CICM SAQ 2015.2 Q25

Difficult to give exact template, as style may vary, but should include:

Initial Assessment/Primary Survey

• Assess for signs of life and if absent commence CPR, check underlying rhythm and treat appropriately following APLS guidelines

Airway and breathing

• Administer 100% oxygen
• Intubation for airway protection and suction with ETT cuffed size 7 (ILCOR guidelines – cuffed ETTs acceptable in children) (age/4 +4) (half size bigger and smaller available) with C spine precautions
• Ventilate with appropriate settings (Vt 6-8ml/kg, RR 15-20, PEEP > 5cm H2O)
• SpO2 and ETCO2 monitoring, ABG and CXR
• May get some discussion re management of ARDS

Circulation

• Assess pulse rate and volume, blood pressure and capillary return, Doppler may be helpful if hypothermic
• Secure IV and arterial access
• If inadequate circulation fluid bolus of 20 ml/kg 0.9% Saline – avoid hypotonic intravenous fluids
• Consider vasopressor support early
• Blood glucose, FBE, U & E

Cerebral support

• Avoid any further episodes of hypoxia and hypercarbia. Avoid hyperoxia Optimise circulation
• BSL control

Temperature

• Actively rewarm to core temperature of 34C
• Passively rewarm above 34C
• If post cardiac arrest – maintain hypothermia 32.5 – 33.5C for > 24 hours
• Could allow a normothermia strategy (T36C), but fever must be controlled

Other

• Primary and secondary survey for associated trauma
• Look for precipitating cause (hypoglycaemia, epilepsy, toxin ingestion, marine envenomation)
• Antibiotics not indicated routinely
• Collateral history – immersion time, resuscitation at scene, medical history
• Admit to ICU with appropriate paediatric expertise
• Counsel family regarding likely outcomes.