Questions and Answers
What are the 4 parameters needed in evaluating the breathing of a victim?
What are the 5 parameters needed in evaluating the victim's circulation?
In pediatrics, the most common cause of arrest is secondary to Pulmonary ________.
disease
High-quality CPR involves starting compressions within 10 seconds after recognizing cardiac arrest. True or False?
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What is the purpose of an AED (Automated External Defibrillator) during CPR?
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What is the recommended dose of autoinjector for a patient weighing 10 to 30 kg during chest compression interruption?
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What is the maximum single dose of IM injection for a patient weighing 30 kg?
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What is the recommended maximum single dose of IV/IO injection if a patient is hypotensive?
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What is the dosage of racemic solution for croup treatment?
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What is the recommended continuous infusion dosage of Vasopressin for catecholamine-resistant hypotension?
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What is the loading dose of Milrinone for myocardial dysfunction and increased SVR/PVR?
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What is the recommended dose of Sodium Bicarbonate for sodium channel blocker overdose?
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Study Notes
Pediatric Resuscitation
Systematic Approach
- Main goal: Prevent cardiopulmonary arrest
- Most common cause of arrest in pediatrics: Secondary to pulmonary conditions
- Continuously evaluate, assess, and manage the patient until stable enough for transport to the next level of care
- If patient deteriorates, perform life-saving measures or interventions
Initial Assessment
- Visual and auditory tool to assess the patient's condition in the first few seconds of encounter
- Evaluate:
- Appearance or level of consciousness (AVPU)
- Breathing pattern (rate, effort, and abnormal sounds)
- Color (pink, pale, mottled, or cyanotic)
- Physiologic condition (respiratory distress, respiratory failure, life-threatening condition with or without signs of life)
Secondary Assessment
- Focus on resuscitation-oriented history and pertinent physical examination of the patient using the mnemonic:
- S - Signs and Symptoms
- A - Allergies
- M - Medications
- P - Past Medical History
- L - Last Meal
- E - Events prior to critical condition
Tertiary Assessment
- Includes laboratory, radiologic, and other diagnostic tests
- Makes a final diagnosis/impression and renders specific interventions to the patient
Pulmonary Conditions
- 4 types:
- Upper airway obstruction
- Lower airway obstruction
- Lung parenchymal disease
- Disorder of breathing control
Breathing
- 4 parameters to evaluate:
- Rate of breathing
- Effort of breathing
- Air entry or breath sounds
- Oxygen saturation
Circulation
- 5 parameters to evaluate:
- Heart rate
- Blood pressure
- Central and peripheral pulse
- Capillary refill time
- Urine output
- Presence of shock distinguished by severity:
- Compensated shock
- Hypotensive shock
- Classify the type of shock the patient is suffering from (e.g., hypovolemic, distributive, obstructive, cardiogenic)
Disability
- Check for:
- Level of consciousness (AVPU)
- Neurologic status of the patient
- Blood sugar
Exposure
- Check for:
- Fever (temperature of 37.8°C)
- Rashes
- Bruises on the patient's body
CPR
- Components:
- Chest compressions
- Airway
- Breathing
- High-quality CPR:
- Start compressions within 10 seconds of recognizing cardiac arrest
- Push hard, push fast: Compress at a rate of 100-120/min with a depth of:
- At least 5cm for adults, but no more than 6cm
- At least one-third of the chest, approximately 5cm, for children
- At least one-third of the chest, approximately 4cm, for infants
- Allow complete chest recoil after each compression
- Minimize interruptions to 30 seconds or less
AED
- Components:
- Lightweight, portable, computerized device
- Can identify an abnormal heart rhythm as shockable or non-shockable
- Can deliver a shock to stop the abnormal rhythm and allow the heart's normal rhythm to return
- How to use an AED:
- Open the carrying case (if applicable) and power on the AED if needed
- Attach the AED pads to the victim's bare chest, avoiding clothing, medication patches, or implanted devices
- "Clear" the victim and allow the AED to analyze the rhythm
- If the AED advises a shock, it will prompt you to clear the victim and then deliver a shock
- If the AED prompts that no shock is advised or after any shock is delivered, immediately resume CPR, starting with chest compressions
Medications
- Epinephrine:
- Dose: 0.01mg/kg (0.01ml/kg of 1 mg/ml concentration) IM q 15 minutes PRN (max single dose 0.3 mg)
- Indications: Asthma, croup, and anaphylaxis
- Norepinephrine:
- Dose: 0.05 to 0.5 mcg/kg per minute IV/IO infusion
- Indication: Hypotensive (usually distributive) shock
- Vasopressin:
- Dose: 0.0002 to 0.002 unit/kg per minute (0.2 to 2 milliunits/kg per minute) continuous infusion
- Indication: Catecholamine-resistant hypotension
- Milrinone:
- Dose: Loading dose: 50 mcg/kg IV/IO over 10 to 60 minutes followed by 0.25 to 0.75 mcg/kg per minute IV/IO infusion
- Indication: Myocardial dysfunction and increased SVR/PVR
- Sodium bicarbonate:
- Dose: 1 mEq/kg IV/IO slow bolus
- Indications: Metabolic acidosis, hyperkalemia, and sodium channel blocker overdose
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Description
This quiz covers the principles and guidelines for pediatric resuscitation, including assessment and management of pediatric patients. It includes decision-making scenarios for medical professionals.
