Epals 01 Flashcards by spencer shaw

Adrenaline dose
Arrest

10mcg/kg
0.1ml (1:10,000)

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Fluid bolus

Shock = 10ml/kg
Up to 40-60ml/kg

Euvolaemic/DKA
Trauma/cardiac = 10ml/kg
Up to 20ml/kg

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Glucose

2ml/kg 10%

Neonate = 2.5ml/kg

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Defibrillation energy

Cardiovert
1J/kg then 2J/kg

Arrest
4J/kg

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Amiodarone

5mg/kg

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Atropine

20mcg/kg

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Calcium chloride

10%
0.2ml/kg

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Lorazepam

100mcg/kg

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Adenosine

100mcg/kg

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Adrenaline Anaphylaxis

<5: 150mcg
6-12: 300mcg
>12: 500mcg

Or 1mcg/kg IV adrenaline

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D assessment

AVPU
Tone, posture, focal
BG
Pupils

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Weight estimation

(Age+4)x2

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Urine output above

Baby 6 wet nappies/day
Infant>2
Child>1ml/h

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CVS/Resp failure

RR>60
HR>180 (<1y)
HR>160 (>1y)

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Max O2 delivery
Diff equipment

Mouth -17%
Nasal spec - 40%
O2 mask - 60%
BMV - 90%
HFNC - 100%

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Vent rate
Cardiac arrest
V
Resp arrest

Cardiac: 10-12
V
Resp arrest: 12-20
Newborn: 30

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Ambu bag sizes

250ml: preterm
500: term- preschool
1000: school aged
2000: adult

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LMA sizes

1 - neonate (<5kg)
2 - infant (10-20kg)
3 - children (30-50kg)

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Resuscitation tape
Name

Broselow
Sandell

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DOPES acronym

Intubated patient issues

Displacement
Obstruction
PNX
Equipment
Stomach

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Trache problem
Algorithm

Remove inner tube
Suction
Deflate cuff
Remove tube
Rescue breaths
CPR

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Adrenaline infusion

Low infusion (beta)
<0.1mcg/kg

High inf (alpha)
>0.1mcg/kg

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Sodium bicarbonate
For TCA, prolonged arrest
Renal failure and high K

8.4% , 1ml/kg

Under 3m
4.2%, 1ml/kg

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Magnesium dose
TdP

10%
0.5ml/kg

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Naloxone doses

<5y 100mcg/kg max 2mg >5 = 2mg

ABG Normal range Bicarb CO2

Bicarb 22-26 CO2 4.5-6

Childhood airway diseases

Laryngotracheitis (croup) Epiglottis Bacterial tracheitis Bronchiolitis Asthma Anaphylaxis

Moderate asthma Tx

10 puff salbutamol in spacer every 20min for 1h +/- ipratropium Steroids; 2-5; 20mg Pred >5; 30-40mg pred

Acute severe asthma Tx

Neb salbutamol 2.5-5mg +/- iprtropium 250mcg +/- 150mg MgSO4 Steroids

Life threatening asthma Tx

As per Acute severe +/- IV salbutamol +/- IV hydrocortisone +/- IV aminophyline +/- IV magnesium

Tx neonatal cardiac problem

?prostaglandin infusion ? Duct dependent issue

Fluid refractory septic shock Tx (60ml/kg)

Cold shock - adren 0.05mcg/kg/m Warm shock - norad 0.05mcg/kg/m

Status epilepticus Tx

- Lorazepam 100mcg/kg x2 - Phenytoin infusion 20mg/kg over 20min - RSI

DKA dx

BG>11 Ketones; 2+urine, 3+blood Acidosis <7.3, bicarb<18

DKA management

Bolus for shock 10ml/kg Maintenance fluid + deficit over 24h Insulin 0.1 unit/kg/h Regular obs; BG, neuro, U+E

Hyponatraemic seizure

Correct Na to 125 3ml/kg of 3% NaCl Then 0.5mmol/h

Hypokalaemia Tx

0.5mmol/kg/hr

Trauma triad

Acidosis Hypothermia Coagulopathy (ca)

SCIWORA

Spinal cord injury without radiological abnormality

Aim PaCO2 in TBI

4:5-5kPa

Bloated abdomen Mx

NG tube Consider abdo path USS, CT, surgical

Total blood Vol child

70ml/kg

AMPLE hx

Allergies Medication PMH Last ate Events

Massive hameothorax Dx and Tx

20ml/kg from drain Clamp drain Massive haem protocol Thorocotomy

Morphine dose

0.1mg/kg

Hypothermia Tx

Actively reward to 32-34C

Newborn algorithm

Start clock Dry baby Asses tone, color, RR, HR 5 inflation breaths ?Repeat inflation Ventilate 30s CPR 3:1 Reassess every 30s

Weight estimation

(Age+4)x2 Up to age 10

RR <1y under xRR <12y over xRR

<1y under 40RR <12y over 20RR

sBP 1m over xBP 1y over xBP 10y over xBP

1m over 50BP 1y over 70BP 10y over 90BP

HR Newborn min Infant max Child max

Newborn min 100 Infant max 180 Child max 160

ETT size 1/2 sizes available Preterm/term Infant Children Adolescent

Preterm/term: 3mm Infant; 4mm Children; 5-6mm Adolescent 7mm

WETFLAG

Weight (age+4)x2 Energy 4J/kg Tube (age/4)+4 (+\-0.5) Fluid 20ml/kg or 10 Loraz 0.1mg/kg Adrenaline 0.1ml/kg (1:10,000) Glucose 2ml/kg (10%)

WETFLAG

Weight (age+4)x2 Energy 4J/kg Tube (age/4)+4 (+\-0.5) Fluid 20ml/kg or 10 Loraz 0.1mg/kg Adrenaline 0.1ml/kg (1:10,000) Glucose 2ml/kg (10%)

CPR method <1yo >1yo

<1yo; 2 fingers Or encircle with thumbs above xiphi >1yo 1-2 hands

Airway positions <1yo >1yo

<1yo; neutral; roll under shoulder >1yo; sniffing morning air Roll under head/neck

Cardioversion

1J/kg 2J/kg Amiodarone and 2J/kg

Mechanism for hyperventilation in brain injury

Reducing CO2 Causes vasoconstriction Lowers blood flow Reduces ICP Aim lower end of normal

Tracheal tube size

(Age/4)+4

Blood pressure cuff width

Over 80% upper arm length

CPR with intubation Ventilation rate per age Infant 1-8 8-12 >12

Infant: 25/min 1-8: 20/min 8-12: 15/min >12: 10/min

IO access can remain in situ for x hours

72h

IO insertions points

Prox tib Small child 1cm inferior and medial Old child: 2/3cm inf Humerus 1-2cm above surgical neck on most prominent part greater tubercle Distal femur Leg straight, 1-2cm above patella and medial

IO contra indications

Osteogenesis imperfecta Haemophilia Coagulopathy Infected skin Fracture or distal to fracture Previous IO within 48h

IO complications

Extravasation, Compartment syndrome Skin necrosis Fracture Damage to growth plate - none reported Infection - rare ? Fat Embolism