Paediatric Cardiac Arrest Flashcards
What are the 3 care objectives in paediatric traumatic arrest?
- Major haemorrhage control over all other interventions
- Management of correctable causes in order of need
- Standard cardiac arrest management after trauma management
When should medical causes be considered traumatic paediatric arrest?
When Hx, MOI or injuries inconsistent with traumatic arrest.
If pt in VT/VF.
In traumatic paediatric arrest, control of major haemorrhage can be achieved with…?
Tourniquets, haemostatic dressings and/or direct pressure
When should a pelvic splint be applied in traumatic paediatric arrest?
In undifferentiated blunt trauma, after other interventions. If pelvic fracture clearly contributing to arrest, it may be applied earlier.
What are the 4 key components to High Performance CPR in paediatric arrest?
- Prioritise airway and ventilation
- Perform high quality CPR
- Minimise interruptions to chest compressions
- Utilise team leader and checklist
What are the 4 elements associated with “Minimise Interruptions to Chest Compressions” in paediatric arrest?
- Focus on team performance
- Charge defibrillator during compressions
- On-screen rhythm analysis
- Hover hands over chest and resume compressions immediately after disarm/defibrillation
What are the 4 metrics associated with paediatric HPCPR?
100 - 120 compressions per minute
Depth 1/3rd of the chest
1 second ventilation duration
2 minute rotations of compressors
What is the care objective in medical paediatric arrest?
Effective airway control and adequate ventilation with oxygen is the cornerstone of paediatric resuscitation.
Which patients should the medical paediatric cardiac arrest guideline be applied to?
Are newborns managed under this guideline?
Pts <12, who are unresponsive, not breathing normally and;
Pulseless, OR
HR <40bpm (children)
HR <60bpm (infants)
Newborns are not managed under this guideline.
Why is airway and ventilatory support prioritised in the medical paediatric cardiac arrest guideline?
Cardiac arrest is commonly caused by hypoxia, and respiratory arrest followed by bradycardic cardiac arrest may be corrected with ventilation prior to commencing compressions.
Which rhythms are rare in paediatric cardiac arrest?
VF/ pulseless VT.
Fluid admin in shockable rhythms may be…?
Detrimental and should be limited to medication flush and TKVO.
When is a pulse check indicated in paediatric cardiac arrest?
For potentially perfusing rhythms eg. presence of QRS complexes with or without a rise in etCO2.
In the medical paediatric cardiac arrest guideline, ETCO2 can be used as a surrogate mark of…?
Cardiac output.
In the medical paediatric cardiac arrest guideline, ETCO2 can be falsely low in…?
Young infants due to low tidal volumes.
In the medical paediatric cardiac arrest guideline, a gradual fall in ETCO2 may suggest…?
CPR Fatigue
What padding is required for small children in cardiac arrest to position airway appropriately?
Padding under the shoulders to correct flexion in small children while supine due to their comparatively larger occiput.
Use head and neck extension with caution in children _____ years of age.
<8.
What is the compression technique for infants with a single and double rescuer scenario?
2 x R: hands encircle chest, 2 thumbs compress the sternum. Allow full chest expansion for recoil and ventilation.
1 x R: Use two finger technique to minimise time between compressions and ventilations.
What is the compression technique for small children?
One handed technique, otherwise similar to adult technique.
What is the compression technique for medium children?
Two handed technique, as for adults.
In the medical paediatric cardiac arrest guideline, what are the ratios of compressions to ventilations with no ETT/SGA in situ for:
2 x rescuers
1 x rescuer
Pause for ventilations?
2 x R = 15:2
1 x R = 30:2
Pause for ventilations.
In the medical paediatric cardiac arrest guideline, what is the ventilation rate if ETT/SGA in situ?
Pause for ventilations?
10 ventilations per minute.
No pause for ventilations.
What are the goals in the <30 degree hypothermic cardiac arrest?
- Prevent further heat loss prior to ROSC/Tx
- Double intervals for adrenaline and amiodarone
- > 3 shocks unlikely to be successful - consider AAV. If not available, continue DCCS as per usual.
List the 6 reversible causes of medical paediatric cardiac arrest.
- TPT
- Upper airway obstruction
- Exsanguination
- Asthma
- Anaphylaxis
- Hypoxia
What note is made about hypoglycaemia in cardiac arrest?
Is rare. Check and manage BGL’s after all other Mx.
What are the 3 key differences in the medical paediatric cardiac arrest flowchart to that of adults?
- BVM ventilations before DCCS and compressions
- Use of OPA/NPA as airway adjunct of choice
- Defibrillation at 4J/kg
What is the defibrillation rate in medical paediatric cardiac arrest?
4J/kg
If a child is identified as being in asystole/PEA/severe bradycardia, AFTER initial ventilations, what is the Mx?
Prioritise compressions and ventilations, Rx correctable causes.
If a child is identified as being in VF or PVT, AFTER initial ventilations, what is the Mx?
Defibrillate at 4J/kg and immediately commence compressions.
In a traumatic paediatric cardiac arrest, what are the 2 sequential major priorities?
- Prioritise control of major haemorrhage over all other interventions
- Prioritise treatment of correctable causes of cardiac arrest over chest compressions and in order of clinical need.
What ALS managements can address correctable causes in traumatic paediatric cardiac arrest?
Airway - ensure patent airway + adequate O2/ventilation.
Chest decompression and fluids = MICA only.
