Paediatric Life Support

Question 1

Cardioversion of a SVT - initial dose?

Answer 1

1 j/kg

Question 2

Temperature post ROSC

Answer 2

Normothermia or mild hypothermia

Question 3

Head position of infant?

Answer 3

Neutral

Question 4

What choking technique should not be used in infants?

Answer 4

Abdominal thrusts - due to horizontal position of ribs.

Question 5

Severe febrile illness without circulatory failure - fluid bolus?

Answer 5

No

Question 6

What kind of fluid in paeds for any kind of shock?

Answer 6

Isotonic crystalloids

Question 7

Contraindications to NP?

Answer 7

basal skull fracture

coagulopathy

Question 8

Sizing of NP

Answer 8

Nostrils to angle of mandible

Question 9

When SMA useful?

Answer 9

If supraglottic abnormalities causing A problem or BVM (1st line) difficult

Question 10

What circumstances are cuffed tubes indicated in kids?

Answer 10

Facial burns, poor lung compliance, high airway resistance or large glottis air leak.

Question 11

Traditionally what kind of tube up to 8 years old?

Answer 11

Uncuffed

Question 12

Uncuffed tube size?

1. Premature neonates
2. Full term neonates
3. Infants
4. Child 1-2years
5. Child >2 years

Answer 12

1. Gestational age in weeks/10
2. 3.5
3. 3.5-4.0
4. 4.0 - 4.5
5. Age/4 +4

Question 13

Cuffed tube size?

1. Premature neonates
2. Full term neonates
3. Infants
4. Child 1-2years
5. Child >2 years

Answer 13

1. Not used
2. Not usually used
3. 3.0-3.5
4. 3.5-4.0
5. Age/4 + 3.5

Question 14

Cuff inflation pressure?

Answer 14

Less than 25cm H2O

Question 15

Sudden deterioration in an intubated child?

Answer 15

DOPES -
Displacement of tracheal tube
Obstruction of tracheal tube etc
Pneumothorax
Pulmonary disorders - bronchospasm, oedema, hypertension etc
Equipment failure

Question 16

When use air for resus not 100% oxygen?

Answer 16

Neonates

Question 17

Ventilation rate post ROSC?

Answer 17

12-24 breaths/minute usually

NB chronic conditions etc

Question 18

Adrenaline dose paeds in CPR

Answer 18

10mcg/kg

Question 19

Amiodarone dose paeds in VF/VT

Answer 19

5mg/kg bolus

Question 20

Alternative to amiodarone?

Answer 20

Lidocaine (1mg/kg)

Question 21

AED Pad size for <10kg and >10kg?

Answer 21

1. 4.5cm diameter

2. 8-12 cm

Question 22

Primary determinant of survival from VF/pVT?

Answer 22

Time to defib

Question 23

Common causes of bradycardia in paeds

Answer 23

Hypoxia
Acidosis
Severe hypotension

Question 24

Treatment of SVT paeds?

Answer 24

Adenosine (rapid, near heart, flush with saline) and vagal manoeuvres if stable
If unstable - Dc cardioversion 1J/kg, then 2J/kg - synchronise shock with R wave.
3rd line: amiodarone (NB: for junctional ectopics in postop kids -can worsen in other situations) or procainamide or verapamil (not in infants)

Question 25

S/e of amiodarone?

Answer 25

Hypotension

Question 26

Wide complex tachycardia in kids?

Answer 26

Rare.
Supraventricular = more common than ventricular.
Usually underlying heart disease.
Treat: synchronised cardioversion

Question 27

How to treat pulmonary hypertension if it is cause of arrest?

Answer 27

Emphasis on high Fi O2, alkalosis/hyperventilation (maybe as effective as inhaled nitric oxide in reducing pulmonary vascular resistance).
IV epoprostenol or inhaled nitric oxide.