccessful don’t shock again until >30 degrees
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3
Q

When temp is 30-34 degrees what should we do with adrenaline?

A

Increase interval to 6-10min

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4
Q

What is the treatment for malignant hyperthermia? (4)

A
  1. Stop triggering agent
  2. Target normocapnia
  3. Active cooling
  4. Dantrolene
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5
Q

How long should patients be observed following malignant hyperthermia?

A

72 hours - 25% relapse

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6
Q

How long should we perform CPR if we thrombolyse PE?

A

60-90 mins

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7
Q

What dose ALSG state is managment of tension PTX in arrest?

A

Thoracostomy
Can use needle decompression if quicker but needs to be followed up by thoracostomy and chest drain

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8
Q

What is the difference between laryngectomy and tracheostomy in relations to resus?

A

Laryngectomy patients do not have a patent airway and therefore oral measures will not work at all

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9
Q

If suspecting an issue with a tracheostomy what is the very first step to assess?

A

Look/listen/feel mouth and trachy
ETC02 and Mapleson C can help

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10
Q

If you have assessed a trachy and suspect an occlusion what is the first step in the algorithm following the initial look/listen/feel?

A

Remove any speaking valve or cap and inner tubs and place a suction catheter down
If is passes then it is at least partially patent

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11
Q

If you have removed a tracheostomy inner tube but cannot pass a suction catheter down if, what is the next step in the algorithm?

A

Deflate the cuff
If improves then either partial tube obstruction or diplaced

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12
Q

You have removed the inner tube of a trachy and deflated it with no effect. What is the next step?

A

Remove trachy tube

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13
Q

What are the primary emergency oxygenation maneuvers once a tracheostomy has been removed because it wasn’t working? (2)

A
  1. Standard oral oxygenation measure (facemask/adjuncts)
  2. Tracheostomy stoma ventilation (paeds face mask/LMA to stoma)
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14
Q

What are the secondary emergency oxygenation measures once a tracheostomy has been removed? (2)

A
  1. Oral intubation (uncut tube and advance beyond stoma)
  2. Stoma intubation - small trachy tube/size 6 ETT cuffed, consider fibre-optic or bougie
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15
Q

What are the 5 types of heat illness?

A
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16
Q

What are the 3 cardinal signs of heat stroke?

A
  1. Temp >40 degrees
  2. Encephalopathy
  3. Anhydrosis
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17
Q

What is the underlying mechanism that makes heat stroke different from heat exhuastion?

A

SIRS response leading to multi-organ failure with encephalopathy predominating

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18
Q

What biochemical abnormalities can be seen in heat stroke? (6)

A
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19
Q

What are the two types of decompression injury?

A
  1. Decompression sickness - evolved gas being release

2.Arterial gas embolism (AGE) - escaped gas bubble in arterial system (either via alveolar rupture or venous gas via overwhelming lung filtration of PFO/VSD/ASD)

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20
Q

In neonatal resus what are the fist steps to take when the baby is born? (4)

A
  1. Delay cord clamping if possible
  2. Start clock
  3. Wrap + stimulate
  4. Head neutral
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21
Q

If a baby has been stimulated and is not breathing what is the next steps (3)

A
  1. 5 inflation breaths (30cmH20)
  2. 5-6cmH20 PEEP
  3. Oximetry +/- ECG
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22
Q

Following 5 inflations breaths the baby is still not breathing - what are the next steps? (5)

A
  1. Check position
  2. 2 person technique
  3. Suction
  4. Repeat 5 inflation breaths
  5. Consider increasing pressure
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23
Q

You have delivered 5 inflation breaths to a neonate and the chest is now moving - now what?

A

30 secs ventilation breaths once confirmed still no pulse/HR <60bpm

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24
Q

Following 30 secs ventilation breaths there is no pulse or HR <60bpm - what are your next steps? (5)

A
  1. 3:1 breaths:compressions
  2. 100% Fi02
  3. Reassess every 30 secs
  4. Consider I+V with size 3 ETT
  5. IV access and drugs
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25
Q

With regards to neonatal resusitation what should be done if a baby is < 32 weeks in terms of heating?

A
  1. Place undried in plastic wrap
  2. Under radiant heat
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26
Q

What Fi02 should be used in the first stages of neonatal resus based on gestational age? (3)

A
  1. > 32 weeks - 21%
  2. 28-31 weeks 21-30%
  3. < 28 weeks 30%
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27
Q

What are appropriate pre-ductal SATs (right hand) in terms of term after birth (3)

A
  1. 2 mins = 65%
  2. 5 mins = 85%
  3. 10mins = 90%
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28
Q

What should we aim to do with cord clamping in neonatal resus? (3)

A
  1. Aim to delay at least 60 secs until after lungs aerated
  2. If practical can keep unclamped
  3. If < 28/40 ‘cord milking’ - milk mothers blood to baby
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29
Q

When should drugs be used in neonatal resus?

A

If no CO despite good ventilation and chest compressions

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30
Q

What dose of adrenaline should be used in neonatal resus? (2)

A

20mcg/kg (0.2mk/kg 1 in 10,000)
No response consider increasing to 30 mcg/kg

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31
Q

When should sodium bicarbonate be used in neonatal resus and what dose?

A
  1. Prolonged resus
  2. 1-2mmol/kg (2-4ml 4.2 bicarbonate)
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32
Q

What dose of atropine and calcium should be used in neonatal resus?

A

No role in neonatal resus

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33
Q

When should stopping neonatal resusitation be considered?

A

After 20 mins if all reversible causes have been considered

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34
Q

What ratio compressions should be used in paeds resus?

A

15:2

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35
Q

What size BVM should be used in paeds resus?

A

< 1 year = 500ml bag
> 1 year = 1600ml bag

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36
Q

How long should IV access take place for before switching to IO?

A

2 attempts or 90 secs then IO

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37
Q

What is the dose of atropine in paeds resus?

A

20mcg/kg (minumum 100mcg)

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38
Q

What is the dose of amioderone in paeds resus?

A

5mg/kg

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39
Q

What is the dose of lidocaine (can be used instead of amioderone) in paeds resus?

A

1mg/kg

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40
Q

What is the dose of magnesium in paeds resus?

A

25-50mg over several minutes (polymorphic VT)

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41
Q

What dose of calcium chloride should be used in paeds resus?

A

0.2ml/kg of 10%

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42
Q

What dose of sodium bicarbonate should be used in paeds resus?

A

1-2ml/kg 8.4%

(dont mix with adrenaline as it inactivates adrenaline)

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43
Q

What is the dose of glucose in paeds resus?

A

2ml/kg 10% dextrose

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44
Q

What is the dose of adrenaline in paeds resus?

A

10mcg/kg IV 1:10,000

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45
Q

What is the dose of lorazepam in paeds resus?

A

0.1mg/kg

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46
Q

What is the dose of PR diazepam in paeds resus?

A

0.5mg/kg

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47
Q

What is the dose of buccal midazolam in paeds resus?

A

0.5mg/kg

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48
Q

What is the ETT size calculation in paeds

A

(age/4) + 4

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49
Q

What is the ETT length calculation in paeds?

A

(age/2) + 12

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50
Q

How can sinus tachy vs SVT be determined in paeds?

A
  1. SR HR <200bpm
  2. p waves upright 1 in SR
  3. Hx of shock if sinus
  4. Beat to beat variation in SR
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51
Q

What is the SVT algorithm in paeds? (5)

A
  1. Valsalva (cold water in neonates/babies, hand stand in kids)
  2. Adenosine:

Up to 1 year: 150 mcg kg-1, increase 50–100 mcg kg-1
every 1–2 min. Maximum single dose: Neonates 300
mcg kg-1, Infants 500 mcg kg-1)

1–11 years: 100 mcg kg-1 increase 50–100 mcg kg-1
every 1–2 min. Maximum single dose: 500 mcg kg-1
(max. 12 mg)

12–17 years: 3 mg IV, if required increase to 6 mg
after 1–2 min, then 12 mg after 1–2 min

  1. Consider cardioversion or amioderone
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52
Q

DV cardioversion in paeds VT what is the voltage? (2)

A
  1. 2J/kg
  2. If fails 4J/kg
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53
Q

What is the dose of magneisum in torsades des pointes in paeds?

A

25-50mg/kg

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54
Q

In the paeds choking algorithm what should be done for a conscious infant (<1) who has a poor cough?

A

5 back blows (head downward and prone) followed by 5 thrusts (supine and chest position as CPR) continually until resolution or reduced GCS

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55
Q

In the paeds choking algorithm what should be done for a conscious child > 1 who has a poor cough?

A

5 back blows (head down, forward leaning) followed by 5 thrusts (abdominal thrust) continually until resolution or reduced GCS

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56
Q

What is the paeds choking algorithm for unconscious patients? (7)

A
  1. Lie flat and open mouth - look for FB
  2. If seen - 1 x finger sweep
  3. McGills/direct laryngoscopy
  4. Attempt x 5 rescue breaths
  5. No chest rise - reposition head
  6. CPR 15:2 checking for FB every time airway opened
  7. No improvement and hypoxic - surgical airway
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57
Q

What are the adrenaline dose for paeds anaphx? (3)

A
  1. > 12 = 500mcg (0.5ml 1:1000)
  2. 6-12 = 300mcg (0.3ml)
  3. < 6 year = 150mcg (0.15ml)
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58
Q

What is the IV dose of adrenaline for paeds anaphx?

A

1mcg/kg 1:10,000
adult dose = 50mcg

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59
Q

What are the paediatric chlorphenamine doses? (4)

A
  1. > 12 year = 10mg
  2. 6-12 years = 5mg
  3. < 6 year = 2.5mg
  4. < 6 months = 250mcg/kg
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60
Q

What are the paediatric hydrocortisone doses? (4)

A
  1. > 12 years = 200mg
  2. 6-12year = 100mg
  3. < 6 years = 50mg
    4 < 6 months = 25mg
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61
Q

When should tryptase measurements be taken?

A

Immediately and then another sample < 4 hours

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62
Q

What is refractory anaph and how should it be treated?

A
  1. 2 or more doses of adrenaline with no improvement
  2. Adrenaline infusion

= 1mg (1ml of 1mg/ml 1:000) in 100ml normal saline
Start at 0.5/1.0 ml/kg/hr

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63
Q

What are the contraindications to Penthrox?

A

C - linically significant cardiac or resp disease
H - hypersensitivity to methoxyflurane (or any flurinated gas)
E - stablished hx of malignant hyperthermia
C - onsciousness altered
K - kidneys (eGFR <45) or liver disease

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64
Q

What is the gauge and flow rate of an orange cannula?

A

14G and 240ml/hr

65
Q

What is the gauge and flow rate of a grey cannula?

A

16 G and 180ml/min

66
Q

What is the gauge and flow rate of a green cannula?

A

18G and 90ml/min

67
Q

What is the gauge and flow rate of a pink cannula?

A

20G and 60ml/min

68
Q

What is the gauge and flow of a blue cannula?

A

22G and 36ml/min

69
Q

What is the gauge and flow rate of a yellow cannula?

A

24G and 20ml/min

70
Q

What do the resus council recommend for DC shock J in AF/SVT?

71
Q

What does resus council recommend for initial shock J in pulsed VT in adults?

72
Q

How many attempts does DASS say is maximum for tracheal intubation?

A

3 - change something each time

73
Q

Following failed intubation what does DASS recommend moving onto as second line?

74
Q

What is the Parkland formula

A

2-4ml x weight(kg) x TBSA burns

Usually use 3 ml

75
Q

Over what period should fluid calculated by the Parkland formula be given?

A

First half in 8 hours, then second half over 16 hours

76
Q

When should an escharotomy be perfored?

A

With deep burns skin can become stiff. In chest this can impair ventilation and in the limbs circulation

77
Q

How is an escharotomy performed?

A

1.The limb should be kept in the anatomical position.
2. The area is cleaned and incised along the anatomical lines with a scalpel down to the fat
3. The incision should not go down to the muscle or fascia
4.For the limbs the incisions need to release both medial and lateral aspects
5. For the chest the incision needs to release the whole breast plate

78
Q

What biochemical marker suggests a likely poor outcome in hypothermic arrests?

79
Q

What are the recommended methods for measuring temperature in severe hypothermia? (3)

A
  1. Tympanic (accurate to 20degrees C)
  2. Oesophageal
  3. Intravascular

Not rectal

80
Q

At what voltage should you start at to defibrillate AF or SVT?

81
Q

At what voltage should you start at to defibrillate VT?

82
Q

What are the escalating doses of adenosine in adults who are in SVT but stable?

A

6mg
12mg
18mg

83
Q

Describe the anaesthetic intubation grades

84
Q

How do we convert L/min to Fi02?

A

(L/min x 4) + 20

e.g. (5L/min x 4) = 40

85
Q

What is the landmark for anterior humerous IO access?

A

1cm above the surgical neck

86
Q

What is the landmark for proximal tibia IO access?

A

2 finger breadths below the patella and 1-2cm medial to the tibial tuberosity in adults

87
Q

What is the landmark for distal tibia IO access?

A

3 cm proximal to the most prominent aspect of the medial malleolus

88
Q

Describe the Mallampati scoring system

A

Class I: Soft palate, uvula, fauces, pillars visible.
Class II: Soft palate, major part of uvula, fauces visible.
Class III: Soft palate, base of uvula visible.
Class IV: Only hard palate visible.

89
Q

What are the ranges for mild/moderate and severe hypothermia?

A

Mild = 32-35 degrees
Moderate = 28-32 degrees
Severe = 24-28 degrees

90
Q

Describe the APGAR scoring system

A

A-ppearance
0 - pale/blue
1 - pink body, blue extremities
2 - pink

Pulse
0 - absent
1 - < 100
2. > 100

G-rimace
0 - nil
1 - some movement
2 - cry

A-ctivity
0 - limp
1 - some flexion of extremities
2 - well flexed

R - espirations
0 - absent
1 - weak cry or hypoventilation
2 - good

91
Q

Describe the Swiss staging system for hypothermia? (5)

A
  1. Mild (Stage I) – conscious with shivering. 32 to 35°C.
  2. Moderate (Stage II) – Altered mental status without shivering. 28 to 32°C.
  3. Severe (Stage III) – Unconscious. 24 to 28°C
  4. Very Severe (Stage IV) – Apparent death. Core temperature 13.7 to 24°C (resuscitation may be possible). Remember cold delays the brain death.
  5. Death (Stage V) – Death due to irreversible hypothermia. Core temperature <9 to 13.7°C (resuscitation not possible).
92
Q

How long should be check for signs of life in hypothermic arrest?

93
Q

What does METHANE stand for?

A

M - ajor incident declared
E - xact location
T - type of incident
H - azards
A - Access/egress
N - Number and type of casualties
E - emergency services present/requried

94
Q

What is the breakdown of the ‘rule of 9s’? (6)

A
  1. Head and neck - 9%
  2. Anterior trunk - 18%
  3. Posterior trunk - 18%
  4. Upper extremity - 9%
  5. Lower extremity - 18%
  6. Perineum - 1%
95
Q

When is entonox c/i? (6)

A
  1. Head injury
  2. Chest injury
  3. Suspected bowel obstruction
  4. Middle ear disease
  5. Early pregnancy
  6. B12/folate deficiency
96
Q

Describe the ASA grading

A
  1. normal
  2. mild systemic disease
  3. severe systemic disease -
  4. severe systemic disease, constant threat to life e.g. unstable angina, DKA
  5. moribund, will die without operation
97
Q

Describe the LEMON anaesthetic assessment

A
  1. L-ook externally
  2. E - valuate using ‘3,3,2’

3 fingers mouth opening
3 fingers from mentum for hyoid
2 fingers between hyoid and throid gland

  1. Mallampati
  2. Obstruction/obesity
  3. Neck mobility
98
Q

In post extubation hypoxia what does the mnemonic DOPES stand for?

A

D: Dislodgement of the tube – check depth of tube against recorded depth at intubation. Is
ETCO2 still connected and recording?
O: Obstruction – can a suction catheter be passed?
P: Pneumothorax
E: Equipment failure – disconnect ventilator and return to manual BVM.
S: Stacked breaths – especially auto-PEEP in COPD/asthma. Disconnect from ventilator.

99
Q

What dose of glucose should be used in prolonged neonatal resus?

A

250mg/kg = 2.5ml 10% dextrose /kg

100
Q

How is coronary perfusion pressure calculated?

A

CPP = DBP - LV end diastolic pressure

101
Q

What DBP should we aim for in arrest and why?

A

> 30mmHg

CPP should aim for >20mmHg

CPP = DBP - LV end diastolic pressure

LV end diastolic pressure approx 10mmHg (variable in arrest)

102
Q

Where should IM adrenaline be given?

A

Anterolateral aspect of middle third of thigh

103
Q

What is the IV dose of adrenaline for anaphx?

A

50mcg in adults
1mcg/kg paeds

104
Q

What rate should an adrenaline infusion be set up at for refractory anaphx?

A

1mcg/kg/min

105
Q

In the ALS bradycardia algorithm what are the 4 life threatening signs?

A
  1. Shock
  2. Syncope
  3. Myocardial ischaemia
  4. Heart failure
106
Q

In the ALS bradycardia algorithm what are the 4 factors that suggest increased risk of asystole and therefore should have intervention even if no life threatening signs?

A
  1. Recent asystole
  2. Mobitz II
  3. Complete HB with broad QRS
    4 Ventricular pause > 3secs
107
Q

What are the interim measures recommended by ALS whilst awaiting transvenous pacing in bradycardia? (5)

A
  1. Atropine 500mcg to maxium 3mg
  2. Isoprenaline 5mcg/min IV
  3. Adrenaline 2-10mcg/min IV
  4. Alternative drugs*
  5. Transcutaneous pacing

*
- aminophylline
- dopamine
- glucagon (if betablocker/CCB OD)
- glycopyrrolate instead of atropine

108
Q

How should amiodarone be administered?

A

Over 10-60mins in large bore cannula

(decrease risk of hypotension and thrombophlebitis)

109
Q

What is the mechanism of action of metoprolol?

A

Selective beta-1 antagonist, has negligible beta-2 affect

110
Q

What is Mendelsons syndrome?

A

Chemical pneumonitis after being exposed to acidic material (gastric contents)

111
Q

What is the ALS treatment for hyperkalaemic arrest? (4)

A
  1. Protect the heart: give 10 mL calcium chloride 10% IV Consider repeating dose if cardiac arrest is refractory or prolonged.
  2. Shift potassium into cells: Give 10 units soluble insulin and 25 g glucose IV by rapid injection.
  3. Shift potassium into cells: Give 50 mmol sodium bicarbonate (50 mL 8.4% solution) IV by rapid injection.
  4. Remove potassium from the body: Consider dialysis for refractory hyperkalaemic cardiac arrest.
112
Q

Outside of echo, what 2 signs to ALS mention as supporting PE?

A
  1. Low ETC02 despite good CPR (<1.7 KPa)
  2. PEA
113
Q

Under what gestation should a neonate be placed in a food grade plastic wrap or bag?

114
Q

What temperature drop in neonates leads to what increase in mortality?

A

Drop in temp of 1degree C or more below 36.5 degrees C increases mortality by 28%

115
Q

Why do SATs need to be from the right hand in neonates?

A

Right arm supplied by brachiocephalic artery from arch of aorta which branches off aorta before ductus arteriosus. This is more reflective of neonates true oxygenation status during transition from foetal circulation

116
Q

How long should inflation breaths be?

117
Q

How many neonates as a %:
1. Will start breathing within 60-90 secs of birth
2. Start breathing after drying/stimulation
3. Need PPV
4. Need compressions

A
  1. 85%
  2. Further 10%
  3. 5%
  4. 0.3%
118
Q

Why is a pale neonate worse than a blue neonate following birth?

A

Because pale indicates likely both CV and respiratory collapse, blue only respiratory

119
Q

How should an airway be suctioned in neonates?

A

Direct vision with large bore catheter

120
Q

Under what weight and gestation are IGels c/i in neonates?

A

< 34/40 or > 2kg

121
Q

If colloid needed in neonatal resusitation what should be used?

A

O-ve blood

122
Q

How often should neonates be reassesed in resus?

A

Every 30 secs

123
Q

When can intratracheal route of adrenaline be used in neonatal resus and what is the dose?

A

If no other access available

100mcg/kg (1ml of 1:10,000)

124
Q

Describe primary and secondary apnoea in the neonate

A

Primary: Failure to breath leads to anoxia and inhibition of respiratory centre. There will be rapid, regular breathing followed by the primary apnoea period. Associated with bradycardia.

Secondary: Primary apnoea followed by irregular, gasping breaths (primitive spinal gasps), a slight rise in MAP and then secondary apnoea. This is terminal apnoea and associated with drop in MAP and further bradycardia.

125
Q

How long does progression from primary to secondary apnoea take?

A

Approx 20 mins

126
Q

Why can an oesophageal be even harder to recognise in neonates?

A

Because they are so small you get chest rise and transmitted sounds from stomach

127
Q

In the resus council algorithm for refractory anaphx what is the initial treatment for adults + paeds?

A
  1. Fluid bolus (10ml/kg in paeds, 500ml/1000ml adults)

and

  1. Adrenaline infusion =
    1mg (1ml of 1:1000 adrenaline) into 100ml normal saline and commence 0.5-1.0ml/kg/hr and titrate to affect
128
Q

According to resus counil refractory anaphx alorigthm what should be considered if poor response to adrenaline infusion? (3)

A
  1. Add second vasopressor (metaraminol/noradrenaline/vasopressin)
  2. If on beta blocker consider glucgaon
  3. Consider ECMO
129
Q

What do resus council status algorithm state for second line agents and which one has the best evidence?

A
  • Levetiracetam 30–60 mg kg-1 (over 5 min, max 3 g)
    OR
  • Phenytoin 20 mg kg-1 by slow IV infusion
    over 20 min with ECG monitoring
    OR
  • Phenobarbital 20 mg kg-1 by IV infusion over 5 min

All have been shown to be equally effective if several trials

130
Q

After what period of time does likelihood or seizure termination decrease and what consequence does this have to the status algorithm

A

After 5 mins which is when resus council define status

Means first dose benzo should only be given after 5 mins.

131
Q

When giving phenytoin IV, what must be considerd?

A

If given as bolus will lead to bradycardia/hypotension +/- asystole

132
Q

What induction agents are mentioned by resus council for third line status tx?

A

There is no evidence for the ideal third line agent:
1. thiopentone,
2. propofol
3. ketamine
4. midazolam

all appropriate

133
Q

What are the differences between paeds BLS in hospital and OOH? (2)

A
  1. If alone perform 1 minute chest compressions before calling for help if no phone. If have phone and can use speaker do asap.
  2. CPR - 30:2 to decrease number of changes of position. If not willing/unable to ventilate then compression only
134
Q

What depth should paeds CPR be performed to?

A

If infant chest compression depth should be 4cm, if child then 5cm

135
Q

In anaphx what is recommended immediately after calling for help? (2)

A
  1. Lie flat (+/- legs up) (left lateral if pregnant)
  2. Remove trigger
136
Q

In the paeds tracheostomy algorithm what should be done initially if the patient is breathing? (6)

A
  1. Check safety
  2. Stimulate
  3. Shout for help
  4. Oxygen to face and trachy
  5. Open airway
  6. Capnography
137
Q

In a breathing child, following initial measures what should be done and how next in the trachy algorithm?

A

Pass suction tube

Remove HME, speaking valve and change inner tube then pass suction catheter

If can pass catheter then at least partially unobstructed so suction and continue assessment

138
Q

In the paeds trachy algorithm what should be done if you are unable to pass a suction catheter and how is this performed?

A

Change trachy

  1. Deflate cuff
  2. First change - same size
  3. Second change - 0.5 size smaller
  4. Third change over suction catheter to guide

Assess response to each change, if unsuccessful remove the tube

139
Q

If a child is not breathing, what does the trachy algorithm state should be done first?

A

5 rescue breaths:
- if patent upper airway using mouth
- if obstructed upper airway then via trachy/stoma

If no signs of life start CPR 15:2

140
Q

What are the primary oxygenation maneuvers in the paeds tracheostomy algorithm?

A
  1. Standard oral: cover stoma and BVM +/- adjucts or SGA
  2. Stoma : either paeds facemask applied to stoma or SGA
141
Q

What are the secondary oxygenation maeuvers in the paeds tracheostomy algorithm?

A
  1. Oral intubation: uncut tube advanced below the stoma 0.5 size smaller than trachy size
  2. Attemp stoma intubation: size 3.0mm ETT or trachy

Ideally with difficult airway expert + fibreoptics

142
Q

How does RCUK define bradycardia in terms of HR?

A

< 1 years = < 80bpm
> 1 years = < 60bpm

143
Q

In the paeds bradycardia algorithm what is the first step? (RCUK)

A

Adequate oxygenation - either with via facemask or PPV

144
Q

Following optimal oxygenation in a paeds bradycardia algorithm defines the next step? (RCUK)

A

If unconscious commence CPR

If conscious move on to next step

145
Q

In a child who is bradycardic but conscious and has been optimally oxygenated, what should be the next steps? (RCUK) (3)

A
  1. Atropine if suspected excessive vagal tone (20mck/kg and max 300mcg)
  2. If no response to atropine consider adrenaline
  3. Paced rarely required and should be guided by aetiology
146
Q

What does RCUK suggest makes SVT more likely than sinus tachy in infants and children?

A

Abrupt onset and:

Infants: HR >220bpm
Children: HR > 180bpm

147
Q

In decompensated SVT what does RCUK recommend in paeds? (5)

A

DC cardioversion with sedation:

1st shock = 1J/kg
2nd shock = 2J/kg
Consider up to 4J/kg

Consider amioderone BEFORE third shock and give slowly (>20mins)

If delay to cardioversion and IVA consider atropine

148
Q

In decompensated broad complex tachy paeds what does RCUK recommend doing in conscious and unconscious patients?

A

Conscious = sedation +

Unconscious = immediate cardioversion

1st shock = 1J/kg
2nd shock = 2J/kg
Consider up to 4J/kg

Consider amioderone BEFORE third shock and give slowly (>20mins)

149
Q

If no IVA what does RCUK recommend for sedation for paeds cardioversion?

A

IN or IM ketamine - do no delay cardioversion for IVA if decompensated.

150
Q

What are the 5th centile BPs that RCUK use to define hypotension and decompensation needing cardioversion for each age group? (4)

A

1 month = SBP 50
1 year = SBP 70
5 years = SBP 75
10 years = SBP 80

151
Q

What is the adrenaline dose for paeds bradycardia? (RCUK)

A

10mcg/kg and repeat if needed

152
Q

What is the dose of magnesium to be used in polymorphic VT in paeds?

A

25-50mg/kg up to 2g given over 15 mins (can be repeated)

153
Q

In arrest what should be the defib voltage in monophasic and biphasic defibrillators?

154
Q

In life threatening asthma, what is the safe dose of IV salbutamol given slowly?

155
Q

With (end inspiratory) plateau pressure:
1. What is it used as a surrogate marker of
2. What is its clinical relevance to PHEM?
3. How is it measured
4. What is considered high

A
  1. End inspiratory volume
  2. Used to measure dynamic hyperinflation e.g COPD/asthma ventilation
  3. End inspiratory occlusion for 3 seconds e.g insp hold
  4. > 26 cmH20
156
Q

What is more specific to risk of barotrauma plateau pressure or peak pressure?

A

Plateau pressure as it is the pressure delivered to the alveoli

157
Q

What are the physiological targets for post ROSC paeds patients (RCUK)? (5)

A
  1. Avoid MAP <5th percentile
  2. Pac02 = 4.5-6.0 kPa (don’t use ETCO2)
  3. Pa02 10-13 kPa (or 94-98% SATs)
  4. Mandatory targeted temperature 36-37.2 degrees
  5. Normoglycaemia

FIMC (17 decks)

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