Paed Haemorrage

Question 1

What is the first steps in major haemorrhage control?

Answer 1

Stop the haemorrhage

1. Airway manoeuvres & positioning
   - OPA if airway not patent
2. Breathing
   - breathing or ventilation
3. Circulation
   - Fluid resuscitation with normal saline
   - pelvic splint
4. Supportive care

Question 2

When should an SGA be used?

Answer 2

If no gag reflex and prolonged ventilation is required.

Question 3

What is the recommended ventilation volume?

Answer 3

6 - 8 mL / kg

Question 4

What are the suggested starting rates for ventilation based on age?

Answer 4

< 3 months: 25
3-12 months: 25
1-4 years: 20
5-11 years: 16
12-15 years: 14

Question 5

What should be adjusted to during ventilation?

Answer 5

EtCO2 target.

Question 6

What are the target values for SpO2 and EtCO2?

Answer 6

SpO2 > 95 %
EtCO2 30 - 35 mmHg

Question 7

What is the first line of treatment for circulation?

Answer 7

Fluid resuscitation targeting adequate perfusion.

Question 8

What is the heart rate range for 12 - 15 years?

Answer 8

60 - 130 bpm.

Question 9

What is the systolic blood pressure (SBP) for 12 - 15 years?

Answer 9

90 mmHg.

Question 10

What is the heart rate range for 5 - 11 years?

Answer 10

80 - 140 bpm.

Question 11

What is the systolic blood pressure (SBP) for 5 - 11 years?

Answer 11

80 mmHg.

Question 12

What is the heart rate range for 1 - 4 years?

Answer 12

90 - 160 bpm.

Question 13

What is the systolic blood pressure (SBP) for 1 - 4 years?

Answer 13

70 mmHg.

Question 14

What is the heart rate range for 3 - 12 months?

Answer 14

100 - 180 bpm.

Question 15

What is the systolic blood pressure (SBP) for 3 - 12 months?

Answer 15

60 mmHg.

Question 16

What is the heart rate range for < 3 months?

Answer 16

100 - 180 bpm.

Question 17

What is the systolic blood pressure (SBP) for < 3 months?

Answer 17

50 mmHg.

Question 18

What is the maximum dose of normal saline IV for fluid resuscitation?

Answer 18

40 mL/kg, titrated to response.

Question 19

What should be done if there is inadequate response to fluid resuscitation?

Answer 19

Consult AV Medical Advisor via AV Clinician for further management.

Question 20

What should be done for blunt trauma to the pelvis?

Answer 20

Pelvic splint.

Question 21

What supportive care measures should be taken? (6)

Answer 21

1. Warm the patient
2. provide pain relief
3. spinal immobilisation if required
4. manage wounds/fractures
5. seizures
6. hypoglycaemia
7. pressure care.

Question 22

Care objective: Major haemorrhage

Answer 22

1. Immediate control of major haemorrhage
2. Ensure:
   - airway patency
   - breathing with adequate oxygenation and ventilation
   - circulation with adequate perfusion
   3.prioritise transport
3. Supportive care as required