Paeds and Neo Resus

Question 1

NeoResus: optimisations if PPV efforts not effective:

Answer 1

Airway position
—> Neutral, +- towel
—> Sniffing (extend head)
—> Open mouth

Suction
—> Gentle, brady

100% O2

Increase PIP
—> increments of 5-10
—> Look for chest movement
—> Max 50cmH2O

Change to LMA
Or
Intubate

rapidly deescalate FiO2/ PIP once effective

Question 2

NeoResus: PPV settings

Answer 2

Floppy, laboured breathing or apnoea, PR <100.

TERM
Room air
30/ 5
—> increase up to 40 PRN- PR, chest movement

PRETERM (<35/40)
30% FiO2
25/5

ALL:
Rate 40-60
10L at wall
8L at tank

Question 3

NeoResus: key heart rates

Answer 3

<60 = CPR
<100 = continue PPV resus
>100 = normal/ post resus care

Question 4

NeoResus: how long a trial of stimulation should occur before PPV?

Answer 4

Max 1 minute

Question 5

APGARs

Answer 5

1 and 5 minutes

7-9 normal
4-6 moderately abnormal
<4 bad

5 domains, score 0, 1 or 2:
Appearance
Pulse
Grimace
Activity
Resps

Question 6

Estimated weight:

Answer 6

(Age + 4) x2

1-10yo

Question 7

NeoResus: indication and ratio for CPR

Answer 7

HR <60 despite 30 secs optimised PPV

3:1

Question 8

NeoResus: indication and dose for adrenaline

Answer 8

HR remains <60 despite brief period of CPR with optimised ventilation

1 : 10, 000

Term: 0.5ml
10microg /kg IV
Halve this for prem
Half again for extreme prem

Question 9

NeoResus: what gestation goes into a plastic bag?

Answer 9

28/40 or less (or unknown)

Question 10

ETT size estimate for Infant:

Answer 10

Gestation/10

Prem/ (<1200g) = 2.5mm
Newborn (>3kg) = 3.5mm
Size 4 up until 12mo (then age/4+4 applies)

Question 11

ETT insertion depth for neonate:

Answer 11

Weight + 6

At alveolar ridge

Or, triple ETT size.

Question 12

ETT size estimate for child:

Answer 12

<10yo

age/4 + 4 uncuffed
Down 1 size cuffed

Question 13

ETT insertion depth for child:

Answer 13

Age/2 + 12

Or, ETTx 3

For oral tube at teeth

Question 14

3 differences between adult and paeds ALS:

Answer 14

Ratio 15:2

4J/kg shock

Adrenaline 10microg/kg

Everything else is the same.

Question 15

Differences in post-ROSC care for kids:

Answer 15

SBP target >5th centile for age

No TTM
- Children who do not regain consciousness with ROSC, should jus have hyperthermia avoided

Early feed/sugar

Parental support
Social work

Staff support
Hot debrief
Staff counselling

Everything else is the same.

Question 16

Blood Pressure estimate calculation (paeds):

Answer 16

2 x age

+90 = Median (50th centile) systolic
+70 = Lower limit (5th centile) systolic