1. 100% FiO2 2. treat hypotension w/fluids - 10 - 30 mL/kg 3. pressors - epi 1-10 mcg/kg, vasopressin 10 mu/kg 4. diphenhydramine 1 mg/kg or pepcid 0.25 mg/kg 5. methylprednisone 2 mg/kg 6. albuterol 4 - 6 puffs

Peds Crisis Flashcards by Madison Davis

Air Embolism s/s

drop in ETCO2
hypoxia
hypotension
mill-wheel murmur

How well did you know this?

Not at all

Perfectly

Air Embolism treatment

LLD + Tburg
100% FiO2
Flood field, stop all insufflation, N2O etc
Central Line + Aspirate
CPR 100 - 120/m

crani case - compress jugular veins
epi 1 - 10mcg/kg; epi 0.02-1 mcg/kg/m

How well did you know this?

Not at all

Perfectly

Anaphylaxis s/s

hypotension
tachycardia
rash, bronchospasm

How well did you know this?

Not at all

Perfectly

Anaphylaxis tx

100% FiO2
treat hypotension w/fluids - 10 - 30 mL/kg
pressors - epi 1-10 mcg/kg, vasopressin 10 mu/kg
diphenhydramine 1 mg/kg or pepcid 0.25 mg/kg
methylprednisone 2 mg/kg
albuterol 4 - 6 puffs

How well did you know this?

Not at all

Perfectly

Anterior mediastinal mass airway collapse

oxygen 100%
CPAP/PEEP
lateral/prone
rigid bronch

How well did you know this?

Not at all

Perfectly

anterior mediastinal mass CV collapse

Increase O2 to 100%
 Give fluid bolus
 Reposition to lateral or prone
 Ask surgeon for sternotomy and
elevation of mass
 Consider ECMO

How well did you know this?

Not at all

Perfectly

bradycardia definition

< 30 days = < 100
<1 yr = <80
> 1 yr < 60

How well did you know this?

Not at all

Perfectly

bradycardia + hypotension

chest compressions

epi 10 mcg/kg

How well did you know this?

Not at all

Perfectly

bradycardia (no hypotension)

100% oxygen
fix ventilation
vagal - atropine 0.01 mg/kg

How well did you know this?

Not at all

Perfectly

CCB overdose

cacl 10 - 20 mg/kg IV

ca gluconate 50 mg/kg IV

How well did you know this?

Not at all

Perfectly

BB overdose

glucagon 50 mcg/kg

How well did you know this?

Not at all

Perfectly

bronchospasm s/s

drop in ETCO2
drop in O2
airway pressure increases
shark fin

How well did you know this?

Not at all

Perfectly

bronchospasm tx (intubated pt)

Increase FiO2 to 100%
1. Auscultate the chest:
• Equal breath sounds?
• Endobronchial ETT?
• Wheezing?
2. Check ETT:
• Kinked?
• Secretions/blood in ETT? Needs suctioning?
3. albuterol 2-10 puffs
4. deepen anesthetic
5. ketamine 1-2 mg/kg IV
6. EPI 1-2 MICROgrams/kg IV (MAX 1 mg)
7. steroids: methylprednisolone 2 mg/kg IV(MAX 60 mg) or dexamethasone 0.15-0.25 mg/kg(MAX 16 mg)
8. Consider chest radiograph
9. For refractory bronchospasm, consider magnesium
sulfate 50-75 mg/kg (MAX 2 grams) bolused over 20
minutes, (CAUTION, may cause hypotension)

How well did you know this?

Not at all

Perfectly

bronchospasm tx (non-intubated)

Administer supplemental oxygen
Auscultate the chest, differentiate from
stridor/extrathoracic airway obstruction
albuterol (with spacer) 2.5-5 mg. If severe, 5-20 mg/hr inhaled
chest radiograph
Consider IV steroids:
methylprednisolone 1 mg/kg IV
or dexamethasone 0.15-0.25 mg/kg
EPINEPHrine
1-2 MICROgrams/kg IV (MAX 1 mg) or
10 MICROgrams/kg
subcutaneous/intramuscular (MAX 0.5 mg)

How well did you know this?

Not at all

Perfectly

Cardiac Arrest

Increase O2 to 100%. Turn off anesthetics. Start timer
1. If ETT, 100-120 chest compressions/min + 10 breaths/min. Avoid hyperventilation
2. If no ETT, 15:2 compression
3. For chest compressions, maximize EtCO2 > 10 mmHg
• Use sudden increase in EtCO2 for ROSC, Do NOT stop compressions for pulse check
4. Obtain defibrillator. Attach pads. If VF/VT, shock 2 joules/kg. Continue chest compressions for 2
minutes

How well did you know this?

Not at all

Perfectly

cardiac arrest part 2

If still in VF/VT, shock 4 joules/kg q2 min (up to 10 joules/kg on subsequent shocks)
-Resume chest compressions immediately regardless of rhythm
- EPINEPHrine 10 MICROgrams/kg IV q 3-5 min while in arrest (MAX 1 mg)
• If still no ROSC after second dose of EPINEPHrine, activate ECMO (if available)
- Check pulse & rhythm q 2 min during compressor change
-Lidocaine 1 mg/kg bolus (MAX 100 mg); may repeat (total: 2 doses) OR amiodarone 5 mg/kg
bolus; may repeat (total: 3 doses)

How well did you know this?

Not at all

Perfectly

H&Ts

hypoxia
hypotension
tension pneumothorax
hypovolemia
hypothermia
acidosis
hyperkalemia
cardiac tamponade
hypoglycemia
thrombosis
toxin
trauma

How well did you know this?

Not at all

Perfectly

difficult airway unexpected

100% fio2
call for help - surgical airway cart, rigid bronch
OPA/NPA/LMA attempts
OG decompression
reverse?

after 2 attempts change providers; consider alternative approaches

macroglossia (beckwith-wiedemann, Pierre robin, mediastinal mass - prone or lateral)

How well did you know this?

Not at all

Perfectly

younger kids difficult airway

rigid bronch

How well did you know this?

Not at all

Perfectly

older kids difficult airway

jet ventilation or cricothyrotomy or trach

How well did you know this?

Not at all

Perfectly

hyperkalemia

s/s
tall peaked T waves
heart block
sine wave
v fibb/asystole

How well did you know this?

Not at all

Perfectly

hyperkalemia treatment

CPR/PALs if unstable
100% fio2
ca gluconate 60 - 100 mg/kg OR cacl 20 mg/kg
switch to NS
dextrose 1 g/kg and insuline 0.1 units/kg
albuterol

How well did you know this?

Not at all

Perfectly

Hyperkalemia other treatments

bicarb 1 mEq/kg
lasix 1 mg/kg
terbutaline 10 mcg/kg

How well did you know this?

Not at all

Perfectly

dopamine

2 - 20 mcg/kg/m

How well did you know this?

Not at all

Perfectly

epinephrine

1 - 10 mcg/kg | 0.02 - 1mcg/kg/m

cacl

10 - 30 mg/kg or caglu 50 mg/kg

phenylephrine bolus

1 mcg/kg

phenylephrine gtt

0.1 - 2 mcg/kg/m

ICP increased

1. Secure airway 2. Sedation prior to transport 3. PaCO2 30 - 35 and PaO2 > 80 4. HOB @ 30 5. hypertonic saline 3% 1-5 mL/kg over 20 m 6. mannitol 1 g/kg 7. lasix 1 mg/kg

transfusion reactions

1. epi 1 mcg/kg 2. diphenhydramine 1 mg/kg 3. methylprednisolone 2 mg/kg

tension pneumothorax

14 - 16G for teens | 18 - 20 G for infants

tachycardia definition

> 220 for infant, > 180 for a child

tachycardia treatment

100% fio2 vagal adenosine for SVT 0.1 mg/kg synchronized cardiovert 1 J/kg

wide complex tachycardia

amiodarone 5 mg/kg

torsades

magnesium 50 mg/kg (max 2 g) | lidocaine 1 mg/kg IV (max 100 mg)

pulmonary HTN

iNO 20 - 40 ppm 2. deepen sedation 3. paralyze 4. if hypotensive, vasopressin 0.03 u/kg

``` oxygen 100% (anemia, hypotension?) - drop demand on the heart - nitro 5 mcg/kg/m -heparin 10 u/kg ```

massive hemorrhage

O - PRBCs and AB + plasma until cross matched - monitor for hyperkalemia - monitor calcium - warm PRBCs and FFP

Hct < 21%

4 mL/kg PRBC increase Hct by 3%

Plt < 50 k

10 mL/kg apheresed platelets increases plt by 30 - 50 k

INR > 1.5

10 mL/kg plasma increases coags by 20%

fibrinogen < 100 mg

10 mL/kg cryo increases it by 30 - 50

1. attach charcoal filter 2. oxygen 10 L/m 3. hyperventilate 4. dantrolene 2.5 mg/kg

dantrolene

20 mg/vial mix w/60 mL max dose 10 mg/kg

ryanodex

250 mg in 5 mL

LA toxicity

100% oxygen - midaz 0.1 mg/kg - epi 1 mcg/kg - avoid prop/vasopressin/CCB/BB

intralipid therapy

20% @ 1.5 mL/kg gtt @ 0.25 mL/kg/m repeat q3-5m double if BP remains low continue for 10m once BP stablizes

max IL therapy

10 mL/kg over first 30m

laryngospasm s/s

inspiratory stridor accessory muscles drop in oxygen, HR loss of end tidal

laryngospasm tx

1. oxygen + remove stimulus 2. positive pressure + jaw thrust 3. propofol bolus 4. succinylcholine 0.1 mg/kg IV or 4 mg/kg IM 5. atropine 0.02 mg/kg IV or 0.04 mg/kg IM 6. DVL and ETT

what are the RF for cardiac arrest? (6)

1. cardiac surgery 2. < 1 mo old 3. ASA >= 3 4. prematurity 5. CHD 6. emergency

heart disease r/t cardiac arrest

AS CM single ventricle 54% arrested in a general operating room

name the drug etiologies of cardiac arrest during anesthesia

- OD - Sux - Neo dysrhythmia - Med swap - drug rxn - LA - inadequate reversal of paralytic - opioid respiratory depression

name the CV causes of cardiac arrest

``` hypovolemia hemorrhage inadequate volume administration hypeerK, hypoCa, hypoglucosee vagal (abd. eye. neck. heart) ```

ROSC

return of perfusing rhythm and BP for 20 mins post-arrest

full recovery after OR cardiac arrest in kids =

48 - 61%

asystole in the OR -

most likely an initial rhythm in response to vagal stimulation

reversal of vagal stimulation

glyco 10 - 20 mcg/kg atropine 10 - 20 mcg/kg insufflation, carotid massage

predictor of mortality

CPR > 15m

when should ECMO be initiated

10 m after failed resuscitation

hypotension for a neonate

<60 sbp

infant hotn

< 70 sbp

hotn child

SBP <70 + 2xage

hotn for > 10y

SBP < 90

where do you check pulse in a newborn

umbi

where do you check pulse for infant

brachial

child pulse check?

carotid or brachial

what drugs can go down ett

``` naloxone atropine vasopressin epi lido ``` *2 - 5 x IV dose + 5mL flush*

defibb

vtach | vfibb

cardiovert

afibb afluttere svt

how much do you flish drugs during cardiac arrest

0.25 mL/kg 5 mL = infant 10 mL = child

preferred site for an IO

anterior tibia, below growth plate

afteer ROSC -

avoid hyperthermia, hyperglycemkia, seizures