Paediatric ACE

Question 1

How to find child equipment based on given age ?

Answer 1

Find estimated weight by age on pch website / AID trolley cards

Grab PAWS pack weight based and bring ACE trolley with RSI checklist

Question 2

What to prepare before the child arrives

Answer 2

SOAPME

• Suction with yankauer or nasal suction from paws pack
• Oxygen: BVM connect to ETCO2 (neonate 250ml, paeds 500ml, big child/adult 1500ml). NP. NRM.
• Airway: OPA. NPA. ETCO2 adapter. Laryngoscope. Stylet. ETT (check inflation).
• cuffed (age/4)+4
  *uncuffed (age/4)+3.5
  *size 0.5 above and below
  Syringe (10ml). LMA. Bougie. *difficult airway plan. Pressure meter. Lube.
  *trouser leg TAPE
• Pharmacological agents: sedatives, analgesic, paralytic.

Sedative: propofol, ketamine, midazolam
Analgesic: morphine, fentanyl
Paralytic: suxamethonium, vecuronium, rocuronium

Atropine + metaraminol

• Monitoring equipment: Sats, CO2, ECG, BP, IVC, NGT, BSL, Temp

Question 3

What to do when patient arrives ?

Answer 3

Danger: safe to commence
Response: check whether pt is responding
Send for help: code blue paediatric

Airway: LEON

• look for trauma/ deformity
• doctor evaluate 332: difficulty of intubation
• obstruction/obesity
• neck mobility
• infant (under 1yr): neutral head + jaw support
• child: head tilt + sniffing
• suction if required
• opa central lips to angle for mandible

Breathing: look listen feel > 2 initial rescue breaths> check signs of life > if not CPR 15:2

• check O2sats check RR
• give doctor BVM with ETCO2

Circulation: check HR+ feel brachial/femoral pulse.

• CPR - infants 2 fingers, child 1 hand
• apply defib
• gain access: IVC IO ARTLINE
• VBG/ABG

Disability: GCS, BSL

E: temp, external trauma

Question 4

Set up for RAPID SEQUENCE INTUBATION (RSI)

Answer 4

• Suction
• Cricoid pressure
• Laryngoscope (Straight/curved) 📐
• lubricated ETT with stylet in it
• Bougie back up
• LMA back up
• BVM with ETCO2 To patient
• Auscultate chest to see air entry equal/ not in belly
• CUFF UP
• tape trouser legs
• set up ventilator what they say and start
• Cobb’s > ETCO2 > hme filter > ventilator
• CXR

Question 5

Settings for ventilator

Answer 5

Ventilator set to:

• Paeds/adult
• set to estimated weight

*Tidal Volume: the amount of air a person inhales during a Normal breath of air.
Set it to ensure adequate ventilation without causing trauma to lungs.
* calculate SIMV: 6-8ml/kg. NIV:4-6ml/kg
* RR normal range 20-30
*I:E ratio (inspiration to expiration ratio)
*insp time: 0.5-0.6

• pressure support: when patient can breath but isn’t able to get sufficient VT, supports them on inspiration to get enough O2 (10)
• minute volume: RR x VT
• PEEP : positive end expiratory pressure. Use to open up the alveoli and provide better gas exchange. Good for patients with APO allow fluids in lungs to escape (5)

Question 6

Post intubation care

Answer 6

• fill in mechanical invasive ventilation form
• obs 15/60 firs hour or everytime they change settings
• post intubation sedation infusion :propofol
• blous if patient ^ in agitation score
• NGT
• IDC