The collapsed child

Question 1

Common causes of cardiorespiratory arrest

Answer 1

Respiratory:

• Failure
• Obstruction
• Smoke inhalation

Cardiac:

• Arrythmia
• HF
• Myocarditis

Neurological:

• Cerebral edema
• Coning
• Head injury
• Birth asphyxia

Severe hypoxic-ischemia

• Drowning
• Suffocation

Drug ingestion

Trauma:

• MVA
• Intentional
• Falls
• Leading to airway trauma->pneumothorax, major vessel disruption, cardiac tamponade

Question 2

Pediatric advanced life support

Answer 2

Call for help
Open airway
Check for respiration
High flow oxygen ventilation
Mouth to mouth
15:2 CPR

During CPR:
LMA/ETT, oxygen
IV/IO access
Plan actions before interrupting

Consider and correct:
Hypoxia
Hypovolemia
Hyper/hypokalemia, metabolic
Hypo/hyperthermia
Tension pneumothorax
Tamponade
Toxins
Thrombus

Defibrillator->assess rhythm

1. Shockable (VF, pulseless VT)
   - Shock 4j/kg
   - Adrenaline 10mcg/kg after second shock, then every second loop
   - Amiodarone 5mg/kg after 3rd shock
2. Non-shockable (PEA, asystole)
   - Adrenalin 10mcg/kg immediately, then every second loop

Return of spontaneous circulation->
Post resuscitation care

Question 3

What is involved in post-resuscitation care

Answer 3

Re-evaluate ABCDE
12 lead ECG
Treat precipitating cause
Re-evaluate oxygen and ventilation
Temperature control->cool

Question 4

How to establish an airway

Answer 4

Chin lift->sniffing in child, neutral in infant
Jaw thrust if suspect cervical spine injury
Clear airway
2 breaths

Question 5

DRABCD

Answer 5

Danger
Response
Send for help
Open airway
Normal breathing? 2 breaths
Check pulse (10 seconds). Start CPR 15:2
Defibrillator, ensure help is coming

Question 6

Should the heimlick be attempted in infants and why/why not

Answer 6

No->risk damage to liver/spleen

Question 7

Choking child management

Answer 7

DRABC
Effective cough

1. Yes
   - Encourage coughing
   - Support and assess continuously
2. No
   - ->Conscious: 5 back blows then 5 chest thrusts with infant in head down position. Heimlick in older children >1 yo (chest)
   - ->Unconscious: open airway, 5 breaths, CPR

Question 8

External cardiac massage

Answer 8

In infants: encircle hands across chest compressing lower third of sternum with thumbs

In young children->heel of one hand/two in older

Question 9

Ratio of compressions to breaths in children vs infant

Answer 9

In children 15:2

In infants 3:1

Question 10

Child is breathing, non-responsive

Answer 10

Turn in recovery, left lateral position

Question 11

Focal points for assessment of collapsed child

Answer 11

Call for help
Rapid assess of responsiveness “are you all right”
If responsive + breathing, leave in position and await help
If no responding/not breathing- basic life support
Breathing but not responding->turn to recovery position
Continue basic life support until help, if CPR 1 minute, and no help, go get help

Apply pressure to any bleeding
Assess neurology->pupils, posture and LOC

Once help/in hospital

• continue BLS uninterrupted
• Commence ALS as indicated
• Commence monitoring
• ALWAYS check blood sugar levels
• Perform investigations and commence definitive treatment

Once stabilised, transfer to ICU