Paediatric Resusctation Guide Flashcards
Rather than shockable rhythms, children are more likely to have
pulseless electrical discharge (PEA)
or
asystole
what aetiologies for cardiorespiratory arrest are children more likely to have
more often a respiratory illness or airway obstruction leading to hypoxia and a respiratory arrest
also, hypovolaemia and shock from sepsis, blood loss in trauma, severe gastroenteritis or anaphylaxis
how is the child anatomy different
larger head, short neck, large tongue, larger epiglottis, smaller airways, more compliant chest
DRSABCDE
danger
responsiveness (AVPU)
send for help
airways
breathing
circulation
diability
environmental, exposure, and extended examination
how to open the airway if a neck injury is suspected
use jaw thrust to avoid worsening the injury
how much ventilation should be given before moving on to external cardiac compressions
at least 2
assessing for response
This may include squeezing the shoulders firmly and asking loudly “Are you okay?”
assess for neurological function using AVPU
A = alert GCS 15
V = responds to voice GCS 12
P = responds to pain GCS < 9
U = unresponsive GCS 3
Airways
open the mouth, look for obstruction and remove if possible
use a suction catheter if required
can use forceps to remove foreign bodies under direct vision
do not use the blind finger sweep as this can damage mucosa
open the airway by positioning the patient
- neutral for infants
- sniffing position for children
head tilt and chin lift/jaw thrust
use an airway adjunct :
- oropharyngeal airway (guedel): use in unconscious patients. insert under direct vision
- nasopharyngeal airway: lubricate and insert into the nostril. dont use if there is suspicion of a base skull fracture.
breathing
assess if the patient is breathing
look for chest wall movement
if they are not breathing give two effective rescue breaths
create a seal over the mouth and blow out for 1-2 seconds, watching for the chest wall rising
use a bag valve mask with a reservoir
bag sizes:
neonate - 250ml
small child - 500ml
older children - 1500ml
apply high flow oxygen
circulation
assess for signs of life, and a pulse (either brachial or femoral) for no longer than 10 seconds.
do not assess carotid in infants, too difficult due to short necks.
if there are no signs of life commence external chest compressions - cardiopulmonary resuscitation CPR
ensure the patient is on a hard flat surface
finger/hand position = lower half of sternum
compress 1/3 of the chest wall 15 compressions:2 breaths
attach monitoring and assess rhythm
defibrillation pad position: one over apex in the mid-axillary line, just below the right sternum
in small infants, you can place one on the chest to the left of the sternum and one on the back below the left scapula
follow the APLS algorithm
insert at least one IV cannula (take bloods)
if this is unsuccessful, use intraosseous
give fluid bolus: 20ml/kg of 0.9 saline
APLS algorithm
what are the shockable rhythms
ventricular fibrillation and pulseless ventricular tachycardia
what are the non-shockable rythms
asystole
PEA
asystole
PEA
ventricular fibrillation
pulseless ventricular tachycardia
drugs to give during CPR
reversible causes of cardiac arrest
4 Hs and 4 Ts
hypoxia
hypovolaemia
hyper/hypokalaemia/metabolic disorders
hypothermia/hyperthermia
tension pneumothorax
tamponade
toxins
thrombosis (pulmonary/coronary)
disability
neurological examination:
- assess pupillary size and reaction
- tone and reflexes in the limbs
- focal neurological signs
- signs of raised intracranial pressure
- signs of meningism and evidence of seizures (treat)
environmental, exposure and extended examination
expose the patient to look for rashes, life-threatening injuries
- temperature, normalise hypothermia in drownings
- check BGL and correct
expose patient and fo a full secondary survey exmination - to ellicit underlying cause
what to do for sepsis or meningitis
antibiotics
what to do for anaphylaxis
adrenaline
what to do for seizures
benzodiazepines is first line
post resus care
re-evaluate ABCDE
12 lead ECG
treat precipitating causes
re-evaluate oxygenation and ventilation
temp control (cool)
fluids in children
0.9% saline, 20ml/kg bolus
can be given approx 1-3 times
in trauma consider packed red blood cells (10ml/kg) early rather than repeating saline
dehydration
mild = 5%
moderate = 7.5%
severe = 10%
replacement fluids may be given as oral rehydration solution via a nasogastric tube, or as intravenous fluids
IV fluid in children should be
0.9% saline, 5% dextrose
more dextrose for neonates
replacement fluid =
weight x %dehydration x 10
in mL per 24 hours
add this to their daily maintenance fluid requirement, subtract any bolus fluid given
maintenance fluids (mL per 24 hours)
Always use 0.9% saline + 5% dextrose
(Exception: increased dextrose % in neonates)
< 10kg = 100mL/kg
10-20kg = 1000mL + 50mL/kg (for each kg above 10kg)
>20kg = 1500mL + 20mL/kg (for each kg above 20kg)
