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AHA Guidelines 2010 > Part 14: Pediatric Advanced Life Support > Flashcards

Part 14: Pediatric Advanced Life Support Flashcards

0
Q

What is the most common type of shock in children?

A

Hypovolemic

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1
Q

When should cricoid pressure be discontinued during ETT in children?

A

If it interferes with ventilation or the speed or ease of intubation

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2
Q

What systolic blood pressure defines hypotension in term neonates?

A

< 60 mm Hg in term neonates (0 to 28 days)

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3
Q

Is it reasonable to ventilate with 100% oxygen during CPR in children?

A

Yes, there is insufficient information on the optimal inspired oxygen concentration.

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3
Q

What is the likelihood of successful ETT placement with minimal complications related to?

A

Length of training Supervised experience in the field Adequate ongoing experience, and Use of rapid sequence intubation

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4
Q

Is there a difference in the incidence of complications between various age groups in children?

A

Yes, LMA insertion is associated with a higher incidence of complications in young children compared with older children and adults.

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5
Q

What size of cuffed ETT is reasonable to select for emergency intubation of an infant less than 1 year of age?

A

3.0mmID

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6
Q

What factors can influence capillary refill time in child?

A

Ambient temperature

Site

age

lighting

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7
Q

Is it reasonable to ventilate and oxygenate infants and children with BVMR (under what settings)?

A

In the prehospital setting, especially if transport time is short

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8
Q

How can one estimate the size of cuffed ETT after age of 12?

A

Cuffed ETT = 3.5 + (age/4)

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9
Q

When BVMR ventilations is unsuccessful and when ETT is not possible, is LMA acceptable?

A

Yes, when used by experienced providers

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9
Q

What size of uncuffed ETT is it reasonable to select for patients between 1 and 2 years of age?

A

4.0mmID

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9
Q

How can the size of uncuffed ETT be estimated for age > 2?

A

Uncuffed ETT: 4 + (age/4)

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9
Q

What type of shocks occur less frequently in children?

A

Distributive,

cardiogenic

obstructive

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10
Q

Should a routine cricoid pressure be applied to prevent aspiration during ETT in children?

A

There is insufficient evidence to recommend its routine use

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11
Q

What methods for confirming correct position of ETT placement is recommended by AHA 2010 for children?

A

Look for bilateral chest movement Listen for equal breath sounds over both lung fields, especially over axillae Listen for gastric insulation sounds over the stomach Check for exhaled CO2 Check for oxyhemoglobin saturation (if perfusing rhythm present) If still uncertain, perform direct laryngoscopy and visualise the ETT to confirm that it lies between the vocal cords In hospital settings, perform a chest x-ray

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12
Q

What type of ETT is acceptable in children? (cuffed/uncuffed)

A

Both are acceptable for intubating infants and children

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13
Q

What should the cuff inflating pressure be usually limited to?

A

less than 20 to 25 cmH2O

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14
Q

What force and TV should be delivered in children during BVMR ventilation?

A

Use only the force and TV needed to just make the chest rise visibly

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14
Q

What should one remember about pulse oximetry following hyperoxygenation in paeds?

A

The oxyhemoglobin saturation detected by pulse oximetry may not decline for as long as 3 minutes even without effective ventilation

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15
Q

What systolic BP defines hypotension in children >= 10 yrs of age?

A

< 90 mmHg

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16
Q

What possibilities should you consider, should an intubated patient’s condition deteriorate?

A

Displacement of the tube Obstruction of the tube Pneumothorax Equipment failure

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17
Q

What size uncuffed ETT is reasonable to select for infants up to one year of age?

A

3.5mmID

18
Q

What systolic BP defines hypotension in infants?

A

< 70 mmHG (1 month to 12 months)

19
Q

Can BVMR ventilation be as effective, and safer than ETT ventilation for short periods during out-of-hospital resuscitation?

A

Yes

20
Q

What tube should you place instead, if you meet resistance during intubation in paeds?

A

Place a tube 0.5mm smaller instead

23
Q

Name 4 signs of paediatric respiratory distress

A

Increased respiratory effort

including nasal flarring

retractions

seesaw breathing, or

grunting

25
Q

In the victim with a perfusing rhythm but absent or inadequate respiratory effort, give 1 breath every _ to _ seconds, using higher rate for the younger child. (fill in the blanks)

A

3 to 5 seconds (12 to 20 breaths per minute)

27
Q

What are the possible complication of excessive ventilation during cardiac arrest in children?

A

Increased intrathoracic pressure impediment of venous return, therefore cardiac output cerebral and coronary blood flow Reducing likelihood of ROSC Air trapping and barotrauma Risk of stomach inflation, regurgitation and aspiration

28
Q

If the infant or child is intubated, ventilate at a rate of about 1 breath every _ to _ seconds without interrupting chest compressions. (fill in the blanks)

A

6 to 8 seconds (8 to 10 times per minute)

29
Q

How can one decrease the risk of gastric inflation when ventilating children?

A

Avoid excessive peak inspiratory pressures Applying cricoid pressure in an unresponsive victim (may require third rescuer) Passing a nasogastric or orogastric tube to relieve gastric inflation

30
Q

What mnemonic can be used to delivery optimal ventilation in a child with perfusion rhythm but absent or poor respiratory effort?

A

“squeeze-release-release” at a normal speaking rate

31
Q

What is the advantage of using cuffed ETT in children?

A

Cuffed ETT may decrease risk of aspiration

32
Q

Is capillary refill time alone a good indicator of circulatory volume?

A

No, but it is a useful indicator of moderate dehydration when combined with other indicators such as

decreased urine output

absent tears

dry mucous membranes

generally ill appearance

33
Q

What size cuffed ETT is reasonable to select for children between 1 and 2 years of age

A

3.5mm

34
Q

How should FiO2 be adjusted after ROSC in children, provided that appropriate equipment is available?

A

Minimum concentration needed to achieve arterial oxyhaemoglobin saturation at least 94%

36
Q

Under what circumstance might a cuffed tube be preferable to an uncuffed tube in children?

A

Poor lung compliance High airway resistance Large glottic air leak

37
Q

Up to what weight are length-based resuscitation tapes helpful and more accurate than age-based formula estimates of ETT size for children?

A

Up to approximately 35kg even for children with short stature

38
Q

What systolic blood pressure defines hypotension in children (1 to 10 years)

A

< 70 mmHg + (2 x age in years)

39
Q

Name 5 typical signs of compensated shock

A

Tachycardia

Cool and pale distal extemities

Prolonged (>2 seconds) capillary refill (despite warm ambient temperature)

Weak peripheral pulses compared with entral pulses

Normal systolic blood pressure

40
Q

What additional signs indicate inadequate end-organ perfusion in children? (name 6)

A

Depressed mental status

Decreased urine output

Metabolic acidosis

Tachypnea

Weak central pulses

Deterioration in colour (eg, mottling)

42
Q

What should you consider if there is a large glottic air leak

that interferes with oxygenation and ventilation following

intubation?

A

Consider replacing the tube with one that is 0.5mm larger,

or place a cuffed tube of the same size if an uncuffed tube

was used originally.

43
Q

Does color change or the presence of a capnography

waveform rule out right mainstem bronchus intubation?

A

No

44
Q

Why should tube position be confirmed by direct

laryngoscopy during cardiac arrest, if exhaled CO2 is not

detected?

A

Because the absence of CO2 may reflect very low

pulmonary blood flow rather than tube misplacement

45
Q

What may alter confirmation of endotracheal tube

positioning by colorimetric end-tidal CO2 detector?

A
  • Detector contaminated with gastric contents or acidic drugs (eg. endotracheally administered adrenaline)
  • An IV boluse of adrenaline may transiently reduce pulmonary blood flow and exhaled CO2 below the limits of detection
  • Severe airway obstruction (eg. status asthmaticus) and pulmonary oedema may impair CO2 elimination below the limits of detection
  • A large glottic air leak may reduce exhaled tidal volume through the tube and dilute CO2 concentration
46
Q

What device may be used if capnography is not available

to confirm ETT placement in children weighing > 20kg?

A

EDD

47
Q

What is the maximum recommended suction force in

children for suctioning the airway via an endotracheal

tube?

A

-80 to -120mmHg

48
Q

What should the paramedic’s effort focus own during

resusctiation in children if the PETCO2 is consistently

< 10 to 15 mmHg?

A

Improving chest compressions and

making sure that the victim does not receive

excessive ventilation

49
Q

Which drugs can be administered via an endotracheal

tube?

A

LEAN

lidocaine

epinephrine

atropine

naloxone

50
Q

How should a drug be administred via ETT during CPR?

A
  • Stop chest compressions briefly
  • Administer medications
  • follow with a flush of at least 5 mL of normal salie and
  • 5 consecutive positive pressure ventilations
51
Q

Are tapes with precalculated doses printed at various

patient lengths more accurate than age-based methods?

A

Yes

52
Q

What is the recommended prinicple for maximum dose

administration in children?

A

In general, the dose administered to a child should not

exceed the standard dose recommended for adult patients

53
Q

What are the signs of toxicity due to Lidocaine?

A
  • Myocardial and circulatory depression
  • Drowsiness
  • Disorientation
  • Muscle twitching
  • Seizures
54
Q

What is the recommended bolus for signs of shock in a

child even if blood pressure remains normal?

A

20ml/kg

55
Q

What signs in paediatrics are indicative of respiratory failure?

A

An increased respiratory rate An inadequate respiratory rate, effort, or chest excursion, especially if mental status is depressed Cyanosis with abnormal breathing despite supplementary oxygen

AHA Guidelines 2010 (5 decks)

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