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2012-11-25 07:21:31

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  1. time to change to other recovery psotion side
  2. depth of chest compression
  3. Age >1 yr  ET tube internal diameter uncuffed=
    (age/4) +4 mm
  4. Age >1 yr ET tube length oral uncuffed
    (age/2) + 12 cm
  5. Age >1 yr ET tube nasal uncuffed
    (age/2) + 15 cm
  6. Et tube type for me
  7. Neonates Et diameter uncuffed
    3-3.5 mm
  8. Preterm ETT diameter uncuffed
  9. Cuffed ETT diameter age >2 yrs, 1-2 yrs, <1 yr
    • (age/4) +3.5 mm
    • size 3
    • size 1-2
  10. best size of self inflating bag
  11. in recovery oxygen sats target
  12. Four H's
    Hypoxia, Hypovolaemia, hyper/hypo-kalaemia/metobolic disorders, hypothermia
  13. Four T's
    Tension pneumothorax, toxins, cardiac tamponard, thromboembolic event
  14. In PEA what Ts/Hs cause it
    Tamonade, tension pneumothorax, hypovolaemia

    also occurs in hypothermia, electolyte imbalances and calcium channel toxicity or massive PE
  15. In Asystole what Ts/Hs cause it
    Hypoxia and Hypovolameia
  16. VT/ VF what Ts/Hs cause it

    one other cause

    suggestive hx of collapse?
    Hypothermia, Hypoxia, hyperkalaemia (abnormalities in ca, gluc, k), toxic substances (digitalis/tricylics)

    +congenital heart disease

    hx of sudden witnessed collapse
  17. Dose of adreniline in PEA/Asystole
    10mcg/kg (0.1mllkg of 1:10,000)
  18. As last resort us ETT adrenaline at what dose

    ie 1ml/kg of 10,000
  19. time between each dose of adrenaline =
    immediately then every 2min
  20. IO landmarks
    anterior surface 2-3 cm below tibial tuberocity or 3cm above the lateral condyle.
  21. Sodium bicarb used in what situations
    • tricyclic overdose, hyperkalaemia, pfound acidosis as this may inhibit the effect of adrenaline.
    • 1mmol/kg = 1ml/kg of 8.4%
  22. When to use calcium
    documented hypocalcemia, hyperkalemia, treatment of hypermagnesaemia and calcium channel blocker overdose
  23. Atropine use
    combating excessive vagal tone
  24. Dose and synconicity of defibrilliation
    4J/kg asynconus
  25. Rate of chest compression
  26. ventilation rate
    10-12 bpm
  27. paediatric paddles used for
    children under 10kg
  28. change operator every
    ~ 3min
  29. in asystole, at 2min check also asses
    paddle positions
  30. If organised rythem then -

    If ROSC (return of spontaneous rythme) - breathing rate =
    Assess for signs of life

  31. Signs of life -=
    reg rep effort, cough, eye opening or increase end tidal co2
  32. If organised electrical activity after resus, check for pulse then what
    if no pulse or pulse below 60 with poor perfusion + no signs of life go to PEA sequence
  33. Placement of defib pads in under 10kg child. If only large pads are avaliable go for,
    apex mid axillary line, other just below the clavical, right of sternum,

    large on;y on on back and one lower left chest on the front.
  34. Don't use AED with whom
    infants, ok with children
  35. use monophasic or byphasic
    eith is acceptable but biphasic is better.
  36. Pitfalls of capnography

    effects of adrenaline and bicar
    absence of wave form more likely due to poor pulmnonary perfusion, good CPR = better co2 output,

    adrenaline will decrease co2, bicarb will increase co2
  37. theraputic hypothermia target and length of treatment, effect of shivering
    32-34 for 24hrs, may need sedation or neuromuscular blockade if shiering
  38. What should be adjusted post resusitation to maximise outcome
    Haemocrit, electrolytes, acid base, glucose
  39. What is needed post resusitation
    CXR, ABG, Hb, Haemocrit, Plt, G&S, UEC, Clotting, BM, LFT, urine dip +MCS, ECG
  40. Liver related complications post arrest
    time to onset?
    effect of ischaemia?
    • up to 24hrs --> hepatocyte damage
    • coagulation factor depletion
    • concominant intravascular coagulopathy
  41. Cardiac related complications post arrest

    • poor cariac perfusion
    • 20ml/kg ivf,
    • normalise pH,
    • Oxygenation support,
    • inotropes to optimise cardiac output,
    • correct elecrtolytes
    • resolve hypoglycaemia
    • maintain temp
  42. respiratory considerations post arrest
    decreased GCS c impaired gag,

    needs intubation monitoring of ventilation sats above 90
  43. Kidney related considerations post arrest


    Tx req
    need to maximise renal tubular patency

    measure urine output

    good 02, intropes/fluids for bp, diuretics for output, normalisation of UEC + pH on bloods and urine
  44. post resus care cardiac
    dobutamine, dopamine, adrenaline
  45. Brain related treatments
    control of seizures, reduced intracranial pressures.
  46. weight of child and different age groups
    • 0-12m= 0.5age + 4 [age =months]
    • 1-5yr= 2age + 8 [age=years]
    • 5-12yr= 3age + 7 [age=years]
  47. Weight of child >1
    0.5 x age in months + 4
  48. weight of child by age(1-5 years)=
    2age +8
  49. increase rsp effort signs
    inc rr, stridor, assess muscle, wheeze, grunting, child position, nasal flaring
  50. efficacy of breathinng
    • expansion c symetry
    • air entry fron, back auxilla, normal or reduced, asymetrical or bronchial
    • sats
  51. hypoxia leads to what change in heart rate
    initally tachy then brady
  52. hypoxia cause what effect of skin
    vasoconstriction + pallour
  53. signs of raised ICP Cushing triad, plus what other signs
    irregular slow respiration, hypertension, bradycardia + widening pulse pressure(elevated systolic with normal/ decreased diastolic)
  54. assessment of cirulation
    skin colour/temp, hypotension, hr, cap refil, pulse volume, confusion, cold peripheries, reduced urine output
  55. cuff size
    80% length of arm and bladder more than 40% of arm
  56. what is ment by pulse volume
    • absent peripheral and weak central = shock
    • bounding pulse can be increased by inc car output, arterio-venous shunting(PAD) or hypercapnia
  57. Urine output minimum in infants and children
    • infants 2mg/kg/hr
    • child, 1mg/kg/hr
  58. Decorticate =
    flexed arms, extended legs
  59. Decerebrate
    extended arms and extended legs
  60. Signs of cardiac cause for respiratory symptoms
    Cyanosis not correcting with respiroty effort, tachycardia out of proportion to resp effort, raised JVP, gallop rythem, enlarged liver, absent femoral pulses
  61. What menatal state changes can you get with respiratory insufficency
    irratablity or drowsyness.
  62. Rate to use o2 through nasal catheter
  63. signs of sever asthma
    • rr >30 in >5yrs or>50 in2-5yr
    • hr >120 in>5yrs or >130 in 2-5yrs
    • too breathless to feed/talk
  64. Signs of life threatening asthma
    exhaustion, poor resp effort, silent chest, hypotention, agitated/decreased concious effort
  65. considere ventilation of astmatic is pco2 raises above?
  66. target sats in bronciolitsis
  67. Antibiotics for pneumonia if probable agent is:
    common pathogen
    ass c sepsis
    staphylococcus aureus
    pertussis or atypical
    • cefuroxime
    • cefotaxime
    • flucloxacillin
    • macrolide
  68. WETFAG stands for
    • Weight - 2(age+4)
    • Energy - 4J/kg
    • T- trach tube - int diam (age/4) + 4, leng oral (age/2) +12, nasal length (age/2) + 15
    • F 20mls/kg
    • A adren - 0.1ml/kg of 1:10000
    • Glucose 2mls/kg 10% dextrose
  69. Normal values: < 1 yr (HR, RR, systolic BP 5thand 50th)
    • HR 110-160
    • RR 30-40
    • BP 65-75 and 80-90
  70. Normal values: 1-2 yr (HR, RR, systolic BP 5thand 50th)
    • 100-150
    • 25-35
    • 70-75 85-95
  71. Normal values: 2-5 yr (HR, RR, systolic BP 5thand 50th)
    • 95-140
    • 25-30
    • 70-80 85-100
  72. Normal values: 5-12 yr (HR, RR, systolic BP 5thand 50th)
    • 80-120
    • 20-35
    • 80-90 90-110
  73. Normal values: >12 yr (HR, RR, systolic BP 5thand 50th)
    • 60-100
    • 15-20
    • 90-105 100-120
  74. Abx of choice in toxic shock syndrome, why
    vanc or fluclox as needs to be anti-staphyloccal
  75. What is considered a fast hr in a infant
    • inf - 200
    • child 150
  76. concentration of adrenaline infusion
  77. atropine dose
    0.02mg/kg min.1mg max 2.0mg
  78. Drug for SVT
  79. VT in an awake, shocked child ?dose of shock and type,
    synconised 1J/kg then 2J/kg
  80. SVT = on ecg
    trachy + normal qrs
  81. VT= on ecg
    tachy + narrow qrs
  82. treatment of brady + ABC falure
    o2, ventilate, fluids
  83. treatment of brady + vagal overstimulation
    o2 ventilate, atropine
  84. treatment of brady + raised ICP
    intubate, ventilate to keep co2 as normal as possible, head up (20deg) and in line, mannatol (0.5g/kg), ?? steroids
  85. treatment of brady + bblocker or dig toxicity
    o2 + adrenaline
  86. complete heart block
    o2 adren or isoprenaline
  87. Symptoms of sinus tachy
    • hr <200
    • beat to beat variablity and responds to stimulation
    • hr slows gradually in response to tx
    • hx consistent with shock
  88. symptoms of SVT
    • hr >220
    • no beat to beat varraiblity
    • termination of SVT is abrupt
    • poor feeding, breathlessness, signs of heart failure in infants, in older children symptoms of dizziness, palpitations and chest discomfort.
  89. Causes of VT
    • overdose of: tricyclics, procainamide, quinidine or macrolids.
    • Hx of renal disease
    • ++K, Mg, Ca
  90. vagal manouvers
    cold water dunk, massage, valsalva, blow through straw
  91. dose of adenosine
  92. SVT - no shock thus valsalva, then defibrilate at what dose? try what drug
    synchonus 1j/kg then 2j/kg then amiodarone
  93. SVT - no shock thus valsalva, no difib avaliable try what drug? then what
    adenosine at 100mcg/kg, wait 2 min then 200mcg/kg, wait 2 min then 300mcg/kg, then 400-500, but max 12mg in children or 300mcg neonates + then shoc + then think amiodarone
  94. side effects of adenosine, half life? - 10 sec
    flushing, nasuea, dysnopea, chest tightness, impending dome
  95. VT with pulse + shock Tx is
    DC shock 1j/kg, then 2j/kg, then amiodarone 5mg/kg over 30 min
  96. VT no shock pulse present, Tx?
    Amiodarone 5mg/kg over 30 min, dc synchronus shock
  97. VT secondary to tricyclics - other tricks? if hypotensive consider
    alkalization to ph 7.45-7.5, use NaHCO3 1-2mmol/kg or hypoventilate. noradrenaline
  98. GCS normal (4-adult) eye opening score
    • 4 spontaneous
    • 3 to verbal stimuli
    • 2 to pain
    • 1 no response
  99. GCS paed <4yr eye opening score
    • 4 spontaneous
    • 3 to verbal stimuli
    • 2 to pain
    • 1 no response
  100. GCS normal (4-adult) Best motor response
    • 6 obeys commands
    • 5 localises to pain
    • 4 withdraws from pain
    • 3 abnormal flexion to paindecorticate
    • 2 abnormal exstension to pain decerebrate
    • 1 no response to pain
  101. GCS normal (4-adult) Best verbal response
    • 5 Orientated and converses
    • 4 disorentated and converses
    • 3 inappropriate words
    • 2 incomprehesible sounds
    • 1 no response to pain
  102. GCS paed <4yr motor response
    • 6 obeys commands or spontanous
    • 5 localises to pain or with draws to touch
    • 4 withdraws from pain
    • 3 abnormal flexion to pain decorticate
    • 2 abnormal exstension to pain decerebrate
    • 1 no response to pain
  103. GCS paed <4yr
    • 5 alert; babbles, coos words to ususal ablitiy
    • 4 less than usual words, spontaneous irritable cry
    • 3 cries only to pain
    • 2 moans to pain
    • 1 no response to pain
  104. Causes of Fixed dilated pupils
    Hypothermia, anticholingergic drugs, during and post seizure, sever hypoxia, barbituate ingestion
  105. causes of  small or pinpoint reactive pupils
    Metabolic disorders, narcotic ingestion, medularry lesions, organophospate ingestion
  106. causes of unilateral dilation
    third nerve palsy, ipsilateral lesions, focal epiletic seziures
  107. symptoms suggestive of  cause of decreased concious state: Meningitis
    Fever, rash, onset over 1-2 days
  108. symptoms suggestive of  cause of decreased concious state: Child abuse
    young age,vague or inconsistant hx, other injuries
  109. symptoms suggestive of  cause of decreased concious state:
    Large liver, hypoglacameia, vomitng, odd smells
  110. symptoms / signs suggestive of  cause of decreased concious state:
    high bm acidotis polyuria
  111. symptoms / signs suggestive of  cause of decreased concious state: Hypertensive encephalopathy
    Headaches, high blood pressure, fundal changes
  112. symptoms / signs suggestive of  cause of decreased concious state: cerebrovascular event
    Sudden onset, focal neurological signs, severe headaches
  113. symptoms / signs suggestive of  cause of decreased concious state: poisoning
    Hx of exposure,pupillary signs,
  114. symptoms of meningits in a 1 year old
    Jaundice, poor feeding, wimpering, pale and blotchy, neck retraction, fretful, bulging fontanelle, blank expression, floppy, pyrexia, seizures, purpuric rash, lethergy, vomiting, drowsiness
  115. symptoms of meningits in a 12 year old
    pyrexia, seizures, purpuric rash, lethergy, vomiting, drowsiness photophobia, joint pain, neck stiffness, confusion, headaches, diarrhoea
  116. c/i to immedicate lumbar puncture
    reduced concious level,  signs of raised ICP, focal neurology, paillodema, bleeding disorders
  117. Dose CT or absence of papilodema r/o raised ICP
  118. Signs of raised ICP 8 (what additional symptoms might you get with if mass effect is the cause 6)
    • Headache, vomiting with out nausea, ocular palsy, altered GCS, back pain, papilledema, visual disturbances.
    • +mass effect = pupillary dilataion, abducens palsy, increased systolic pressure, widened pulse pressure, bradycardia, abnormal resp pattern
  119. infusion rate of novorapid in diabetes and what is the Kcl/l conc
    • 0.05units/kg/hr
    • 40mmol KCL/l
  120. what might make you suspicious of child abuse
    • vague or inconsistent hx,
    • deleay in presentation
    • Parent or carer appears to want to leav, is hostile or has a lack of anxiety
    • Hx of incident does not fit with pattern of injury
    • infant is not mobile
    • Childs interaction/appearence with carer suggests abusive relastionship
    • Child discloses abuse
  121. how long before you give benzos to stop fit?
  122. define status epliepticus
    generalised convusion continuous or intermittent without full recovery for 30 min
  123. Febrile convusions are from age          to          . how long must they last to be complex?
    6m  5 yrs, 15 min
  124. Causes of seizures in children
    • febrile
    • Cerebral hypoxia
    • CNS infection
    • Metabolic abnormalities (eg low bm, low Na, low Ca, high ammonia, hepatic encephalopathy)
    • Epilepsy
    • Anticonvulsant withdrawl
    • head injury
    • cerebral tumour
    • posining from tricylics or other drugs
    • systemic drugs
  125. considere what other abnormal movements disorders as DD to seizures
    • Postruing raised ICP
    • Dystonic reactions
    • peusdoepilepsy
    • Glucose
  126. High flow o2 and Glucose; 5 min of seziures then what
    • If IV access 0.1mg/kg lorazepam
    • No IV access 0.5mg/kg bucal midazolam or 0.5mg/kg recal diazapam
  127. Seziures; first dose of benzos given. now what,  
    wait 10 min and considere other causes of seizure, rpt 0.1mg/kg lorazapam via IO/IV, call for senior help and prepare phenytoin.
  128. seizures; 2 * benzos not worked then what?
    • wait 10min Phenytoin 20mg/kg IV/IO over 20min
    • consider rectal paraldehyde (0.4ml/kg) with olive oil
  129. seizures resistant to benzo and phenytoin now what
    with an anethetist 20min after start of infusion. rapid sequence induction, with thiopentone and short acting paralysing agent transfer to picu. Check ABC, bloods for glucose, ABG, urea, electrolytes and calciumm treat vital function problems, and metabolic abnormaliteis slowly. Treat pyrexia with paracetamol and diclophenac pr.
  130. lorazempma duration of action?
    • 12-24 elimation time
    • less resp depres than diaz
    • substitute 0.25mg/kg IV/IO if required
  131. midazolam - fast/slow acting, durtion long/short, resp depresion? Which is better diaz or midaz
    fast, short, 5% of patinets get resp depression, twice as effective as diazipam
  132. In terms of fluids what syndrome to think of re cns/acute resp problems
    increased ADH secreation --> reduced fluid output.
  133. List the three main fluid compartments
    • interstial
    • intracellular
    • intravascular
  134. 5% dehydration means?
    50g water/kg body weight 
  135. % of body weigh that is water?
    % of body weight that is intravacular fluid
    • bw -70%
    • iv - 8% (80mls/kg)
  136. hypovolameic shock will occur when? eqivilent to what mls/kg body weight
    • 25% of circulating volume lost
    • 20mls/kg body weight
  137. rapid loss of fluid from intravascular compartment will be replaced from other comaprtments?
    false, if fast can not be replaced in time and signs of dehydration maty not be present.
  138. Shock is treated by
    rapid replacement of fluids with electrolytes equivilent to plasma
  139. Dehydration is treated by
    gentle replacement of fluids with electrolyte concentrations relative to those lost in fluids.
  140. damage from electrolytes is related to
    extreme levels caused by pathology or rapid rates of change secondary to treatment.
  141. clincally dehydrated but not in shock = about what % water loss, how much fluid is that
    • 5%
    • 50ml/kg
    • 10 x % x Kg weight
  142. clincally dehydrated but in shock = about what % water loss
    at least 10%
  143. If patient is overloaded after first fluid bolus, what do they need?
  144. if replacing fluids of dehydrated patient when should you reasses? what should you reasses? what is a sutiable rate of na drop
    • 2-3 hrs ?returned to shock, ?weight gain ? electrolytes,
    • Na drop of about 0.5 - 1mmol/l/hr
  145. You reassess your dehydrated patient 3 hrs post iv therapy,
    what do you do if Na is not decreasing?, if weight is increasing but Na is not?When should I re moniter
    • 1) increase rate of infusion
    • 2) swap to lower conc of Na+ in the solution.
    • 3) 3hrs
  146. Child with hyponatraemia, normal obs and had chicken pox. ? what diagnosis, ? what Tx
    Varacella encephalopathy leading to SIAHD, needs fluid restriction and possibly iv N saline
  147. Co2 cleared by ventialtion, measure of ventilation is?
    minute ventilation (tidal vol x rr)
  148. base deficit=
    Base excess=
    • amount of base required to be added to balance the ph.
    • the amount of base required to be removed to normalise ph
  149. Atmospheric preseeure is 100 kpa, if air is 21% the parital pressure of O2 in air is (a), A-a drop is (b) kPa so the blood pO2 should be (c)
    • a. 21kPa
    • b. 7.5kPa
    • c. 13.5kPa
  150. If inspiring 50% o2, what should the pO2 be?
  151. Cspine precautions of a cooperative child
    inline immobilization and hard collar
  152. Cspine precautions of a uncooperative child
    hard collar only
  153. Cspine precautions of a unconcious child
    inline immobilization, hard collar, blocks and straps
  154. if cspine an issue and child vomits then -
    keep in line + suction
  155. fluid resusitation in trauma?
    10ml/kg alloquats call surgeons
  156. when is fast fluids bad in trauma
    if it might blow the clot of a internal haemorrhage
  157. when is fast fluids important in trauma
    in head injury maintaing bp is important, there fore if evcessive internal bleeding is unlikely in the situation then rapid re-expansion of intravascular compartment is good.
  158. at what point should you use blood as the resusitation fluid
    after 40ml/kg has been given.
  159. Whats the latest the surgeons should get involved?
    after 20mls/kg is given
  160. What GCS or pupilary change suggest need for immidate intervention
    Chil GCS of 8 or lower, pupilary abnormalities,
  161. What GCS or pupilary change suggest need for urgent intervention
    decresed GCS or focal signs
  162. interventions to be considered in neuro decompensation
    O2, control of co2 tension, maintain bp to supprot cerebral perfusion, Head up til at 20-30, in-line stabalisation, avoidance of compression of neck veins,mannitol (0.5g/kg) or hypotonic solution to lower ICP, anesthesia/sedation/analgesia to reduce cerebral metabolism, prompt tx of fits, an urgent CT head, alert neurosurgical team, Regular GCSs
  163. Spinal imaging requiored if any of?
    • posterior midline spinal tenderness
    • focal neurological deficit or pain
    • sedative drugs
    • painful distracting injury
    • reduced mental state
  164. Additional specific concerns where additional support is required
    Focalpain/tenderness, abnormal or uncertain imaging, drowsy or uncooperative or unable to assess
  165. if imaged and speecif concerns addressed thentest the following
    • able to axial rotate head 45o to left and right
    • appropriate head control, tolerates rotation of the trunk and bears weight of head when vertical.
  166. Tamponard list signs, symptoms and hx flags
    • Hypotensive
    • Muffled heart sounds
    • tachypnoea
    • tachycardia
    • may be the result of a penertrating injury of chest or upper abdomen
    • distended neck veins
  167. Tension pneumothorax list signs, symptoms and hx flags
    • SOB
    • Tachyponea
    • Tachycardia
    • Hypoxia
    • Surgical emphasema
    • (sometimes) distended neck veins
    • ipsilateral decreased air entry
    • (sometimes) delayed cap refil
    • ipsilateral hyper-resonance
    • tracheal deviation
    • (sometimes) hypotension
  168. Flail chest signs, symptoms and hx flags
    • possible abnormal chest movements
    • hypoxia
    • crepitus
    • Possible hx of chest compression or signifigant impact
    • tachycardia
    • tachypnoea
  169. Massive haemothorax list signs, symptoms and hx flags
    • SOB
    • Pain on breathing
    • Hypoxia
    • Tachypnoea
    • tachycardia
    • hypotension
    • ipsilateral decreased air entry
    • ipsilateral dullness to percussion
    • trach deviation to other side.
  170. Open pnuemothorax list signs, symptoms and hx flags
    • Tachycardia
    • Tachypnoea
    • possible hypotension
    • ipsilateral decreased air entry
    • ipsilateral hyperresonace
    • sucking wound
  171. Treatment of Tamponard
    • high flow o2 + resovouir mask
    • IV access for volume replacement
    • Emergency needle pericardiocentesis
    • Emergency thoracotomy probably required
  172. Treatment of Open pneumothorax
    • High flow o2 through reservoir mask
    • 3 sided (out let valve style) occlusive dressing
    • surgical repair and definitive chest drain
  173. Treatment of massive haemothorax
    • High flow oxygen through reservoir mask,
    • iv access and volume replaced
    • large bore chest drain inserted urgently
  174. Treatment of Flail Chest
    • High flow oxygen through reservoir mask,
    • analgesia (iv morph then ? regional)
    • CPAP ventilatory support
    • ventilate and intubate if decompensating
  175. Treatment of Tension pneumothorax
    • High flow oxygen through reservoir mask
    • immediate needle thoracocentesis to relieve tension
    • chest drain inserted urgently to continue drainage and prevent recurrence
  176. adjuncts to abdominal examination
    • gastric decompression
    • urinary catheterization
    • fast scan
    • rectal examination
  177. managment of haemoperitnoneum is conservative, but signs of decompensation are required as laparotomy may still be required. what monitering is required?
    • frequent obs and hb levels
    • manage input output precisely
    • correct coagulopathies
    • have surgeons ready
  178. indications for laporotomy
    • perforated hollow viscus
    • persistent haemodynamic instablity
    • worsening distension and peritonism on clinical examination by an experienced surgeon
    • evidence of ruptured diaphram
    • evicerated (hanging out) bowel
  179. contraindication to nasogastric tube
    possible base of skull fracture
  180. imaging of choice if perforation of viscus is suspected
  181. the majority of children with solid organ damage can be managed
  182. Signs of a seerious head  injury
    • high energy transfer
    • loss of conciousness
    • altered level of conciousness on assessment
    • neurological signs such as headaches, persistent vomiting, convulsions, limb wealness,
    • evidence of penertrating head injury
  183. Causes of secondary brain injury
    • hypoxia
    • inadequate cerebral perfusion (low bp, high ICP)
    • excesive metabolic demands (fitting / hypoglycaemia)
  184. Places to look for blood loss
    • external
    • lungs percuss, inspect and auscultate
    • abdomen, palpate
    • limbs (femores)
  185. relation of pain to ICP
    ICP increased by pain
  186. gcs at which intubation is suggested
  187. standard dose of morphine for a child
  188. time taken for morphine to reach peak influence
    alternative med? dose? benifit/down side
    • 10min
    • fentanyl dose 0.5mcg/kg, fast onset, shorter 1/2 life
  189. indications for CT Head
    • witnessed loss of consciousness lasting > 5min
    • amnesia (antegrade or retrograde) lasting > 5 min
    • abnormal drowsyness
    • 3 or more descrete episodes of vomiting
    • clinical suspicion of non accidental injury
    • post traumatic seizure but no history no history of epilepsy
    • age >1yr and GCS< 14 in ED
    • age <1 year GCS <15 on assessment in ED
    • suspicion of open or depressed skull injury or tense fontanelle
    • any sign of basal skull fracture (haemotympanum, panda eyes, cerebrospinal fluid leakage from ears or nose, battles sign)
    • focal neurological deficit.
    • age <1 presence of brusing, swelling or lacerations > 5cm on the head.
    • dangerous mechanism of injury (high-speed road traffic collision either as pedestrian, cyclist, or vehical occupant, fall from > 3m, high speed injury from a projectile or an object.   
  190. what is the difference between retrograde and anterograde amnesia
    • retrograde is loss of access to information that was learnt before an injury occured.
    • anterograde is the loss of the ablity to form new memories after the brain insult.
  191. Spinal cord transection can cause profound                , resulting from the (b)
    shock, major vasodilation secondary to loss of vessel tone from autonomic dysfunction.
  192. most common location for vertebral #
    upper 3 vertebrae.
  193. maintaining cervical spine protection can be achichieved by:
    • keeping child on a firm surface (but removing spinal board as soon as it is practical to do so to avoid pressure injuries)
    • using in-line immobilisation for airway manoeuvers or when log-rolling.
    • applying a hard collar and blocks if required.
  194. in combative children - in-line stablization should
    not be inforced
  195. assessment of cspine consists of and can include  :
    • Inspection: looking for superfical injuries to the neck
    • Palpation: feeling for tenderness and any "step"
    • Neurological examination: if there any neurological signs a spinal specialist must be consulted
    • Plain xray
    • Ct /MRIscan
  196. Plain xray; role? excludes cord injury?
    • cord injury more likely if boney injury
    • no does not exlude it
  197. The four review lines on a spinal xray

    • A = Spinolaminar line
    • B= Posterior vertebral line
    • c= Anterior vertebral line
    • d= facet line only in true lateral
  198. Spinal imaging required if
    • Posterior midline tenderness
    • focal neurological deficit or pain
    • painful distracting injury
    • reduced mental state
  199. why ct when palin xray shows fracture
    show stablity, bone fragments that are in the spinal canal, angle of fracture.
  200. clear history from a witness that the injury did not involve  the cspine is enough to rule need for a ct
    quite possibly
  201. Injuries of the thorasic and lumbar spine it is/isn't common to include multiple levels.
    the large degree of mobility can lead to
    • is common as the force is dissapated
    • neurological involvement without signifigant skeletal injury.
  202. The main two factors in cellular destruction secondary to burns is
    contact time and temp.
  203. Symptoms that may indicate inhalation injury
    hx of exposure to smoke in confined area, carbonaceous sputum, depsits around the mouth the mouth and nose,
  204. Why should early intubation be considered in thermal injures
    odema is caused by thermal injury that can rapidly inpair the airway.
  205. After preoxygenation, how long should attemps at intubation be tried.
    ~ 30 sec
  206. to ensure correct positioning of ett you should listen where
    • anterior superior and inferios chest bilaterally
    • below auxilla
    • subdiaphramtic
  207. signs of inadaquacy to breathing post burns
    abnormal rate, abnormal movement, cyanosis (late sign)
  208. Burns: hypovolaemia is a early/late complication.
    best IV access is: consider?
    • late.
    • 2 cannula in non burnt areas
    • IO acceptable
  209. Burns equation first 24hr fluid requirement:
    When this fluid given
    • %burns x weight x 4
    • 1/2 over first 8 hrs (from time of burn)
    • remainder of next 16 hrs
  210. Burns: after 24hrs,
    give fluid to maintain urine output at 2ml/kg/hr
  211. Burns: calculating percentage: palm and adducted finger = how much
  212. Reasons for decreased concious level following burns.
    whyh needs measuring in intial assessment
    • hypoxia, head injury, hypovolaemia
    • provides baseline for later
  213. Issues re burns and exsposure
    burns vicitims loose heat quickly
  214. Types of burns
    • Superfical - sunburn/ reddened skin
    • parital thickness - pink mottled skin and blisters
    • full thickness- skin is white, chared and leathery
  215. care of wounds, cover?, cold compress? blisters?
    • sterile towels or cling film loosely applied
    • cold compresses but only gor 10min and only if less than 10% burns which are superfical or partial (kids get cold quick).
    • blisters left intact
  216. analgesia in burns:
    morphine 100-200 mcg per kg, titrate
  217. Specialist burns input required if any of the following
    • >10% partial or full thickness burns
    • >5 % full thickness burns
    • specialist areas: facem hands, feet perineum
    • circumfrential burns
    • inhalation injuries
    • chemical, radiation or high voltage elecrtical burns
  218. are cspine injuries associated with water
  219. How hypothermia alters APLS arrest protocol
    • VF/ VT algorithm only 3 shocks should be attempted, then CPR continued until patient is warm.
    • Time between resusitation drugs should be doubled in temp range 30-35.
  220. resusitation should be continued until core temperature is at least 32.
  221. treatment of stomach contents after intubation
    drain stomach contents
  222. methods of warming for children below 30 deg temp
    • warmed intubation air system
    • infrared heat lamp
    • remove cold/wet clothes
    • Warmed iv fluids to 39 deg
    • endovascular warming
    • gastric and bladder lavage with nsaline at 42
    • peritoneal levage with potassium-free dialysate at 42 deg
    • extracorporal blood warming
  223. methods of warming for children below 30 deg temp
    • warmed intubation air system
    • infrared heat lamp
    • remove cold/wet clothes
    • warmed blankets
    • heated blanket
  224. Electrolyte issues with hyporthermia
  225. the abc of radiological interpretation
    • adaquacy
    • alingnment
    • apparatus
    • bones
    • cartilage and soft tissue
    • disk space and diaphragm in the chest
  226. grunting is a form of peep in children with stiff lungs. is seen in infants in what situations?
    primarily pneumonia or pulmonary odema, also maybe raises ICP, abdo distension and peritonism.
  227. normal oxygenation of a child is
    97 to 100%
  228. cyanosis of a cyanotic heart disease child will be .... by o2 therapy
    largely unchanged
  229. bounding pulses occur in?
    as a result of increased cardiac output in conditons like septasemia, a/v systemic shunt (patent DA) and hypercapnia.
  230. temp affects cap refil how?
    • hot nil
    • cold decreases sensitivity
  231. a correct arm cuff is measured how?
    should be 80% of the length of the upper arm and bladder should strech 40% of the circumfrence.
  232. a child who is avpu p = what GCS
  233. severe extension of the neck could be sign of?
    menigitis or FB