Regarding the assessment and management of the airway and breathing in children during resuscitation, which ONE of the following is TRUE?
Answer: C: An LMA cannot offer airway protection. Definitive airway protection requires insertion of an endotracheal tube, cuffed or uncuffed. No studies have proven that an ETT is better than BVM in the prehospital setting. Studies of resuscitation at out-of-hospital paediatric arrest either favour BVM or show no advantage of endotracheal intubation. One LOE I study compared paramedic out-of-hospital BVM with intubation for children with cardiac arrest, respiratory arrest or respiratory failure and found equivalent rates of survival to hospital discharge and neurologic outcome. One LOE I systematic review that included this study also reached the same conclusion.
A nasopharyngeal airway of appropriate length is the equivalent distance from the tip of the nose to the tragus of the ear.
Differences in the anatomy of the airway of the child compared with adults include a more anterior and cephalad larynx, a long floppy epiglottis and a shorter trachea.
References:
Regarding providing effective ventilation during paediatric resuscitation, which ONE of the following is INCORRECT?
Answer: D: Adequate inflation of the lungs is often possible with BVM ventilation, but this is a difficult technique for the non-expert. BVM ventilation is an acceptable technique if the lungs can be inflated adequately (Class B). BVM ventilation was associated with fewer complications than endotracheal intubation in out-of hospital prospective controlled studies when transport times to hospital were short (LOE II). BVM ventilation was no less appropriate than endotracheal intubation during cardiac arrest or trauma in retrospective studies (LOE III-2).
Cricoid pressure has not been shown to decrease aspiration risk. One LOE 5 study in adults has shown that cricoid pressure or laryngeal manipulation aids in intubation in some patients, but is a hindrance in others. The ILCOR treatment recommendation is that if cricoid pressure is used during emergency intubations in infants and children it should be discontinued if it impedes ventilation or interferes with the speed or ease of intubation.
Both cuffed and uncuffed tracheal tubes are acceptable for infants and children undergoing emergency intubation. Current ILCOR and ARC recommendations for endotracheal tube size, based on the internal diameter, consist of the following:
1- Uncuffed tubes:
2- Cuffed tubes:
If the tracheal tube meets resistance during insertion, a tube with an internal diameter (ID) of 0.5 mm smaller should be used. If there is no leak around the tube with the cuff deflated, reintubation with a tube ID 0.5 mm smaller may be beneficial when the patient is stable.
The Khine formula of estimating the appropriate cuffed tracheal tube size is: ID (mm) = (age/4) + 3. It is used in young children, from full-term newborns to children aged 8 years. However, recent evidence suggests that this formula underestimates the optimal tube size by 0.5 mm.
In the initial management of cardiac arrest in children, which ONE of the following is TRUE?
Answer: D: Children generally suffer cardiopulmonary arrest after a respiratory insult, therefore in an unwitnessed arrest attention is given to airway and breathing management – hence CPR first, then call for help. A single rescuer encountering an unwitnessed collapse of an infant or child should start CPR immediately and then obtain assistance. A rescuer witnessing a sudden collapse should obtain help immediately and then start CPR.
A variable dose manual defibrillator is preferred in children. A semi-automated external defibrillator may be used for infants and children (Class A) but its safety has not been proven. If a manual defibrillator is not available for infants and small children (aged 1–8 years), use of an adult AED with dose attenuation (e.g. delivering 50 J) is acceptable. If that is not available, an adult AED dose machine should be used. For children older than 8 years, a standard AED machine (for adults) may be used.
A 5-year-old boy has an unwitnessed collapse in a shopping center. Bystanders attempt CPR with a compression ventilation ratio of 30:2. Which ONE of the following is TRUE?
Answer: D
SUMMARY OF RATES AND RATIOS:
Based on: Australian Resuscitation Council. Guideline 12.2. Advanced life support for infants and children, diagnosis and initial management. December 2010. Online. Available: www.resus.org.au; 5 Jan 2011.
Reference:
When estimating drug dosages in children in the resuscitation room, which ONE of the following is INCORRECT?
Answer: C: Weight estimation is very important in paediatric resuscitation. Some evidence has shown that current estimation formulae underestimate children’s weights. The doses of drugs and volume of fluid therapy are based on body weight, which in non-obese patients is estimated according to age or height. In obese patients, initial doses, except selected drugs such as suxamethonium, should be based on ideal weight estimated from height.
Approximate weights according to age are:
Alternatively, weight can be estimated using a standard chart of children’s height and using the 50th percentile to estimate weight.
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