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APLS > BLS/ALS - VF/VT and drowning > Flashcards

BLS/ALS - VF/VT and drowning Flashcards

1
Q

What are the first steps in BLS

A
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2
Q

What are the initial aspects of opening an infants airway

A

Stabilise head
Neutral position of neck
Lift chin

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3
Q

If a chin lift is not effective what do you do with an infants airway

A

Jaw thrust
Note neck remains in neutral position

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4
Q

What is the main difference between the initial approach to an infants and a childs airway

A

Infant - neutral position
Child - Sniffing position

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5
Q

What comes after DRSA in BLS

A

Breathing - look, listen and feel

-> If the child is not breathing within 10 seconds, give two rescue breaths.

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6
Q

How does the delivery of rescue breaths given to an infant vary with that of a child

A

Infant - head neutral position
-Give breaths coving nose and mouth of infant when delivering

Child - sniffing position

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7
Q

What comes after breathing in BLS

A

If the child is unresponsive and is apnoeic or has abnormal breathing, cardiac compressions should commence unless a pulse can definitely be palpated in less than 10 seconds.

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8
Q

Where do you check for a pulse in a child? Infant?

A

Child - carotid, femoral or brachial

Infant - Femoral or brachial
[neck short and carotid can be difficult to palpate]

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9
Q

Compression to breath ratio in child?
Where is the hand?
How deep to press?
How fast?

Infant?

A

15:2 -
Heel of palm on lower half of childs sternum
Press 1/3 of chest deep
100-120bpm

15:2
2 fingers
1/3 diameter
100-120bpm

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10
Q

PALS with VF / VT on the monitor
When do you do the first shock?
What strength of shock?
What drugs are used? Dose? When?

A

Immediately
4j/kg
Adrenaline 10mcg/kg after 2nd shock then every 2 minutes
Amiodarone after 3rd shock 5mg/kg - only once

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11
Q

What are the 4Hs and Ts

A

Hypoxia -> 100% oxygen
Hypothermia ->
Hypovolaemia -> consider bolus 20mls/kg
Hyper/hypokalaemia

Tension pneumothorax
Tamponade
Thromboembolism
Toxins - expecially TCA -> sodium bicarbonate

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12
Q

Shock strength for VF/VT

A

Biphasic current is delivered at a dose of 4 joules per kg (and round up) - Max 200J

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13
Q

Where do you put pads on kids / infants

A

Kids - normal
Small/ infant - AP

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14
Q

11kg child with VF what shock strength

A

4 joules per kg rounded up to the closest setting on the defibrillator.

11kg, round up to 50 joules

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15
Q

60kg in VF shock strength?

A

60kg, we still use our 4 J/kg rule but only deliver a shock of 200 joules

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16
Q

how much adrenaline in arrest for a 25kg child?
Amio?

A

Adrenaline 25kg = (10mcg/kg) = 2.5mls of 1 in 10,000
Amiodarone = 5mg/kg = 125mg

17
Q

When charging a defib who stands away who carry on

A

Chest compressions continue while charging
Everyone else moves away

18
Q

Timings of adrenaline and amiodarone in APLS VF / pulseless VT

A

Adrenaline 10mcg/kg after 2nd shock then every second loop

Amiodarone 5mg/kg Once after 3rd shock

19
Q

Do you synchronise when defibrillating pulsless VT or VF?

A

NO

[The defibrillator is NOT synchronised for pulseless VT or ventricular fibrillation. Attempting to synchronise in these states will delay defibrillation or the defibrillator may be unable to synchronise]

20
Q

2 times where sodium bicarbonate is used in ALS

A

tricyclic anti-depressant overdose
or severe hyperkalemia

21
Q

Which compression technique is better in infants?

A

The encircling finger technique is more effective than the two finger technique in infants

22
Q

How often should you switch the person doing chest compressions

A

Ideally the rescuer should be rotated every 2 minutes (1 cycle) with minimal interruptions

23
Q

How to work out ETT size for kids

A

(Age/4) + 4

Have half size up and below

24
Q

What is the most common rhythm in a paediatric arrest?

A

Asystole

25
Q

Management of non-shockable rhythms in PALS algorithm?
Which drugs? How often?

A

Adrenaline - 10mcg/kg immediately then every second cycle

26
Q

In an infant how do you insert a OPA ?

A

Measure from tip of the incisors to the angle of jaw

Under vision Eg with a tongue depressor / laryngoscope
-insert in correct orientation (ie you don’t flip it in infant)

27
Q

How big a BVM do you want for infant?
What other things are important

A

Over bridge of nose and under lower lip
(not over chin)

Neutral position
finger under Jaw (not over soft tissues under chin)
Some pressure on mask

28
Q

BVM a child?
What else is important?

A

Over bridge of nose and below lower lip

Sniffing position
Fingers can come under chin to pull jaw up into mask

29
Q

What are the aspects of the preparation for intubation?

A

Team, Patient, IV drugs, monitoring, equipment

30
Q

Hypothermic arrest following drowning. Name 4 ways to aid re warming

A

Remove wet clothes
Blankets
Bair hugger
Direct heat packs eg over groin/axilla
Warmed IV fluids - 39 degrees
warmed vent 42 degrees
Warmed fluid into stomach/bladder
Extracorporeal blood warming

31
Q

Poor prognosis when downing

A

immersion >10mins
Delay in effective CPR
ED arrival - asystole, CPR, GCS<5
First respiratory effort after > 40mins
Need for vasoactive drugs

32
Q

Gold standard for confirming intubation

A

Capnography

33
Q

How is an infants airway anatomy different? What can you do?

A

The larynx is high and anterior and the epiglottis is relatively large.

External laryngeal manipulation and use of a straight laryngoscope may assist intubation

34
Q

If the radius of an infant’s airway is narrowed by half, the resistance to airflow past this obstruction will …?

A

increase 16 times!

[Infants are very prone to upper and lower airway obstruction due to small airway size. Airway resistance is inversely proportional to radius to the power of 4.]

35
Q

SVT algorithm + doses

A

Shock initial 1J/kg
Then 2J/kg

Adenosine 100mcg/kg then 200mcg/kg Then 300

36
Q

Bradycardia algorithm

A
37
Q

Newborn life support algorithm

A
38
Q

Newborn life support algorithm

A
39
Q

Which vagal maneuvers in kids

A

Ice bath
Blow on straw
Hand stand

NOT CAROTID MASSAGE

APLS (4 decks)

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