Paediatric Life Support

Question 1

Describe the PLS algorithm

Answer 1

Open airway: head tilt, chin lift. Jaw thrust.

Check breathing for 10s
Look: chest movement
Listen: breath sounds
Feel: air movement

Give 5 rescue breaths - mouth over infant’s nose and mouth - child pinch nose, mouth to mouth

Assess for sign’s of life - movement, coughing

Check pulse for 10s
>1y - carotid, femotal
<1y - brachial, femoral

— no signs of life unless definite pulse for >60/min

Chest compressions:
15 chest compressions : 2 breaths

Rate 100-120 compressions/min

Infant: 2 thumbs on lower half of sternum with hand round the thorax/compresss serum with tips or two fingers
Small child: heel of one hand over lower sternum
Large child: both hands over lower half of sternum

Attach defibrillator/monitor

Assess rhythm

Question 2

What are shockable rhythms?

Answer 2

Ventricular fibrillation

Pulseless ventricular tachycardia

Question 3

What are non-shockable rhythms?

Answer 3

Pulseless electrical activty

Asystole

Question 4

What should you do if there is a shockable rhythm?

Answer 4

1 shock 4J/kg
Immediately resume CPR for 2 min
Assess rhythm again…

After 3rd shock, Give adrenaline IV/IO - 10 micrograms/kg + Amiodarone 5mg/kg IV over 3 mins, once compressions resumed

Repeat adrenaline on alternate cycles until spontaneous circulation returns

Amiodarone is given after 3rd shock and one further time after 5th shock if still in VF/PVT

Question 5

What should you do if there is a non-shockable rhythm?

Answer 5

Immediately resume CPR for 2 minutes

Give adrenaline immediately then every 3-5 mins (on alternate cycles) - 10 micrograms/kg

Question 6

What are reversible causes or collapse

Answer 6

Hypoxia
Hypovolaemia
Hypokalaemia/hyperkalaemia/metabolic
Hypothermia
Tension pneumothorax
Thrombosis (coronary/pulmonary)
Tamponade
Toxic/therapeutic disturbances

Question 7

A to E assessment in children?

Answer 7

Airway and cervical spine:
Presume cervical spine injury:
Jaw thrust
Avoid neck extension\Head block and strapping

Question 8

B

Answer 8

Breathing
Look, listen, feel and percuss

15L/min High flow oxygen via non-rebreathe
Bag mask then mechanical ventilation if needed
Is asymmetry consider pneumothroax/haemothorax and if present, drain

Question 9

C

Answer 9

Bleeding from superficial wound? -
Apply pressure to stop

Shocked?
Insert 2 large bore venous cannulae
Take blood for FBC, G&S, XM
Crystalloid 20ml/kg and reassess
Seek surgical opinion

Question 10

D

Answer 10

GCS:
Secure airway
Respiratory support of GCS < 8 or P on AVPU

Pupil size and reactivity
If unequal or concerns regarding head injury, neuroprotect, arrange CT head

Question 11

E

Answer 11

Examine all parts of body
Analgesia
Gastric tube (not nasal in head injury)