Paediatric Resusctation Guide

Question 1

Rather than shockable rhythms, children are more likely to have

Answer 1

pulseless electrical discharge (PEA)
or
asystole

Question 2

what aetiologies for cardiorespiratory arrest are children more likely to have

Answer 2

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

Question 3

how is the child anatomy different

Answer 3

larger head, short neck, large tongue, larger epiglottis, smaller airways, more compliant chest

Question 4

DRSABCDE

Answer 4

danger
responsiveness (AVPU)
send for help
airways
breathing
circulation
diability
environmental, exposure, and extended examination

Question 5

how to open the airway if a neck injury is suspected

Answer 5

use jaw thrust to avoid worsening the injury

Question 6

how much ventilation should be given before moving on to external cardiac compressions

Answer 6

at least 2

Question 7

assessing for response

Answer 7

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

Question 8

Airways

Answer 8

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.

Question 9

breathing

Answer 9

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

Question 10

circulation

Answer 10

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

Question 11

APLS algorithm

Answer 11

Question 12

what are the shockable rhythms

Answer 12

ventricular fibrillation and pulseless ventricular tachycardia

Question 13

what are the non-shockable rythms

Answer 13

asystole
PEA

Question 14

asystole

Answer 14

Question 15

PEA

Answer 15

Question 16

ventricular fibrillation

Answer 16

Question 17

pulseless ventricular tachycardia

Answer 17

Question 18

drugs to give during CPR

Answer 18

Question 19

reversible causes of cardiac arrest

Answer 19

4 Hs and 4 Ts

hypoxia
hypovolaemia
hyper/hypokalaemia/metabolic disorders
hypothermia/hyperthermia
tension pneumothorax
tamponade
toxins
thrombosis (pulmonary/coronary)

Question 20

disability

Answer 20

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)

Question 21

environmental, exposure and extended examination

Answer 21

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

Question 22

what to do for sepsis or meningitis

Answer 22

antibiotics

Question 23

what to do for anaphylaxis

Answer 23

adrenaline

Question 24

what to do for seizures

Answer 24

benzodiazepines is first line

Question 25

post resus care

Answer 25

re-evaluate ABCDE
12 lead ECG
treat precipitating causes
re-evaluate oxygenation and ventilation
temp control (cool)

Question 26

fluids in children

Answer 26

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

Question 27

dehydration

Answer 27

mild = 5%
moderate = 7.5%
severe = 10%
replacement fluids may be given as oral rehydration solution via a nasogastric tube, or as intravenous fluids

Question 28

IV fluid in children should be

Answer 28

0.9% saline, 5% dextrose
more dextrose for neonates

Question 29

replacement fluid =

Answer 29

weight x %dehydration x 10
in mL per 24 hours
add this to their daily maintenance fluid requirement, subtract any bolus fluid given

Question 30

maintenance fluids (mL per 24 hours)

Answer 30

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)