Paediatric resuscitation.

/10

What size non cuffed ETT should you look to use on a 6yr old boy.

This is for uncuffed endotracheal tubes. For cuffed endotracheal tubes you drop down by 0.5 so the formula is Age/4 + 3.5. Practically, use the formula as a starting point and have a tube 0.5 higher and lower ready and available if you find you need them.

Age/4 + 12 = 13.5

Age/4 + 4 = 5.5

Age/4 + 3.5 = 5

/10

Which of the following is incorrect about intraosseous needles in infants.

The EZ IO has meant putting in IOs has become far easier. It does however require practice as its use will occur in a very stressful situation.

Insertion is on the flat part of the tibia a finger breath below the tibial tuberosity.

For< 40kg when using an EZIO use a pink 15mm IO needle.

It is good for fluids but not drugs.

The IO route is essentially the same as IV (dose and speed).

/10

All of the following about an infants compared to an adults airway are correct except one.

The infants vocal cords in fact slant anteriorly not posteriorly. Adults are fairly horizonttal.

The infant larynx is more anterior.

The infants tongue is comparatively larger.

Vocal cords in an infant slant posteriorly.

An infants most narrow part of the airway is the cricoid.

/10

When doing chest compressions on a neonate what is the correct rate?

If the neonate is intubated then you can do uninterrupted compressions at 120/min. Remember that fixing the hypoxia is usually the way to get the heart rate up and that chest compressions are usually only required for a short time.

3 compressions to 1 breath at 90 compressions per minute.

Compressions in time with "Stayin Alive".

3 compressions to 1 breath at 60 compressions per minute.

Compressions in time with "God save the Queen".

/10

When performing hand bagging of an infant which is the best starting position of the neck in order to open the airway?

Things like the rounded occiput, short neck and anterior larynx supports using a neutral neck position to open the airway in those < 1yr. Mind you if it is not working fiddle the position as there is variation from infant to infant.

Neck in a neutral position.

Neck under extended.

Neck hyperextended.

Neck slightly extended.

/10

Which of the following is not an emergent priority in a patient who is conscious with evolving meningicoccal disease?

Intubation of infants developing septic shock can precipitate cardiovascular collapse. If required it needs to be thought through carefully. This means optimising fluid resuscitation, getting inotropes started and agreeing on which induction and maintenance drugs will be used.

Endotracheal intubation.

Ceftriaxone at 100mg/kg IV

Fluid resuscitation.

Early involvement of NETS.

/10

What average weight do you think a 4yr old would be?

APLS used to use the formula (Age + 4) times 2. Then it changed to 3 different formulae depending on age ---for 1 to 5yr olds it is (Age times 2) + 8. Mild you that gives you 16kg, the same as the old APLS equation. Essentially use a calculated weight if you are forced to but get a real weight as soon as possible.

About 15kg

(Age times 2) + 8 = 16kg

Where I work probably 30kg.

(Age + 6) times 2 = 20kg

/10

Which of the following is correct about umbilical vein catheterisations?

Cut the umbilicus to about 1.5cm from the skin after looping and gently typing umbilical tape around it and have your umbilical vein catheter and mosquito forceps primed and ready. It varies a little but generally the umbilical vein remains patent and able to be catheterised for up to a week after birth.

The umbilicus has a single vein at 12oclock and 2 arteries at 5 and 7pm.

The umbilicus has a single artery at 12oclock and 2 veins at 5 and 7pm.

Cut the umbilicus flush to the skin to get a clean spot to start.

It can only be used for 24hrs after birth.

/10

Pick the incorrect statement about the use of the NeoPuff.

Technically there would be no time limit to its use. You have of course not protected the airway but if you are ventilating well you can use it as a bridge until assistance arrives or the patient improves.

You generally set the max inspiratory pressure around 20cm H20.

You can alter the Fi02.

You can alter the PEEP by screwing or un screwing the spring valve.

You can use it only for 15minutes to buy time before intubation.

/10

Who of the following tragically had a twin that died at birth?

Elvis was born 35min after his stillborn twin Jesse.

Elvis Presley.

Vladimir Putin.

Madonna.

Adolf Hitler.

You got {number correct}/{number of questions} correct answers