Peds Resus Flashcards
Common causes of Cardiopulmonary Arrest in Children
Respiratory
- Pneumonia
- Near drowning
- Smoke Inhalation
- Aspiration and obstruction
- Apnea
- Hemorrhage
- Suffocation
- Bronchiolitis
Cardiovascular
- CHD
- CHF
- Pericarditis
- Myocarditis
- Arrhythmia
- Septic Shock
CNS
- Seizures (or complications of)
- Hydrocephalus (or shunt malfunction)
- Tumor
- Meningitis
Other
- Trauma
- SIDS
- Anaphylaxis
- GI hemorrhage
- Poisoning
Prognostic factors for Peds Cardiopulmonary Arrest
Location (in hospital vs out of hospital) (better in hospital)
Resuscitation at the scene (improves)
Presenting Rhythm (VF better, asystole/PEA/severe brady is bad)
Length of Resuscitation (> 20 min is bad - strongest prognosticator) - decrease by 2.1%/min
Drowning or trauma involvement (better survival compared to cardiac origin arrests)
Order of Priorities in Peds Arrest
ABCDE
Airway- Breathing-Circulation-Disability/Drugs-Exposure
- Identify patient’s level of consciousness
- Properly position the patient on a firm surface, considering potential for head or cervical spine injury
- Establish a patent airway
- Assure proper oxygenation and ventilation
- Attend to circulation
- Consider drug therapy
List the steps to establish a patent airway
- Proper Positioning, ie. head tilt/chin lift, jaw thrust
- Clear the airway, ie remove obvious FB, suction airway
- Use adjuncts - nasal airway or oral airway with decreased LOC patient
- Assisted ventilation with PPV - bag-valve mask and PPV
- LMA
- Intubation
Methods of Oxygen Delivery/Capabilities
Nasal prongs 30-40% O2 Simple mask 30-60% O2 Non-rebreather mask 50-60% O2 Self-inflating BVM 60-90% Flow-inflating BVM 100% ETT - 100%
Indications for Intubation
Sustained apnea
Inadequate CNS control of ventilation
Functional or anatomic airway obstruction
Strong Potential for obstruction (inhalation airway burns, expanding airway hematoma)
Loss of protective airway reflexes
Excessive WOB - can lead to resp insufficiency
Need for higher pressures to maintain alveolar gas exchange
Need for sustained mechanical ventilation support
Potential occurrence of any of any of the preceding during patient transport
Calculation to pick ETT size
Uncuffed ETT (internal diameter mm) = age/4 + 4
Cuffed ETT (internal diameter mm) = age/4 + 3.5
Child’s 5th fingernail
Parameters to determine Proper placement of ETT
ETT depth - 3 x ETT size Symmetric chest expansion Symmetric breath sounds No abdominal distention End tidal CO2 - colorimetric detector, End tidal monitor (yellow means in trachea) CXR
3 Components of the Pediatric Assessment Triangle
Appearance
Work of breathing
Circulation to Skin
CPR Ratios
30: 2 Single rescuer
15: 2 Two rescuers
IO sites
Proximal tibia (< 2 years) Distal tibia (> 2 years) Distal femur
Drugs that can be given by ETT
NAVEL
Naloxone Atropine Versed (midaz) Epinephrine Lidocaine
Dose of Atropine
0.02 mg/kg (for bradycardia) - minimum 0.1 mg
Dose of Dopamine
Low dose (1-5 mcg/kg/min) - augment renal blood flow and enhance U/O Higher dose (10-20 mcg/kg/min) - alpha-adrenergic effects- vasoconstriction - increase BP
Dose of Epinephrine
Resuscitation
- 01 mg/kg IV/IO (1:10,000)
- 01 mg/kg ETT (1:1000)
Anaphylaxis
0.01 mg/kg IM (1:1000)
Dose of Adenosine
0.1 mg/kg rapid push (max 6 mg)
If 2nd dose need –> 0.2 mg/kg (max 12 mg)
When to use Calcium in Peds Resus
Documented HYPOcalcemia
Documented HYPERkalemia
Documented HYPERmagnesemia
Calcium Channel Blocker overdose
When do you want to use NaBicarb
Not commonly used routinely in Peds Resus
Can be useful to reverse metabolic acidosis - only if adequate ventilation - to blow off the CO2 byproduct
What rhythm do you defibrillate for?
Ventricular Fibrillation (VF) Ventricular Tachycardia (VT)
Dose for Defibrillation
2-4 J/kg up to 10 J/kg
What med to use for shock-refractory VF/pulseless VT?
Amiodarone
Or lidocaine - no peds data
