Paediatric Resus : Week 8

Question 1

What are the age ranges for newborn, neonatal, and infant?

Answer 1

Newborn: birth–2 hrs, Neonatal: 2 hrs–28 days, Infant: 28 days–1 year.

Question 2

At what age does risk-taking behavior commonly begin in children?

Answer 2

Around 12–18 years (teenagers).

Question 3

Why might a towel be placed under a child’s shoulders instead of their head?

Answer 3

To prevent airway occlusion due to a large occiput in younger children.

Question 4

Why do children with laryngomalacia make noisy breaths?

Answer 4

Their trachea lacks solid cartilage and can collapse inward during inspiration.

Question 5

Why is a straight laryngoscope blade preferred in children under 4-6 years?

Answer 5

To directly lift the floppy epiglottis.

Question 6

Why are children more affected by airway swelling?

Answer 6

Their airway is narrower, so minor swelling significantly impacts airflow.

Question 7

What is the difference in asthma and bronchiolitis age ranges?

Answer 7

Asthma: usually >2 years; Bronchiolitis: usually <2 years.

Question 8

What is grunting in infants a sign of?

Answer 8

Auto-PEEP: the baby is generating back pressure to keep alveoli open.

Question 9

Why is small blood loss dangerous in children?

Answer 9

They have lower total blood volume (80 mL/kg), so small losses are significant.

Question 10

How do children maintain cardiac output during shock?

Answer 10

Mainly through increased heart rate (tachycardia).

Question 11

Why do children desaturate and become hypoglycaemic faster than adults?

Answer 11

They have higher metabolic rates and lower energy reserves.

Question 12

Why is hypothermia dangerous in paediatrics?

Answer 12

It increases metabolic demand and is difficult to reverse once established.

Question 13

What are key signs of a sick child?

Answer 13

Poor tone, uninterested in environment, abnormal posture, mottled skin, altered eye focus.

Question 14

What is the ABCDE approach in paediatrics?

Answer 14

Airway, Breathing, Circulation, Disability, Environment.

Question 15

What does ‘DEFG’ stand for in paediatric disability assessment?

Answer 15

Don’t Ever Forget Glucose.

Question 16

What are the compression:ventilation ratios for paediatric CPR?

Answer 16

Infant/child: 15:2; Newborn: 3:1.

Question 17

What is the initial shock dose for paediatric defibrillation?

Answer 17

4 Joules/kg.

Question 18

What BVM issue occurs when using adult-sized equipment on paediatrics?

Answer 18

Dead space prevents oxygen from reaching alveoli.

Question 19

When should an IGEL be inserted in paediatrics?

Answer 19

When mask ventilation is ineffective—insert in under 30 seconds.

Question 20

What is the correct method to confirm IGEL placement?

Answer 20

Check chest rise, misting in tube, and auscultation.

Question 21

What is the standard dose of adrenaline in paediatric cardiac arrest?

Answer 21

10 mcg/kg (e.g., 45 kg child = 4.5 mL of 1:10,000 solution).

Question 22

When is amiodarone given during paediatric arrest?

Answer 22

On the 3rd shockable rhythm; dose is 5 mg/kg.

Question 23

How much fluid is given per bolus in paediatric shock?

Answer 23

10 mL/kg of normal saline; up to 40 mL/kg total.

Question 24

What does a sudden rise in ETCO₂ indicate during paediatric CPR?

Answer 24

Return of spontaneous circulation (ROSC).

Question 25

Why insert an orogastric tube during ventilation?

Answer 25

To decompress the stomach and improve ventilation.

Question 26

What are the 4 Hs in paediatric cardiac arrest?

Answer 26

Hypoxia, Hypovolemia, Hypo/hyperthermia, Hypo/hyperkalaemia.

Question 27

What are the 4 Ts in paediatric cardiac arrest?

Answer 27

Tension pneumothorax, Tamponade, Toxins, Thrombus.

Question 28

What is the 'zero point survey' in paediatrics?

Answer 28

Proactive assessment including weight, equipment, drug doses before touching patient.

Question 29

How should parents be managed during resus?

Answer 29

Keep them present but not involved, assign a staff member to support and gather history.

Question 30

What is closed-loop communication?

Answer 30

Confirming orders verbally: e.g., 'I am giving 80 mcg adrenaline' → 'Thank you for giving it.'

Question 31

Why is a child’s airway more easily obstructed than an adult’s?

Answer 31

It's funnel-shaped, narrower, and has a proportionally larger tongue and floppy epiglottis.

Question 32

Why are children more affected by croup than adults?

Answer 32

Their smaller trachea means minor inflammation can significantly narrow the airway.

Question 33

Why is it important to avoid touching the epiglottis in children?

Answer 33

It can trigger vagal stimulation, leading to bradycardia.

Question 34

What effect does a higher surface area to volume ratio have on children?

Answer 34

Increases risk of hypothermia.

Question 35

How does a child’s chest wall affect respiratory assessment?

Answer 35

Less rigid ribs lead to more visible retractions and chest movement with effort.

Question 36

What are signs of severe respiratory distress or impending arrest in children?

Answer 36

Silent chest, cyanosis, and sudden reduction in effort after initial labored breathing.

Question 37

Why is central capillary refill more accurate in children?

Answer 37

Peripheral perfusion can be misleading due to cold or stress.

Question 38

What is the significance of reduced bowel or urine output in children?

Answer 38

It may indicate dehydration, sepsis, or circulatory compromise.

Question 39

What behavioral signs indicate a potential neurological issue in children?

Answer 39

Persistent irritability, altered tone, posturing, or reduced response to pain.

Question 40

What does 'consolable vs inconsolable' help determine?

Answer 40

Whether the child’s irritability is due to discomfort or serious neurological dysfunction.

Question 41

Why is it better to use two hands for a BVM mask seal in paediatrics?

Answer 41

Ensures an effective CE-grip seal and controlled ventilation.

Question 42

What is the preferred airway adjunct in paediatrics during arrest?

Answer 42

IGEL, due to ease of placement and effectiveness.

Question 43

What should be done if BVM ventilation fails before using adjuncts?

Answer 43

Reassess positioning and mask seal before adding adjuncts.

Question 44

What syringe size is typically used to push fluids through an IO line?

Answer 44

50 mL syringe (pressure bag not effective with IO).

Question 45

What is a normal ETCO₂ range for paediatrics?

Answer 45

35–45 mmHg.

Question 46

What does a rise in ETCO₂ suggest during CPR?

Answer 46

Likely return of spontaneous circulation (ROSC).

Question 47

Why should reassessments occur after every move or intervention?

Answer 47

Equipment or airway placement may shift and require correction.

Question 48

What is the purpose of applying a 12-lead ECG post-ROSC?

Answer 48

To identify rhythm abnormalities or underlying metabolic causes.

Question 49

What temperature is considered critical hypothermia in children?

Answer 49

Below 35°C — resus drugs and shocks become less effective.

Question 50

What is the protocol if a child is in arrest and hypothermic?

Answer 50

Only 3 shocks should be delivered until the core temp rises.

Question 51

Why is observing spontaneous movement and posture in a child important?

Answer 51

A lack of movement or abnormal posture may indicate neurological dysfunction or serious illness.

Question 52

What’s the clinical importance of eye movement in children during assessment?

Answer 52

Fixed gaze or unresponsive eyes may signal reduced consciousness or cerebral hypoxia.

Question 53

How do sick children usually respond to examination?

Answer 53

They may not resist or interact, indicating reduced energy or altered mental state.

Question 54

What does HALTS stand for in bias checking during a resus?

Answer 54

Hungry, Angry, Late, Tired, Stressed — factors that may impair clinical performance.

Question 55

What is Zero Point Survey?

Answer 55

Pre-contact preparation: scene safety, equipment, team roles, and bias check.

Question 56

Why is it important to maintain 360° access to a paediatric patient during resus?

Answer 56

Ensures efficient teamwork and rapid intervention from all angles.

Question 57

How do you prepare 1:10,000 adrenaline for paediatrics?

Answer 57

Dilute 1 mL of 1:1,000 adrenaline with 9 mL saline to get 100 mcg/mL.

Question 58

How much adrenaline would a 15 kg child receive during cardiac arrest?

Answer 58

10 mcg/kg = 150 mcg = 1.5 mL of 1:10,000.

Question 59

When should amiodarone be given in paediatric cardiac arrest?

Answer 59

On the 3rd shockable rhythm, at 5 mg/kg IV/IO.

Question 60

What is the fluid resus limit for paediatrics before reassessment?

Answer 60

4 boluses (10 mL/kg each), up to 40 mL/kg total.

Question 61

What should you allow for during ventilation of an asthmatic arrest?

Answer 61

Longer expiratory time due to gas trapping and hyperinflation.

Question 62

How does hyperinflation appear in an asthmatic child?

Answer 62

Barrel chest, no chest rise, poor air movement.

Question 63

What CPR considerations exist for children post-drowning?

Answer 63

Prioritise effective ventilations to reverse hypoxia as the cause of arrest.

Question 64

What does a perfect paediatric resus handover include?

Answer 64

ISBAR format: Identification, Situation, Background, Assessment, Recommendation.

Question 65

Why is leadership important in paediatric resus?

Answer 65

It maintains team structure, reduces confusion, and supports closed-loop communication.

Question 66

What is the benefit of assigning someone to support the parents?

Answer 66

Provides emotional support and frees up the team for clinical tasks.

Question 67

What ETCO₂ trend suggests a successful ROSC?

Answer 67

A rapid rise in ETCO₂ followed by stabilization between 35–45 mmHg.

Question 68

After ROSC, what should be reassessed?

Answer 68

Airway patency, ventilations, equipment, ETCO₂, perfusion, and temperature.

Question 69

What ECG findings post-arrest could point to metabolic causes?

Answer 69

Peaked T waves (hyperkalaemia), broad QRS, or arrhythmias.

Question 70

What must be done each time the paediatric patient is moved post-arrest?

Answer 70

Reassess equipment, airway placement, ventilation quality, and circulation.