Pediatric crisis scenarios

Question 1

Describe treatment for hyperkalemia.

Answer 1

hyperventilate with 100% fiO2
stop LR
initiate CPR if unstable
calcium gluc 60 mg/kg
dextrose 0.25-1 g/kg + insulin IV 0.1 unit/kg
albuterol
bicarb 1-2 mEq/kg
lasix 0.5- 1 mg/kg

Question 2

Describe treatment for laryngospasm.

Answer 2

100% O2 
call for help
hold PPV
Jaw thrust/Larson's
propofol 1-3 mg/kg
succinylcholine 0.1-2 mg/kg IV or 2-4 mg/kg IM
atropine 0.02 mg/kg
secure airway
anticipate complications (NPPE)- lasix, bipap
suction
IV lidocaine

Question 3

Describe treatment for trouble ventilating with falling HR.

Answer 3

Call for help
check for pulse
start chest compressions
100% fiO2
check tube placement (vagal stimulation? i.e. tube hitting carina) 
give epi: 1 mcg/kg
move to OR
atropine 0.02 mcg/kg
suction

Question 4

Describe treatment for LAST.

Answer 4

start chest compressions when HR <60
100% fiO2
turn off anesthetic
call for help
establish secure airway-intubate
Epi
lipid emulsion therapy

Question 5

Describe treatment for VAE.

Answer 5

alert surgeon
stop insufflation
100% fiO2, turn anesthetic off, call for help
left lateral decubitus & trendelenburg
insert central line & aspirate air emboli
CPR to break up bubbles
treat hypotension with epinephrine

Question 6

Describe treatment for SVT.

Answer 6

notify surgeon
removal stimulus/initiating event
call for help & get code cart
adenosine
vagal–> give vagal breath, carotid massage, stick a temp probe up their tush
turn off anesthetic
100% fiO2
hook up to defib & place pads on front & back
give adenosine 0.1 mg/kg; next dose 0.2 mg/kg
synchronized cardioversion 0.5-1 mg/kg