Paediatric Life Support Flashcards
CEWT
- Identify and use the appropriate CEWT for age
- Less than 1 year
- 1 to 4 years
- 5 to 11 years
- 12 years and above - Complete a baseline CEWT score, then appropriate observations for the patient.
- Recognise a deviation in vital signs as indicated by a colour change in the graph.
- Initiate appropriante action
- complete full CEWT score
- Undertake appropriate action as directed on the CEWT
- Ensure appropriate documentation in progress
CEWT score 1-3
Increase frequency of observations
Review oxygen delivery/requirements
Manage pain/fever/anxiety
Consider informing shift coordinator
CEWT score 4-5
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
CEWT score 6-7
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
CEWT score 8+
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
Call CODE BLUE if
Airway threat Apnoea Bleeding (major) Any observations in the purple area You are worried about the patient
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
Use the appropriate tool for the childs age
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?
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
ISOBAR stickers are placed in the patients medical records:
a) true
b) false
True
Basic life support
Danger Responce Send for help Airway Breathing CPR Defibrillation
Continue CPR until responsiveness or normal breathing returns
Cardio-Respiratory arrests are secondary to:
hypoxia caused by bronchiolitis, asthma, croup, inhalation of a foreign body, neurological dysfunction, fluid loss, maldistribution.
Head tilt/chin lift
Neutral for infants
Sniffing for a small child
Backward heard tilt with pistol grip for an older child
Jaw thrust can be used when…
Spinal injury is suspected
The choking algorithm
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
Assess breathing
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
If breathing is absent or inadequate
Give up to two rescue breaths allowing about 1-1.5 seconds per inspiration
Signs of life:
Movement
Coughing
Normal breathing
Commence external cardiac compressions if:
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
Ineffective CPR can be a result of:
Chest compressions being too gentle
Chest compressions being too slow
Incorrect hand position
Too many interruptions
Effective CPR:
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
Chest compressions for an infant
Locate the lower half of the sternum
Using two fingers or thumbs compress 1/3 of the depth of the chest
Chest compressions for a child
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
Chest compressions for an adult
Locate the lower half of the sternum
Use two hands
Compress 1/3 of the depth of the chest
Compression to ventilation ratio in an infant and child
15 compressions : 2 breaths
100 compressions/minute
5 cycles in 1 minute
Compression to ventilation ratio in adults
30 compressions : 2 breaths
100 compressions/minute
5 cycles in 2 minutes
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
The heel of one hand
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
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
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
15 compressions : 2 breaths
The primary cause for arrest in children is respiratory or less commonly circulatory failure
a) true
b) false
True
The primary cause for arrest in children is respiratory or less commonly circulatory failure
a) true
b) false
True
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
Back blows followed by chest thrusts
AED steps
- Turn on, follow voice prompts
- Apply pads
- Press shock
To estimate the appropriate sized uncuffed endotracheal tube internal diameter measurement, the formula is
Age/4 + 4
Only used for children over the age of 1
To estimate the appropriate sized cuffed endotracheal tube internal diameter measurement, the formula is
Age/4 + 3.5
Equipment for intubation
Endotracheal tube Laryngoscope ETT introducer Yankauer sucker Magills forceps Nasogastric tube Syringe pH paper Suture string Tape Lubricant Mastic
Why do we insert a nasogastric tube after intubation?
To decompress stomach and/or remove gastric contents to prevent aspiration
Assisted ventilation
Bag and mask
Oropharyngeal airways
Intubation
Different sizes of self inflating bags
Pre-term infant <2.5kgs : 240ml bag
Child 2.5 - 25kg : 500ml bag
Adult >25kg : 1600ml bag
Use of oropharyngeal airways
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
Potential problems with oropharyngeal airways
Trauma Obstruction Illicit a gag reflex causing aspiration Laryngospasm Vagal response
Cricoid pressure
Closes the oesophagus and straightens trachea
To apply cricoid pressure
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
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
Inserted concave side over the tongue under direct supervision
Measured from the centre of the incisors to the angle of the jaw
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
Patient actively vomits
Instructed by the doctor intubating
Which part of the self inflating bag which is usually used on preterm and paediatric self inflating bags and helps prevent barotrauma
The pressure release valve
Intraosseous access
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
Fluids
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
Resuscitation drugs
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
- 9% saline flush
- Draw up 10mls
- Label the syringe
IV fluids
- 20mls/kg
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
All medications can be delivered through an IO
IO access is considered if no venous access is achieved within 60 seconds
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
Adrenaline and normal saline
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
0.1mls/kg of adrenaline 1 : 10 000
Defibrillation reversible causes
Hypoxia Hypovolaemia Hypo/hyperkalaemia Hypo/hyperthermia Tension pneumothorax Tamponade Toxins/poisons/drugs Thromboembolism
Defibrillation safety precautions
Correct pad/paddle placement Ensure good contact Dry skin Dry floor Shout 'All clear'
Pad placement
One under the right clavicle next to the sternum
second over the apex in the mid axillary line
Code blue first responder
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
Code blue second responder
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
Code blue third responder
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
Code blue team work and communication
Call for help early Identity a team leader Uses names Use concise clear communication Allocate and accept roles Anticipate and plan Maintain situational awareness
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
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
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
Dial 55; state ‘code blue emergency in ward or department’, identify the exact sire and state your name
