Resuscitation Flashcards
Airway assessment?
Look, listen, and feel.
1. No chest movement
2. No air movement
3. Cyanosis
4. Stridor
Airway management?
- Position to open the airway
- infant < 1yr: neutral
- child > 1yr: sniffing
- If there is trauma: Stabilize neck and do jaw thrust - Suction secretions
- Place Guedel or nasopharyngeal airway if there is obstruction from the tongue
How to size adjunct airays?
- mouth to angle of mandible
- nose to base of earlobe
Breathing assessment?
- Look, listen, and feel
- Signs of severe respiratory distress
1. Severe lower chest wall indrawings
2. Very fast breathing
3. Unable to eat or breastfeed due to difficulty breathing
4. Head nodding
5. Grunting
6. Restlessness
Breathing management?
- Position sitting upright
- Place on oxygen
- Neonate: 0.5 – 1 litre/min
- Infant: 1-2 litre/min
- Child: 2-4 litres/min
- If still hypoxic, consider CPAP - Monitor O2 saturation
- If only respiratory distress aim > 90%
- If other emergency signs aim > 94% - If breathing stops or is ineffective, ventilate using bag and mask
- Infants: 1 breath every 2-3 sec (20-30 per min)
- Child: 1 breath every 3-4 sec (15-20 per min)
Circulation assessment?
Shock = All 3 of the following
1. Cold Hands
2. Capillary refill > 3 seconds
3. Fast and weak pulse
Treatment of impaired circulation?
Impaired Circulation = 1 or 2 signs of shock
- Not an Emergency
1. Give oral or IV maintenance fluids
2. Reassess within 1 hour
Treatment of shock?
- Stop bleeding (if needed)
- Place on oxygen
- Obtain IV access
- Place IO if unable to get IV in 5 min
- Draw samples when placing IV - Keep child warm
- Give fluid based on condition
Shock and severe malnutrition criteria?
- Malnourished child
- signs of shock
- Cold hands
- AND cap refill >3 sec
- AND fast and weak pulse
Management of a shocked malnourished child that is fully conscious?
- PO/NGT: 5 ml/kg ReSoMal every 30 minutes for 2 hours (x 4)
- Give maintenance fluid:
PO/NGT: 5 ml/kg hourly alternating ReSoMal with F-75 - PO/NGT not tolerated: RL + 5% Dextrose at IV maintenance rate
Management of a shocked malnourished child that is unconscious?
- Give 15 ml/kg Ringer’s lactate with 5% Dextrose over 60 minutes
- monitor HR and RR every 5 minutes
- HR and RR unchanged
- Blood transfusion: 10 ml/kg over 3 hours - HR increases by 15 bpm or RR increases by 5 bpm during infusion:
Likely heart failure
- Stop IV fluid
Give 1mg/kg frusemide
Call a senior - HR and RR decreasing: improving
- give maintenance fluid
Criteria for shock and trauma?
Suspected acute blood loss + signs of shock
- Cold hands AND cap refill >3 sec AND fast and weak pulse
Fluid plan for shock and trauma?
- stop external bleeding
- Begin shock treatments (keep warm, place on O2, establish vascular access) and contact Surgery and Anesthesia teams
- Take samples for group and cross matching and order 20 ml/kg blood urgently
- Give 10 ml/kg whole blood over 20 mins (if blood is not available immediately, use NS/RL)
- if no improvement
- Give remaining 10 ml/kg whole blood over 20 mins
(if blood not available, use NS/RL)
- Continue repeating 10 ml/kg boluses until improvement (up to total 40 ml/kg NS/RL, no limit for whole blood) - if improved
- Give remaining 10 ml/kg whole blood over 2-3 hours and then reassess circulation
Shock and severe anemia criteria?
Hb <5 / severe palmar pallor + signs of shock
- Cold hands AND cap refill >3 sec AND fast and weak pulse)
Fluid plan for shock and severe anemia?
- Begin shock treatments (keep warm, place on O2, establish vascular access
- Take samples for group and cross matching and order 20 ml/kg blood urgently
- Give maintenance fluid while awaiting blood
- Once blood arrives, give 20 ml/kg whole blood over 3-4 hours
- Monitor vital signs every 15 min.
- If signs of volume overload, give 1 mg/kg Frusemide IV
Criteria for Shock and any other cause including severe infection?
Well-nourished child, signs of shock (Cold hands AND cap refill >3 sec AND fast and weak pulse)
Fluid plan for shock and any other cause?
- Begin shock treatments (keep warm, place on O2, establish vascular access
- Give 10-20 ml/kg Ringer’s lactate or normal saline over 30-60 minutes
- Sepsis, malaria, unknown: choose 10 ml/kg - Re-evaluate (extremity temperature, cap refill, pulses, and mental status)
- no improvement
- Give 10 ml/kg Ringer’s lactate or normal saline over 30 minutes - improvement
- maintenance fluids
Assessment of coma?
AVPU
Alert
Verbal response
- not emergency
Pain response
Unresponsive
- emergency
Management of coma?
- Protect the airway
- Place in recovery position
- Suction secretions
- Give oxygen
- Consider Guedel airway - Assess for hypoglycemia
- Well nourished: RBS <45 mg/dl (2.5 mmol/L)
- Malnourished: RBS <54 mg/dl (3.0 mmol/L)
- If no glucometer available, treat as hypoglycemia - Treat hypoglycemia
- IV/IO: 5 ml/kg of 10% Dextrose
- Unable to get IV/IO: Place one teaspoon moistened sugar under the tongue
How to make dextrose for coma management?
1 ml/kg 50% dextrose + 4ml/kg normal saline
= 5ml/kg 10% dextrose
Assessment for convulsion?
- protect airway
- Place in recovery position
- Suction if needed
- Consider nasopharyngeal airway
- Monitor O2 saturation, place on O2 prongs or face mask
- Consider bag-mask ventilation if seizure is prolonged (>3 min) - check RBS and treat hypoglycemia
- give anticonvulsant
Convulsion management?
- child convulsing for >5 minutes
- give diazepam - still convulsing after 10 minutes
- 2nd dose of diazepam - convulsing after 10 more minutes
- give phenobarbitone IM or phenytoin IV
Convulsion management for neinates?
- Neonates less than 2 weeks
- Avoid diazepam
- Use only phenobarbitone
Assessment of severe dehydration?
The child has diarrhoea AND two of the following signs:
1. Sunken eyes
2. Skin pinch goes back very slowly (>2 sec)
3. Lethargy
4. Unable to drink or drinks poorly
Features and management of some dehydration?
- Not an Emergency
- The child has diarrhea and two of the following signs:
1. Skin pinch goes back slowly (not immediately, but <2 seconds)
2. Irritable
3. Drinks eagerly
4. Sunken eyes
5. Give 75 ml/kg of ORS over 4 hours in small sips every 2-3 minutes
Management of severe dehydration?
- Check RBS, treat hypoglycaemia
- Well-nourished (Plan C)
- Give IV fluids: Normal Saline or Ringer’s Lactate
- Start giving ORS as soon as they can drink (5 ml/kg hourly)
- Continue breastfeeding on demand
IV fluids for severe dehydration?
infants
- 30ml/kg over 1 hr
- and then 70ml/kg over 5 hrs
children >1 hr
- 30ml/kg over 30 mins
- and then 70ml/kg over 2.5 hrs
Management of severe dehydration in SAM?
- Give Oral or NGT fluid
- ReSoMal: 5 ml/kg every 30 minutes x 4 (2 hours)
And Then - 5-10 ml/kg hourly (alternating ReSoMal with F75) for 4-10 hours
Reversible causes of dehydration and their management?
- hypovolemia
- NS/RL - hypoxia
- airway management - hydrogen ion excess
- treat underlying cause - hypoglycemia
- dextrose bolus - hyper/hypokalemia
- calcium gluconate + insulin/dextrose - hypothermia
- gradual rewarming
The Emergency 5T’s and their management?
- tension pneumothorax
- needle decompression - tamponade
- pericardiocentesis - toxins
- toxin based e.g. atropine - thrombosis - pulmonary
- fibrinolytics - thrombosis - cardiac
- depends on age/extent
