Thus far, this issue has not arisen in the course of the CICM general fellowship exam. It would not be unexpected, however. Various other paediatric and neonatal topics have previously appeared, and though they have received fairly peripheral treatment even in the college model answers, we can expect that cardiopulmonary resuscitation is a topic with sufficient value to merit a detailed and thoughtful exploration.
For the disinterested adult intensivist, the best reference for paediatric resuscitation would have to be the canonic Chapter 113 from Oh's Manual (p. 1158), "Paediatric cardiopulmonary resuscitation" by James Tibballs. The recommendations made in that chapter are based on the 2010 ILCOR guidelines ( "Part 10: Pediatric Basic and Advanced Life Support"). As far as this author is aware, they have not been revised since this edition.
For the purpose of improving candidate recall under exam stress conditions, here are some paediatric resuscitation drug doses, derived from various tables in Oh's Manual as well as various forgotten sources lost in the course of this authors' haphazard referencing systems.
|Drug||Dose||for 3kg neonate||for 10kg infant||For 20kg primary schooler|
|Defibrillation energy||4 J/kg||12 J||40 J||80 J|
|Adrenaline||10 mcg/kg||30 mcg||100 mcg||200 mcg|
|Amiodarone||5 mg/kg||15 mg||50 mg||100 mg|
|Glucose 50%||1 ml/kg||3 ml||10 ml||20 ml|
|Maximum replacement rates for commonly used electrolytes|
|Potassium||0.3 mmol/kg/hr||0.9 mmol/hr||3 mmol/hr||6 mmol/hr|
|Sodium (3% saline)||0.5 ml/kg/hr||1.5 ml/hr||5 ml/hr||10 ml/hr|
|Magnesium||0.4 mmol/kg/hr||1.2 mmol/hr||4 mmol/hr||8 mmol/hr|
|Calcium chloride 10%||0.2 ml/kg||0.6 ml||2 ml||4 ml|
Four formulae need to be recalled:
Kleinman, Monica E., et al. "Part 10: Pediatric Basic and Advanced Life Support." Circulation 122.16 suppl 2 (2010): S466-S515.
Wyckoff, Myra H., et al. "Part 13: neonatal resuscitation." Circulation 132.18 suppl 2 (2015): S543-S560.