ROSC + IV fluid therapy

Question 1

What are the indications for the ROSC m.d.

Answer 1

Return of spontaneous circulation (ROSC) after the resuscitation was initiated.

Question 2

What are the conditions for 0.9% NaCl fluid bolus (ROSC m.d.)

Answer 2

Age ≥ 2 years of age
Hypotension
Chest auscultation is clear

Question 3

What are the contraindications to 0.9% NaCl fluid bolus (ROSC m.d.)

Answer 3

Fluid overload

Question 4

What’s the treatment of 0.9% NaCl fluid bolus? (ROSC m.d.)

Answer 4

Age ≥2 years to <12 years
- Route: IV
- Infusion: 10 mL/kg
- Infusion interval: Immediate
- Reassess every: 100 mL
- Max. volume: 1000 mL
Age ≥12 years
- Route: IV
- Infusion: 10 mL/kg
- Infusion interval: Immediate
- Reassess every: 250 mL
- Max. volume: 1000 mL

Question 5

What should be the BVM rate post ROSC?

Answer 5

10 breaths/min OR 1 breath every 6 seconds

Question 6

True of False: If chest auscultation is clear, a 10 mL/kg 0.9% NaCl fluid bolus may be be administered to a maximum of 1000 mL targeting a SBP of ≥ 90 mmHg

Answer 6

True

Question 7

What are the indications for the IV and fluid therapy m.d.

Answer 7

-Actual or potential need for intravenous medication OR fluid therapy

Question 8

What are the conditions for IV cannulation? (IV and fluid therapy m.d.)

Answer 8

Age ≥ 2 years

Question 9

What are the conditions for 0.9% NaCl fluid bolus (IV and fluid therapy m.d.)

Answer 9

Age ≥ 2 years
Hypotension

Question 10

What are the contraindications to IV cannulation (IV and fluid therapy m.d.)

Answer 10

Suspected fracture proximal to the access site

Question 11

What are the contraindications to 0.9% NaCl fluid bolus (IV and fluid therapy m.d.)

Answer 11

Fluid overload

Question 12

What is the treatment of 0.9% maintenance infusion? (IV and fluid therapy m.d.)

Answer 12

Age ≥ 2 years to <12 years
- Infusion: 15 mL/hr
Age ≥ 12 years
- Infusion: 30-60 mL/hr

Question 13

What is the treatment of 0.9% NaCl fluid bolus (IV and fluid therapy m.d.)

Answer 13

Age ≥ 2 years to <12 years
- Infusion: 20 mL/kg
- Infusion interval: N/A
- Reassess every: 100 mL
- Max. volume: 2000 mL
Age ≥ 12 years
- Infusion: 20 mL/kg
- Infusion interval: N/A
- Reassess every: 250 mL
- Max. volume: 2000 mL

Question 14

Mandatory patch point to BHP for authorization to administer IV NaCl bolus to a patient ≥ 2 years to < 12 years with suspected diabetic ketoacidosis (DKA)
(to prevent cerebral edema)

Question 15

What’s the hypotension formula for pediatrics? (up to age 10)

Answer 15

SBP = 70 + (2 x age)

Question 16

What should you do prior to initiating a fluid bolus?

Answer 16

You should obtain 2 blood pressures (one should be obtained manually) indicating hypotension.

Question 17

In a ROSC, what is the target SpO2 and ETCO2?

Answer 17

SpO2: 94-98%
ETO2: 30-40 mmHg

Question 18

Once you start a fluid bolus, what’s the minimum volume that needs to be administered before discontinuing (should the patient become normotensive)

Answer 18

100mL in pediatrics
250 mL in adults