Pediatric Emergencies and Resuscitation, part 2 (Nelson)

Question 1

The most important treatment of cardiac arrest is

Answer 1

Anticipation and prevention
Intervening when a child manifests respiratory distress or early stages of shock can prevent deterioration to full arrest

Question 2

An unwitnessed pediatric cardiac arrest in an outpatient setting should be treated as

Answer 2

asphyxial in nature
Immediately initiate CPR, and activate EMS

Question 3

A witnessed pediatric cardiac arrest in an outpatient setting should be treated as

Answer 3

primary arrhythmia
Immediately activate EMS, and obtain AED

Question 4

Initiate defibrillation at what joules?

Answer 4

2 J/kg

Question 5

PEA is also called

Answer 5

electromechanical dissociation

Question 6

For persistent PEA, you should

Answer 6

search and manage reversible causes (Hs and Ts)

Question 7

Corrective actions for acidosis

Answer 7

Reassess the adequacy of cardiopulmonary resuscitation, oxygenation, and ventilation; reconfirm ETT placement
Hyperventilate
Consider IV bicarbonate if pH <7.2 after above actions have been taken

Question 8

First action for a cardiac tamponade

Answer 8

Adminster fluids first
Then pericardiocentesis

Question 9

Severe hypothermia is

Answer 9

<30 C - limit shocks for Vfib or pulseless Vtach to 3; initiate active internal rewarming and cardiopulmonary support

Question 10

Moderate hypothermia is

Answer 10

30-34 C
Proceed with resuscitation (space medications at longer intervals)
passively rewarm child
and actively rewarm truncal body areas

Question 11

Thoracotomy is appropriate when?

Answer 11

When a patient has cardiac arrest from penetrating trauma and a cardiac rhythm is present and the duration of CPR before thoracotomy is <10 mins

Question 12

How to manage cardiac arrest from hypomagnesemia

Answer 12

1-2 g magnesium sulfate IV over 2 mins

Question 13

How to manage cardiac arrest from hypokalemia

Answer 13

If profound hypokalemia (<2.0 - 2.5 mmol of potassium) is accompanied by cardiac arrest, initiate urgent IV replacment (2 mmol/min IV for 10-15 mmol)

Question 14

Most notable scalp veins are

Answer 14

superficial temporal vein (just anterior to ear)
and posterior auricular vein (just behind the ear)

Question 15

Remarks on IO access

Answer 15

If venous access is not available within approximately 1 min in a child with cardiopulmonary arrest, an IO needle should be placed in the anterior proximal tibia

Question 16

Medications that can be given through the ETT

Answer 16

Epinephrine (10x normal IV dose)
Atropine
Naloxone
Vasopressin
(the rest are dosed 2x normal IV dose)

Question 17

Pulse pressure in cardiac tamponade

Answer 17

Narrow pulse pressure
(in the presence of increased CVP is cardiac tamponade until proven otherwise)

Question 18

Remarks on induced hypothermia

Answer 18

Induced hypothermia has NOT been shown to improve survival and neurologic function in pediatric survivors of CPR

Question 19

Remarks on resuscitation communication with patient’s family

Answer 19

1. Should be done by the most senior provider available.
2. For situations in which the resuscitation is ongoing and the child is not expected to survive, it is recommended that the provider make every effort possible to have the family present at the bedside, if they wish.
3. Family presence during CPR or other emergency resuscitative efforts, even if the child dies, is associated with a more positive medical experience than if they are excluded

Question 20

Dose of amiodarone

Answer 20

5 mg/kg IV/IO
repeat up to 15 mg/kg
Max 300 mg

Question 21

Dose of atropine

Answer 21

0.02 mg/kg IV/IO
0.03 mg/kg ETT
Minimum dose: 0.1 mg
Minimum single dose:
Child, 0.5 mg
Adolescent, 1 mg

Question 22

Epinephrine dosing

Answer 22

IV/IO
0.01 mg/kg (0.1 mL/kg 1:10,000)
max 1 mg

ETT
0.1 mg/kg (0.1 mL/kg 1:1,000)
max 10 mg

Question 23

Glucose dosing for hypoglycemia

Answer 23

0.5-1 g/kg IV/IO

D10W: 5-10 mL/kg
D25W: 2-4 mL/kg
D50W: 1-2 mL/kg

Question 24

Magnesium sulfate dosing for arrhythmia

Answer 24

25-50 mg/kg IV/IO over 10-20 mins
faster in torsades de pointes
max dose 2g