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AS - N934 Advanced Principles II > Pediatric Resuscitation & Emergencies > Flashcards

Pediatric Resuscitation & Emergencies Flashcards

1
Q

Oxygen

A

Ventilate w/ 100% FiO2

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2
Q

Epinephrine

A

Hypotension 1mcg/kg

Cardiac arrest 10mcg/kg repeat Q3-5min as needed

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3
Q

Atropine

A

Symptomatic bradycardia 0.02mg/kg or 20mcg/kg

Max dose 1mg (child) or 2mg (adolescent)

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4
Q

Adenosine

A

100mcg/kg rapid IV bolus & flush
Max 6mg

Double 2nd dose 200mcg/kg
Max 12mg

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5
Q

Amiodarone

A

5mg/kg IV
Max 300mg
Vfib or Vtach

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6
Q

Lidocaine

A

1mg/kg IV followed by 20-50mcg/kg/min on the infusion pump

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7
Q

Magnesium

A

25-50mg/kg IV
Max 2g
Torsades de pointes

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8
Q

Bicarbonate

A

1-2mEq/kg IV based on ABG results

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9
Q

Calcium Chloride

A

CENTRAL

10-20mg/kg IV (0.1-0.2mL/kg 10% solution)

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10
Q

Calcium Gluconate

A

Peripheral

30-60mg/kg IV (0.3-0.6mL/kg 10%)

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11
Q

Procainamide

A

5-15mg/kg IV loading dose over 30-60min then 20-80mcg/kg/min on the infusion pump
EKG monitoring required
Caution: Monitor for hypotension or prolonged QT

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12
Q

Cardiac Arrest Risk Factors

A 
Cardiac surgery
Infants < 1mos old
ASA > 3
Prematurity
Congenital heart disease (aortic stenosis, cardiomyopathy, single ventricle)
Emergency procedures
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13
Q

Medication-Related Cardiac Arrest Etiologies

A 
Anesthetic overdose
Succinylcholine
Neostigmine induced
Medication error/swap
Drug reactions
Inadvertent IV local anesthetic injection
LAST
High spinal
Inadequate paralytic reversal
Opioid-induced respiratory depression
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14
Q

Cardiovascular Causes

A 
Hypovolemia
Hemorrhage
Inadequate volume administration
Hyperkalemia
Hypocalcemia
Hypoglycemia
Vagal
Central line → dysrhythmias, hemorrhage, tamponade
Embolism (air, clot, fat)
Malignant hyperthermia
Hypothermia
Myocardial infarction
Sepsis
Adrenal insufficiency
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15
Q

Respiratory Causes

A

Inadequate oxygenation/ventilation
Inability to ventilate i.e. laryngospasm, bronchospasm, or mediastinal mass
ETT misplacement, kink, plug, or accidental extubation
Difficult airway anatomy
Residual neuromuscular blocker
Aspiration
Pneumothorax

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16
Q

ROSC

A

Return of spontaneous circulation

Restoration a perfusing rhythm & BP that persists at least 20min post arrest

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17
Q

Asystole

Outside Hospital

A

Associated w/ poor ROSC & survival

Often d/t prolonged hypoxia & represents terminal rhythm

18
Q

Asystole

OR

A

Initial rhythm response to vagal stimulation
More likely to reverse & associated w/ good prognosis
Examples: Insufflation or carotid massage

19
Q

Prolonged Arrest

A

Lengthy low-flow intervals, inadequate perfusion, myocardial and cerebral injury

20
Q

What timeframe predicts mortality?

A

CPR > 15min

21
Q

How many CPR hours have been reported in anesthesia-related events w/ good outcome?

A

3 hours

22
Q

When to activate ECMO?

A

After 10min failed resuscitation w/ reversible conditions

23
Q

Periop Cardiopulmonary Arrest

A
  • Inhalational induction 25% (laryngospasm, agent overdose, depressed myocardial function)
  • Craniofacial or spine surgery d/t hypovolemia, blood loss, or VAE
  • Hyperkalemia d/t rapid RBC transfusion
  • VP shunt malfunction ↑ICP
  • LAST
  • Anaphylaxis
24
Q

LAST Treatment

A

IV 20% lipid emulsion 1.5mL/kg over 1min

Followed by 0.25mL/kg/min infusion over 10min

25
Q

Cardiopulmonary Resuscitation

A
  1. Recognize need CPR
  2. Know how to correctly perform (oxygenation, ventilation, circulation, defibrillation/cardioversion)
  3. Vascular access
  4. Medications
  5. Teamwork
  6. Documentation
  7. Post-resuscitation care
  8. Self-care post critical incident
26
Q

When to begin chest compressions?

A

HR < 60bpm

Children are HR dependent

27
Q

Newborn Pulse Check

A

Umbilicus
EKG
Brachial

28
Q

Infant Pulse Check

A

Brachial or femoral artery

29
Q

Child Pulse Check

A

Carotid or femoral

30
Q

Other considerations during pediatric emergency include:

A

100% FiO2

Discontinue all anesthetics

31
Q

Newborn BLS

A 
Compressions 90/min
1/3 chest anterior-posterior diameter
2 encircling thumbs
Lower 1/3 sternum
Breaths 30/min
32
Q

Infant BLS

A 
Compressions 100-120/min
1/3 chest AP diameter (4cm)
2 encircling thumbs
Lower 1/3 sternum
Breaths 10/min
33
Q

Child BLS

A 
Compressions 100-120/min
1/3 chest AP diameter (5cm)
1 or 2 hands
Lower 1/3 sternum
Breaths 10/min
34
Q

Adolescent BLS

A 
Compressions 100-120/min
Depth 5-6cm 
2 hands
Lower 1/2 sternum
Breaths 10/min
35
Q

When to intubate?

A 
Recommended during CPR in the OR
Ensure adequate ventilation
↓aspiration risk
Minimal interruptions to compressions w/ trained anesthesia providers
Check correct placement
36
Q

ETT Medications

A 
Lidocaine
Epinephrine
Atropine
Naloxone
Surfactant
Albuterol
Vasopressin
Diazepam (Valium)
37
Q

Defibrillation

A

V fib or pulseless V tach

2-4 J/kg up to 10 J/kg or maximum adult dose

38
Q

Cardioversion

A

Synchronized rhythms - A fib, A flutter, or SVT

0.5-1 J/kg
Repeat dose 2 J/kg

39
Q

Next step when unable to obtain peripheral venous access w/in 90sec?

A

Another route
Drugs via ETT
Intraosseous (IO)
Femoral vein

40
Q

Appropriate Flush Volume

A

0.25mL/kg NS
Infants 5mL
Children 10mL

41
Q

Care After ROSC

A

Titrate FiO2 (aim Pox 94-99%)
Assess rebound arrest - hyperkalemia treatment (dialysis) or needle decompression for tension pneumo (chest tube)
Confirm ETT & line placement
Avoid hypothermia, hyperglycemia, & seizures
Cooling after arrest?
Update the family
ICU transfer

AS - N934 Advanced Principles II (18 decks)

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