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EPALS EXAM QUESTIONS WITH ANSWERS
effects of inadequate circulation
- metabolic acidosis that leads to tachypnoea.
- agitation, drowsiness, eventual LOC.
- Reduced UO infants: 2ml/kg/hr, child: <1ml/kg/hr Central Pulse points carotid, femoral and brachial COMPARE THESE WITH PERIPHERAL (RADIAL) How much fluid can be lost before hypo tension occurs? 40% Posturing in very sick children Decorticate: fixed arms + extended legs Decerebrate: Extended arms + legs BOTH show SEVERE BRAIN DYSFUNCTION Supraglottic airway devices
Eg: Larygeal mask airway Use if BMV unsuccessful. is an alternative to intubation. Only to be used if child is unconscious When to ventilate?
- Apnea: patient lacks power/muscle to breathe at all
- Hypoventilation: patient moving inadequate volume, CO retention
- Impending ventilatory failure: working so hard that hypoventilation/apnea is inevitable
- ineffective BMV
- need for protection of airway from aspiration of gastric contents
- GCS less than 8 choice of laryngoscope Straight: neonates + under 1s Curved: children and adolescents When to consider tracheal intubation?
- Ineffective BVM
- Severe upper airway obstruction such as burns
- Deep suctioning needed
- Instability How to confirm intubation
- end tidal C02 monitoring
- Symmetrical chest rise and fall
anaphalaxis Dosage: 0.1ml/kg of 1:10,000 solution. IV or IO. can be repeated every 3-5 mins. NEVER GIVE WITH SODIUM BICARB Indications for amiodarone If VF or PVT continues after 3rd defib to give amiodarone alongside adrenaline and give after 5th shock if defib still unsuccessful Indications for adenosine SVT Half life lasts around 10 seconds and should be injected fast and as close to the heart as possible Indications for atropine Bradycardia resulting from vagal simulation indications for naloxone opioid overdose indications for lorazepam seizure longer than 5 mins. dosage: 0.1mg/kg indications for synchronised cardioversion SVT (narrow) and VT (broad) can be chemical or electrical
ECG
PQRST
P wave: SA node QRS Complex: depolarisation of ventricles and ventricular contraction T Wave: ventricular repolarisation. related to electrolytes. SVT Narrow complex. Abrupt onset. Infants > 220/min Child >180/min Treatment= vagal manoevures. cardioversion with synchronised electrical impulses, adenosine. Paediatric airway differences
- airway narrower
- head larger so flexes on neck can cause partial obstruction
- small mouth but large tongue
- nasal breather up to 6 months
- higher larynx (creates sharp angle) Paediatric breathing differences
- small resting lung volume so low o2 reserve
- relies on diaphragm more than muscles Paediatric circulation differences
inadequate distribution of blood, flow insufficent for the demand of the tissues. Eg: anaphlaxis, sepsis Obstructive shock obstruction of blood flow to/from the heart causing insufficient blood supply to the body's tissues. Eg: tension pneumothorax, cardiac tamponade Dissociative shock insufficient oxygen carrying capacity of blood. Eg: anaemia, co2 posioning Hypovolaemic shock reduced circulating volume, severe fluid loss. eg: major haemorrhage cardiogenic shock inadequate function of the heart. congenital/heart disease Cardiac Output Heart rate X stroke volume. As stroke volume decreases so does pulse amplitude Shockable rhythms Ventricular Fibirlation (VF) and Pulseless Ventricular tachycardia (PVT) 1 shock (4J/KG) CPR 2 mins. After 3 shocks give amiodarone + adrenaline Non-shockable rhythms
Pulseless Electrical activity (PEA), Asystole, Bradycardia <60/min. CPR-> adrenaline ASAP then every 3 - 5 mins. CONSIDER + CORRECT REVERSIBLE CAUSES 4 H's Hypoxia Hypovalaemia: loss of circulating vol. FLUIDS Hypo/Hyperkalaemia: Check BM. Hypo/Hyperthermia: >34 do not re-warm. IV fluids and cooling mattress 4 T's Tension Pneumothorax: requires rapid needle decompression Tamponade: may occur post cardio surgery/chest trauma Toxins: antidotes as required Thrombosis PH of blood PH of blood: 7.35-7. <7.35= acidaemia >7.45= alkalaemia blood gas analysis Ph= severity of condition Respiratory acidosis= pneumonia, asthma, neuromuscular disorders + coma. Metabolic acidosis= D+V, sepsis, heart failure, diabetic ketoacidosis + shock.
5 mins give buccal 0.3-0.5mg/kg or loraz 0.1mg/kg 10 - 15 mins give loraz 15 - 35 min give levetiracam/phenytoin/phenobarb management of DKA fluid rehydration over 48 hours. 1 - 2 hours post fluids commencing start insulin infusion monitor serum K+ strict fluid balance 1 hourly gases and BMs 1 - 2 hourly ketones check 2 hourly U+Es 1/2 hourly neuro obs What is Hyponatremia? deficient sodium in the blood. <135 mmol. seizures can occur below 125 mmol What is Hypernatremia? high sodium. over >145 mmol. What is hypokalaemia/hyper? high/low potassium levels. normal ranges: 3.5-5. How to treat hypercalcaemia? Fluid resuscitation (twice daily amount) furosemide Neuroprotection
- use femoral veins for CVL
- head and chest elevate to 30 degrees after hypotension treated to aid venous drainage
- maintain MAP
- low normal co2 (4.5-5kPa)
- hypertonic saline/mannitol if worried about RICP
- provide adequate analgesia and sedation The AcBCDE approach in trauma TREAT WHAT KILLS FIRST C- treat catastrophic haemorrhage with a haemostatic dressing or torniquet on long bone above injury Ac- manage airway being careful with neck immobilise C spine with person holding head or use blocks what is the treatment for cardiac tamponade? surgery to remove blood from around the heart treatment of tension pneumothorax immediate needle thoracostomy what medication do you give in severe blood loss? tranexamic acid within 3 - 4 hours at 15mg/kg. followed by an infusion. What temp is categorized as hypothermic? and how to test? Below 35. Oesophageal or rectal thermometer How to re-warm hypothermic patients?
