PAEDIATRIC LIFE SUPPORT Flashcards
What do we consider to cardiac arrest in a child?
When heart rate drops below 60 bpm
What is the first step of basic life support upon seeing a collapsed child?
Check for danger and shout for help
Having checked for danger and called for help, what should do when approaching a collapsed child?
Check response - AVPU
Do not shake infants or those with possible cervical spine injury
If there is no response in a child who has collapsed how much you assess their airway? How would this be different in an infant?
Child - chin lift to ‘sniffing’ position, jaw thrust
Infant - chin lift to neutral position, avoid over extension
Remove secretions / foreign bodies under direct vision
Having assessed a collapsed child’s airway, what must you do?
Check for breathing
Look - for chest movements
Listen - for breath sounds
Feel - for air movement on your cheek
Do not need to check for pulse here
Having found a collapsed child, you discover no signs of breathing using a look, listen, feel approach. What must you do next?
Call for help. Ideally get someone else to call 2222 or 999 for paediatric crash call
Having found a collapsed child with no signs of breathing, you call 2222 for a paediatric crash call. What should you do next? How would this be different in an infant?
Deliver 5 rescue breaths
Make sure mask is sealed over head tilted mouth
Squeeze bag until you can see a chest rise. Do not over inflate.
In infants, you should put mask on chin first
Having found a collapsed child, you follow BLS protocol and deliver 5 rescue breaths. What should you do next?
Reassess - this time you should check pulse as well
Having found a collapsed child, you follow BLS protocol, deliver 5 rescue breaths and reassess. Where should you check a child’s pulse? How would this be different in an infant?
Child: carotid, femoral
Infant: brachial, femoral
Having found a collapsed child, you follow BLS protocol, deliver 5 rescue breaths and reassess. There is still no signs of improved breathing. What should you do next? How would this be different in an infant?
Start compressions and breaths in a 15:2 ratio
Child: heel of one hand over lower third of sternum, compress 1/3 of chest at a rate of 100-120 pm, remember to allow chest come up fully to allow cardiac filling
Infant: use tips of two fingers, or if there are two of you then can use thumbs on sternum with hands round the thorax. Other rescuer needed to support head and deliver breaths.
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. How long should you perform CPR for before calling the resuscitation team?
1 min
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrive and take over. What is the first thing that must be done whilst CPR is continued?
Establish venous access or if this is causing delay use intraosseous route.
How do you establish intraosseous access in a collapsed child requiring ALS?
18 gauge trochar with needle
Into the anterior surface of tibia, 2-3 cm below tibial tuberosity
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrives and the defibrillator shows VF. Is this a shockable rhythm?
Yes
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrives and the defibrillator shows VF. What amount of shock should be delivered to the child in an attempt to cardiovert them?
4 J/kg
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrives and the defibrillator shows VF so the child is shocked. What should now happen?
Immediately resume CPR for 2 mins
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrives and the defibrillator shows VF. The child is shocked and CPR is recommenced. When should you give adrenaline to this child?
After the 3rd shock and every other shock.
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrives and the defibrillator shows VF. The child is shocked and CPR is recommenced. What dose of adrenaline should be given after the 3rd shock?
IV or IO – 10 micrograms/kg ie 0.1 ml/kg of 1 in 10,000 solution
Via tracheal tube – 100 micrograms/kg
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrives and the defibrillator shows VF. The child is shocked and CPR is recommenced. When should you give amiodarone to this child and what dose should be given?
5 mg/kg after the 3rd and 5th shocks
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrives and the defibrillator shows VF. The child is shocked and CPR is recommenced. What should happen now?
After 2 minutes the rhythm should be assessed again and another shock delivered if still in shockable rhythm
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrives and the defibrillator shows pulseless electrical activity (PEA). Is this a shockable rhythm?
No.
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrives and the defibrillator shows pulseless electrical activity so the child cannot be shocked. What should now happen?
Immediately resume CPR for 2 mins
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrives and the defibrillator shows PEA so CPR is recommenced. What should happen now?
After 2 minutes the rhythm should be assessed again. If shockable a shock should be delivered, if not CPR should be recommenced.
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrives and the defibrillator shows PEA so CPR is recommenced. When should you give adrenaline to this child?
Every 3-5 mins ie every other cycle
Having found a collapsed child in a hospital, you follow ALS protocol and deliver 5 rescue breaths. You then reassess before commencing CPR. The crash team arrives and the defibrillator shows PEA so CPR is recommenced. When should you give amiodarone to this child?
Amiodarone should not be given unless the child is in VF or pulseless VT ie shockable rhythms
