Paediatric Cardiac Arrest

Question 1

What are the 3 care objectives in paediatric traumatic arrest?

Answer 1

1. Major haemorrhage control over all other interventions
2. Management of correctable causes in order of need
3. Standard cardiac arrest management after trauma management

Question 2

When should medical causes be considered traumatic paediatric arrest?

Answer 2

When Hx, MOI or injuries inconsistent with traumatic arrest.

If pt in VT/VF.

Question 3

In traumatic paediatric arrest, control of major haemorrhage can be achieved with…?

Answer 3

Tourniquets, haemostatic dressings and/or direct pressure

Question 4

When should a pelvic splint be applied in traumatic paediatric arrest?

Answer 4

In undifferentiated blunt trauma, after other interventions. If pelvic fracture clearly contributing to arrest, it may be applied earlier.

Question 5

What are the 4 key components to High Performance CPR in paediatric arrest?

Answer 5

1. Prioritise airway and ventilation
2. Perform high quality CPR
3. Minimise interruptions to chest compressions
4. Utilise team leader and checklist

Question 6

What are the 4 elements associated with “Minimise Interruptions to Chest Compressions” in paediatric arrest?

Answer 6

• Focus on team performance
• Charge defibrillator during compressions
• On-screen rhythm analysis
• Hover hands over chest and resume compressions immediately after disarm/defibrillation

Question 7

What are the 4 metrics associated with paediatric HPCPR?

Answer 7

100 - 120 compressions per minute
Depth 1/3rd of the chest
1 second ventilation duration
2 minute rotations of compressors

Question 8

What is the care objective in medical paediatric arrest?

Answer 8

Effective airway control and adequate ventilation with oxygen is the cornerstone of paediatric resuscitation.

Question 9

Which patients should the medical paediatric cardiac arrest guideline be applied to?
Are newborns managed under this guideline?

Answer 9

Pts <12, who are unresponsive, not breathing normally and;
Pulseless, OR
HR <40bpm (children)
HR <60bpm (infants)

Newborns are not managed under this guideline.

Question 10

Why is airway and ventilatory support prioritised in the medical paediatric cardiac arrest guideline?

Answer 10

Cardiac arrest is commonly caused by hypoxia, and respiratory arrest followed by bradycardic cardiac arrest may be corrected with ventilation prior to commencing compressions.

Question 11

Which rhythms are rare in paediatric cardiac arrest?

Answer 11

VF/ pulseless VT.

Question 12

Fluid admin in shockable rhythms may be…?

Answer 12

Detrimental and should be limited to medication flush and TKVO.

Question 13

When is a pulse check indicated in paediatric cardiac arrest?

Answer 13

For potentially perfusing rhythms eg. presence of QRS complexes with or without a rise in etCO2.

Question 14

In the medical paediatric cardiac arrest guideline, ETCO2 can be used as a surrogate mark of…?

Answer 14

Cardiac output.

Question 15

In the medical paediatric cardiac arrest guideline, ETCO2 can be falsely low in…?

Answer 15

Young infants due to low tidal volumes.

Question 16

In the medical paediatric cardiac arrest guideline, a gradual fall in ETCO2 may suggest…?

Answer 16

CPR Fatigue

Question 17

What padding is required for small children in cardiac arrest to position airway appropriately?

Answer 17

Padding under the shoulders to correct flexion in small children while supine due to their comparatively larger occiput.

Question 18

Use head and neck extension with caution in children _____ years of age.

Answer 18

<8.

Question 19

What is the compression technique for infants with a single and double rescuer scenario?

Answer 19

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.

Question 20

What is the compression technique for small children?

Answer 20

One handed technique, otherwise similar to adult technique.

Question 21

What is the compression technique for medium children?

Answer 21

Two handed technique, as for adults.

Question 22

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?

Answer 22

2 x R = 15:2
1 x R = 30:2

Pause for ventilations.

Question 23

In the medical paediatric cardiac arrest guideline, what is the ventilation rate if ETT/SGA in situ?

Pause for ventilations?

Answer 23

10 ventilations per minute.

No pause for ventilations.

Question 24

What are the goals in the <30 degree hypothermic cardiac arrest?

Answer 24

1. Prevent further heat loss prior to ROSC/Tx
2. Double intervals for adrenaline and amiodarone
3. > 3 shocks unlikely to be successful - consider AAV. If not available, continue DCCS as per usual.

Question 25

List the 6 reversible causes of medical paediatric cardiac arrest.

Answer 25

1. TPT
2. Upper airway obstruction
3. Exsanguination
4. Asthma
5. Anaphylaxis
6. Hypoxia

Question 26

What note is made about hypoglycaemia in cardiac arrest?

Answer 26

Is rare. Check and manage BGL’s after all other Mx.

Question 27

What are the 3 key differences in the medical paediatric cardiac arrest flowchart to that of adults?

Answer 27

1. BVM ventilations before DCCS and compressions
2. Use of OPA/NPA as airway adjunct of choice
3. Defibrillation at 4J/kg

Question 28

What is the defibrillation rate in medical paediatric cardiac arrest?

Answer 28

4J/kg

Question 29

If a child is identified as being in asystole/PEA/severe bradycardia, AFTER initial ventilations, what is the Mx?

Answer 29

Prioritise compressions and ventilations, Rx correctable causes.

Question 30

If a child is identified as being in VF or PVT, AFTER initial ventilations, what is the Mx?

Answer 30

Defibrillate at 4J/kg and immediately commence compressions.

Question 31

In a traumatic paediatric cardiac arrest, what are the 2 sequential major priorities?

Answer 31

1. Prioritise control of major haemorrhage over all other interventions
2. Prioritise treatment of correctable causes of cardiac arrest over chest compressions and in order of clinical need.

Question 32

What ALS managements can address correctable causes in traumatic paediatric cardiac arrest?

Answer 32

Airway - ensure patent airway + adequate O2/ventilation.

Chest decompression and fluids = MICA only.