Study Day 2

Question 1

Indications for OPA (2)

Answer 1

1. Unconscious pt who needs their airway actively managed by displacing their tongue anteriorly
2. Bite block to support ETT

Question 2

Contraindications for OPA (3)

Answer 2

1. Trismus
2. Gag reflex present
3. Suspected neurological injury, concern for inducing a gag response

Question 3

Indications for NPA (1)

Answer 3

1. Unconscious with trismus (OPA can’t be inserted)

Question 4

Contraindications for NPA (3)

Answer 4

1. Middle 1/3 facial fractures
2. Significant nasal trauma
3. TBI and neurological event where airway is patent and tidal volume is adequate despite trismus

Question 5

Precautions for NPA (3)

Answer 5

1. Basal skull fractures
2. Cerebrospinal fluid from nares or ears
3. May need to be removed during intubation as it can block view of the glottis

Question 6

How does the triple airway manoeuvre enhance the assessment of the airway?

Answer 6

Pulls the tongue and soft tissues from the back of the throat to achieve and maintain an open airway

Question 7

Outline the difference between the neutral position and the sniffing position

Answer 7

Neutral position is achieved by placing a 2-5cm towel under the occiput to open the airway.
Sniffing position maximises potential view of the vocal cords and is achieved by placing more padding under the occiput.

Question 8

Why is it important to avoid hyperextension of the head?

Answer 8

It can flatten the trachea

Question 9

Why should head positioning be varied when assessing the airway of a small child compared to a medium child

Answer 9

Small children have a larger occiput relative to body size than adults so don’t need their head elevated.
Medium children are best managed supine with their head on the same surface plane as their body.

Question 10

How would you position an infant and small child’s airway?

Answer 10

Infants and small children age a relatively larger occiput than adults related to body size. They are best managed with a small pad under the shoulders.

Question 11

In cardiac arrest, when is a carotid pulse check required?

Answer 11

When QRS complexed are present indicating a potentially perfuming rhythm at the end of a CPR cycle

Question 12

What are the correctable causes of PEA? (6)

Answer 12

1. Hypoxia
2. Exsanguination
3. Asthma
4. Tension pneumothorax
5. Anaphylaxis
6. Upper airway obstruction

Question 13

How does the management of a hypothermic cardiac arrest patient differ to that of a normothermic cardiac arrest?

Answer 13

30+ standard cardiac arrest
<30 double interval for adrenaline
Primary goal is preventing further heat loss.
>3 shocks is unlikely to be successful.
Where hypothermia is clearly the cause of cardiac arrest, mechanical CPR to hospital may be appropriate.

Question 14

When should compressions be performed on a paediatric pt? (3)

Answer 14

1. No palpable pulse
2. HR<60 (infants)
3. HR<40 (children)

Question 15

What actions need to be performed when ROSC is achieved? (3)

Answer 15

1. 12 lead ECG, consider PHT
2. If VF/VT arrest or suspected cardiac cause or post PHT, transport to PCI facility, consider AAV
3. Suspected non-cardiac cause, transport to closest appropriate hospital with notification

Question 16

Technique of compressions for infants, small children and medium children

Answer 16

Infants - two finger or two thumb technique
Small child - one handed similar to adults
Medium child - two handed same as adults

Question 17

What are the compression and ventilation rates for infants (no ETT/SGA)?

Answer 17

Two rescuers: 15:2
One rescuer: 30:2
100-120 compressions/min
Pause for ventilations

Question 18

What are the compression and ventilation rates for children (ETT/SGA insitu)?

Answer 18

100-120 compressions/min
10 ventilations/min
No pause for ventilations

Question 19

What are the criteria to determine APGAR score? (5)

Answer 19

1. Appearance
2. Pulse
3. Grimace
4. Activity
5. Respiratory effort

Question 20

What are the compression and ventilation rates for newborn?

Answer 20

3:1
90 compressions and 30 ventilations/min
0.5 second pause for ventilation

Question 21

What are the ECG rhythm criteria for VF? (5)

Answer 21

Ventricular rate: nil discernible 
Ventricular rhythm: bizarre, chaotic, amplitude >0.1mV
P waves: nil discernible 
PR interval: nil discernible 
QRS duration: nil discernible

Question 22

What are the common causes of cardiac arrest in paeds? (9)

Answer 22

1. Hypoxaemia
2. Hypotension
3. Trauma
4. Drowning
5. Septicaemia
6. SIDS
7. Asthma
8. Upper airway obstruction
9. Congenital heart abnormalities

Question 23

List the clinical elements in the determinants of death (6)

Answer 23

1. No palpable carotid pulse
2. No heart sounds for 2 mins
3. No breath sounds for 2 mins
4. Fixed and dilated pupils
5. No response to centralised stimulus
6. No motor (withdrawal) response or grimace to painful stimulus
   ECG strip of 2 minutes asystole is an optional additional finding

Question 24

What are the side effects of adrenaline? (7)

Answer 24

1. Sinus tachycardia
2. Supraventricular arrhythmias
3. Ventricular arrhythmias
4. Hypertension
5. Dilated pupils
6. May increase the size of AMI
7. Feelings of anxiety

Question 25

What are the benefits of administering adrenaline for cardiac arrest?

Answer 25

Alpha effects
- causes peripheral vasoconstriction
- increases peripheral vascular resistance
- increases venous return and eventually cardiac output and increased coronary perfusion pressures
- aids in perfusion the myocardium and providing a shockable rhythm
Beta effects
- increases irritability of the ventricles and myocardial contractility