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NUR259 - SDLP's > Paediatric Life Support > Flashcards

Paediatric Life Support Flashcards

1
Q

CEWT

A
  1. Identify and use the appropriate CEWT for age
    - Less than 1 year
    - 1 to 4 years
    - 5 to 11 years
    - 12 years and above
  2. Complete a baseline CEWT score, then appropriate observations for the patient.
  3. Recognise a deviation in vital signs as indicated by a colour change in the graph.
  4. Initiate appropriante action
    - complete full CEWT score
    - Undertake appropriate action as directed on the CEWT
    - Ensure appropriate documentation in progress
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2
Q

CEWT score 1-3

A

Increase frequency of observations
Review oxygen delivery/requirements
Manage pain/fever/anxiety
Consider informing shift coordinator

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3
Q

CEWT score 4-5

A

Ward doctor/team RMO to review within 30 minutes
Notify shift coordinator
Obtain a full CEWT score post interventions
If no review in 30 minutes, escalate to registrar review

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4
Q

CEWT score 6-7

A

Registrar to review patient within 15 minutes
If no review within 15 minutes, or clinically concerned, place a MET call
Notify shift coordinator
Obtain a full CEWT score post interventions
Registrar to ensure consultant is notified
Ward doctor/team RMO to attend

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5
Q

CEWT score 8+

A

Place MET call - response within 5 minutes
If no response within 5 minutes place an emergency call Code Blue
Registrar to attend and ensure consultant is notified

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6
Q

Call CODE BLUE if

A 
Airway threat
Apnoea 
Bleeding (major)
Any observations in the purple area
You are worried about the patient
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7
Q

When using an observation and response chart such as a CEWT, it is most important to:

a) take appropriate action (as per CEWT)
b) choose a tool that takes the east amount of time to complete
c) use the appropriate tool for the childs age
d) make sure all observations are in the same coloured band

A

Use the appropriate tool for the childs age

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8
Q

A four year old girl with pneumonia on the ward suddenly becomes tachypnoeic, tachycardic, and requiring increased oxygen. Her full CEWT score is 8. What actions are indicated?

A

Place MET call - response within 5 minutes
If no response within 5 minutes place an emergency call Code Blue
Registrar to attend and ensure consultant is notified

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9
Q

ISOBAR stickers are placed in the patients medical records:

a) true
b) false

A

True

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10
Q

Basic life support

A 
Danger 
Responce
Send for help
Airway
Breathing
CPR
Defibrillation

Continue CPR until responsiveness or normal breathing returns

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11
Q

Cardio-Respiratory arrests are secondary to:

A

hypoxia caused by bronchiolitis, asthma, croup, inhalation of a foreign body, neurological dysfunction, fluid loss, maldistribution.

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12
Q

Head tilt/chin lift

A

Neutral for infants
Sniffing for a small child
Backward heard tilt with pistol grip for an older child

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13
Q

Jaw thrust can be used when…

A

Spinal injury is suspected

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14
Q

The choking algorithm

A

Assess severity

Effective cough - mild airway obstruction
- Encourage coughing, continue to check victim until recovery or deterioration, call for help

Ineffective cough - severe airway obstruction

  • Unconscious: call for help, commence CPR
  • Conscious: call for help, give up to 5 back blows. if not effective give up to 5 chest thrusts
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15
Q

Assess breathing

A

For up to 10 seconds
Look: movement of the upper abdomen and lower chest
Listen: escape of air from the nose and mouth
Feel: movement of chest and upper abdomen

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16
Q

If breathing is absent or inadequate

A

Give up to two rescue breaths allowing about 1-1.5 seconds per inspiration

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17
Q

Signs of life:

A

Movement
Coughing
Normal breathing

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18
Q

Commence external cardiac compressions if:

A

There are no signs of life
There is no pulse (check for no longer than 10 seconds)
- Brachial pulse check in infants
- carotid pulse check in small or older children
There is a slow pulse with poor perfusion

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19
Q

Ineffective CPR can be a result of:

A

Chest compressions being too gentle
Chest compressions being too slow
Incorrect hand position
Too many interruptions

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20
Q

Effective CPR:

A

Person should be on a hard surface
Use a rhythmic action equal time for compression and relaxation
Aim for a compression rate of 100 compressions per minute

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21
Q

Chest compressions for an infant

A

Locate the lower half of the sternum

Using two fingers or thumbs compress 1/3 of the depth of the chest

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22
Q

Chest compressions for a child

A

Locate the lower half of the sternum
Use one or two hands, depending on the size of the child
Compress 1/3 of the depth of the chest

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23
Q

Chest compressions for an adult

A

Locate the lower half of the sternum
Use two hands
Compress 1/3 of the depth of the chest

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24
Q

Compression to ventilation ratio in an infant and child

A

15 compressions : 2 breaths
100 compressions/minute
5 cycles in 1 minute

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25
Q

Compression to ventilation ratio in adults

A

30 compressions : 2 breaths
100 compressions/minute
5 cycles in 2 minutes

26
Q

The ARC recommend when compressing the chest of a small child during CPR use:

a) the heel of one hand
b) two hands
c) the tips of the middle and index finger of one hand
d) thumbs of both hands

A

The heel of one hand

27
Q

The ARC recommend when compressing the chest of an infant during CPR:

a) use the thumbs of both hands
b) use middle and index finger of one hand
c) compress a depth of one third of the depth of the chest
d) use the heel of one hand

A

Use the thumbs of both hands
Use middle and index finger of one hand
Compress a depth of one third of the depth of the chest

28
Q

The ratio for 2 operator in hospital CPR for an infant and small child is:

a) 5 compressions : 1 breath
b) 30 compressions : 2 breaths
c) 15 compressions : 2 breaths
d) 8 compressions : 1 breath

A

15 compressions : 2 breaths

29
Q

The primary cause for arrest in children is respiratory or less commonly circulatory failure

a) true
b) false

A

True

30
Q

The primary cause for arrest in children is respiratory or less commonly circulatory failure

a) true
b) false

A

True

31
Q

Which of the following manoeuvres are recommended by the ARC to dislodge a foreign body in a patient who is conscious with an ineffective cough:

a) abdominal thrusts and Heimlich manoeuvres
b) back blows follows by abdominal thrusts
c) chest thrusts followed by the Heimlich manoeuvres
d) back blows followed by chest thrusts

A

Back blows followed by chest thrusts

32
Q

AED steps

A
  1. Turn on, follow voice prompts
  2. Apply pads
  3. Press shock
33
Q

To estimate the appropriate sized uncuffed endotracheal tube internal diameter measurement, the formula is

A

Age/4 + 4

Only used for children over the age of 1

34
Q

To estimate the appropriate sized cuffed endotracheal tube internal diameter measurement, the formula is

A

Age/4 + 3.5

35
Q

Equipment for intubation

A 
Endotracheal tube
Laryngoscope 
ETT introducer
Yankauer sucker 
Magills forceps
Nasogastric tube
Syringe 
pH paper
Suture string
Tape 
Lubricant 
Mastic
36
Q

Why do we insert a nasogastric tube after intubation?

A

To decompress stomach and/or remove gastric contents to prevent aspiration

37
Q

Assisted ventilation

A

Bag and mask
Oropharyngeal airways
Intubation

38
Q

Different sizes of self inflating bags

A

Pre-term infant <2.5kgs : 240ml bag
Child 2.5 - 25kg : 500ml bag
Adult >25kg : 1600ml bag

39
Q

Use of oropharyngeal airways

A

Size is imperative: measure from centre of teeth/mouth to angle of the jaw laid across the face
In the infant and small child insert the concave side over the tongue under direct supervision. This avoids damage to the palate

40
Q

Potential problems with oropharyngeal airways

A 
Trauma
Obstruction
Illicit a gag reflex causing aspiration 
Laryngospasm 
Vagal response
41
Q

Cricoid pressure

A

Closes the oesophagus and straightens trachea

42
Q

To apply cricoid pressure

A

Place two fingers on the level of the cricoid cartilage and apply gentle pressure
Don’t release pressure unless instructed by the doctor o the patient vomits

43
Q

The recommended method to measure and insert and oropharyngeal airway in an infant and small child is:

a) measure from the corner of the mouth to the angle of the jaw
b) inserted concave side over the tongue under direct supervision
c) measured from the centre of the incisors to the angle of the jaw
d) inserted upside down and turned around in the mouth

A

Inserted concave side over the tongue under direct supervision
Measured from the centre of the incisors to the angle of the jaw

44
Q

During intubation there are only two circumstances where cricoid pressure should be released.

a) when the patient has been fasting
b) patient actively vomits
c) instructed by the doctor intubating
d) when the doctor is inserting the ETT into the trachea

A

Patient actively vomits

Instructed by the doctor intubating

45
Q

Which part of the self inflating bag which is usually used on preterm and paediatric self inflating bags and helps prevent barotrauma

A

The pressure release valve

46
Q

Intraosseous access

A

Infusion site:
- upper tibial site: anterior surface, 2-3cm below tibial tuberosity

Blood marrow aspirate can be used to check BGL and provide cultures
Flush to confirm correct positioning
Fluids need to be administered under pressure

Contraindications:

  • Local trauma
  • Infection
  • Bone disorders
47
Q

Fluids

A

When?
- Should be given when perfusion is compromised

How much?

  • Guided by clinical response
  • 20ml/kg is the amount of one fluid bolus

Which?

  • Crystalloid or colloid
  • Normal saline in most cases first choice
  • Consider blood of more than half the circulation volume has been replaced
48
Q

Resuscitation drugs

A

Adrenaline 1 : 10 000

  • Improves return to spontaneous circulation, improves relative coronary and cerebral perfusion
  • Draw up 10mls
  • Label the syringe
  • Dose: 0.1ml/kg
  1. 9% saline flush
    - Draw up 10mls
    - Label the syringe

IV fluids
- 20mls/kg

49
Q

You are involved in the resuscitation of a 3 year old boy. The doctor cannot obtain IV access and proceeds to inserting an intraosseous needle. Please select the correct statements:

a) IV fluids will run by gravity alone
b) All medications can be delivered through an IO
c) IO access is considered if no venous access is achieved within 60 seconds

A

All medications can be delivered through an IO

IO access is considered if no venous access is achieved within 60 seconds

50
Q

The drugs included in the PMH ward resuscitation trolley are:

a) Adrenaline and sodium bicarbonate
b) Adrenaline, sodium bicarbonate, calcium gluconate and normal saline
c) Adrenaline and normal saline
d) Adrenaline, sodium bicarbonate, calcium gluconate and normal saline, amiodarone

A

Adrenaline and normal saline

51
Q

What is the paediatric dose for adrenaline:

a) 0.1mls/kg of adrenaline 1 : 1000
b) 0.1mls/kg of adrenaline 1 : 10 000
c) 0.1mls of adrenaline 1 : 10 000
d) 10mls/kg of adrenaline 1 : 10 000

A

0.1mls/kg of adrenaline 1 : 10 000

52
Q

Defibrillation reversible causes

A 
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypo/hyperthermia
Tension pneumothorax 
Tamponade
Toxins/poisons/drugs
Thromboembolism
53
Q

Defibrillation safety precautions

A 
Correct pad/paddle placement
Ensure good contact 
Dry skin 
Dry floor
Shout 'All clear'
54
Q

Pad placement

A

One under the right clavicle next to the sternum

second over the apex in the mid axillary line

55
Q

Code blue first responder

A 
Call for help and note time
Check for danger
Establish unresponsiveness
Commence basic life support
Once second person available continue airway management, bag and mask ventilation 100% oxygen
56
Q

Code blue second responder

A

Dial 55, state type and location of emergency
Return to patient with ward resus trolley
Connect oxygen and give laederal bag and mask to person 1
Remove head of bed and position for access
Place cardiac board under patient
Take over ECC

57
Q

Code blue third responder

A

Delegate someone to direct code blue team
Commence drawing up rests drugs and IV fluids
Commence resus record documentation, once team has arrived continue has delegated scribe
Delegate someone to look after the childs parents, ensure privacy and clear room
Delegate someone to collect patients notes

58
Q

Code blue team work and communication

A 
Call for help early
Identity a team leader
Uses names
Use concise clear communication 
Allocate and accept roles
Anticipate and plan
Maintain situational awareness
59
Q

Select the correct statements:

a) to call a MET, call switch and ask for a MET call
b) to call a MET, DURApage the PICU coordinator on 8165
c) the MET provides a medical and nursing review of any child if ward stuff are concerned that failure to review may lead to an emergency situation
d) a code blue call should be used instead of a MET review for a collapsed adult at PMH
e) the MET will bring resuscitation equipment when a MET call is made

A

To call a MET, DURApage the PICU coordinator on 8165
The MET provides a medical and nursing review of any child if ward stuff are concerned that failure to review may lead to an emergency situation
A code blue call should be used instead of a MET review for a collapsed adult at PMH

60
Q

When calling a code blue at PMH:

a) dial 55; state ‘code 55 emergency in ward or department’, identify the exact site and state your name
b) just press the red bell in the patients room and this will automatically alert all to a code blue
c) dial 55; state ‘code blue emergency in ward or department’, identify the exact sire and state your name
d) dial 9; state ‘code blue emergency in ward or department’, identify the exact sire and state your name

A

Dial 55; state ‘code blue emergency in ward or department’, identify the exact sire and state your name

NUR259 - SDLP's (6 decks)

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