Pediatric Emergencies Flashcards
What are the risk factors for pediatric emergencies?
cardiac surgery,
ASA >3
prematurity
infants less then 1 month of age
CHD
emergency procedures
54% of what disease arrested in the general operating room?
heart disease
aortic stenosis, cardiomyopathy, single ventricle account for 75% of the arrests)
What are the medication related causes of arrests during anesthesia? (10)
anesthetic overdose, or relative overdose of inhalation or IV agent
succinylcholine induced dysrhythmia
neostigmine induced dysrhythmia
medication swap
drug reactions
unintended IV injection of local anesthetic
high spinal
LAST
inadequate reversal of paralytic agent
opioid induced respiratory depression
What are cardiovascular causes of cardiac arrest in anesthesia? (12)
hypovolemia
hemorrhage
inadequate volume administration
hyperkalemia
hypocalcemia from blood products
vagal episodes (traction, pressure insufflation with abdomen, eye neck or heart)
CVC (dysrhythmias, hemorrhage, tamponade)
embolism
MH
hypothermia
myocardial infarction
sepsis, adrenal insufficiency
What are respiratory causes of cardiac arrests in anesthesia?
inadequate oxygenation/ventilation
inability to ventilate (laryngospasm, bronchospasm, mass)
ETT misplacement, kink, plug, accidental removal
difficult airway
residual nmb
aspiration
pneumothorax
What is ROSC?
restoration of a perfusing rhythm and blood pressure that persists for a period of at least 20 minutes post arrest
What is a predictor of mortality?
CPR >15 minutes
How many hours of CPR has been reported in anesthesia related events with good outcomes?
3 hours
When should ecmo be called?
10 minutes after failed resuscitation of reversible conditions
What are causes of perioperative arrest? (6)
arrest during inhalation induction (25%)- laryngospasm, agent overdose, depressed myocardial function
arrest during craniofacial or spine surgery (hypovolemia, blood loss, VAE
hyperkalemia (rapid RBC transfusion)
VP shunt malformation (increased ICP)
LAST (1.5ml/kg of 20% lipid over 1 minutes, then gtt of 0.25ml/kg/min for 10 minutes
Anaphylaxis
What are the eight steps of cardiopulmonary resuscitation?
- recognize need for CPR
- know how to perform CPR
- Vascular access
- Medications for CPR
- Teamwork
- Documentation
- Post reuscitation care
- Self care post a critical incident
What is hypotension for a term neonate?
SBP <60
What is hypotension for an infant
SBP <70
What is hypotension for a child
SBP <70 + (age x2)
What is hypotension for >10y
SBP <90
Where do you check for a pulse in a newborn?
brachial, umbilical artery
WHere do you check for a pulse in a infant?
brachial, femoral
WHere do you check for a pulse in a child?
femoral or carotid
What ages can you use 2 thumb encircling?
newborn and infant (<1 year)
How many hands for CPR in an child?
1 or 2 hands
What is defibrillation and it is used for what rhythms?
vtach and vfib
2-4J/kg
repeat with 4j/kg
What is cardioversion and it is used for what rhythms?
SVT
aflutter and afib
0.5-2J/kg
repeat 2J/kg
What medications can be delivered through an ETT?
NAVEL
naloxone
atropine
vasopressin, valium
epinephrine
lidocaine
What is the preferred site of placement of an IO needle in a child?
anterior tibia
Describe care after ROSC
titration of FiO2 to maintain pulse ox levels form 94-99%
assess for rebound of arrest
assess for ETT and line displacements
avoid hyperthermia, hyperglycemia, and seizures
accurate reporting to surgery team, family, ICU team
What is the dose of Epi infusion after arrest?
0.05-1mcg/kg/min
inotrope, chronotrope
What is the dose of dopamine after arrest?
2-20mcg/kg/min
inotrope, chronotrope, dilates splanchic vasculature at. lower doses, pressor effect at higher doses
What is the dose of dobutamine after arrest?
2-20mcg/kg/min
inotrope, decreaseds SVR
What is the dose of milirnone after arrest?
load 25-50mcg/kg
infusion: 0.5-1mcg/kg/min
inotrope, improves diastolic relaxation, decreases SVR
