Pediatric Resuscitation

Course 2018

Hospital Central de Beira

Hospital Central de Nampula

Hospital Central de Maputo

Welcome!

Day One

• Introduction

• Pediatric assessment

• Basic life support

• Respiratory interventions

• Review PALS cards

Day Two

• Team dynamics

• PALS algorithms

• Shock

• Cardiac arrest (types)

• Practice!

Goals

• To learn the PALS approach to pediatric critical illness

• To practice hands on with your colleagues

• To create a shared approach for the stabilization of

critically ill children

PALS approach

• Evaluate > Identify > Intervene

• Evaluate: • Primary assessment

• A: airway

• B: breathing

• C: circulation

• D: Disability

• E: Exposure

• Secondary assessment

• Diagnostic tests

PALS approach

• Evaluate > Identify > Intervene

• Identify

• Respiratory failure

• Circulatory failure

• Cardiopulmonary failure

• Cardiac arrest

• Intervene

• Repeat

Systematic approach

• VIDEO

Basic Life Support

• C A B: new emphasis on early chest compressions

• High quality chest compressions are key to a

successful resuscitation

• Minimal ventilation needed

• Pediatric versus adult etiologies of arrest

Good chest compressions

• Depth: 5 cm older children/adults, or 1/3 chest

• Location

• Timing: 100-120 beats per minute

• Recoil

• Minimize interruptions

• Rotate compressors

Ventilation

• Bag mask ventilation using E-C technique

• Assure mask fit, or use multiple hands

• Consider oral or NP airways for obstruction

• Remember most pediatric codes start with airway

Basic life support

• 1 rescuer: 30 compressions, 1 breath

• 2 rescuers: 15 compressions, 2 breaths

• VIDEO: BLS overview

• VIDEO: Choking

Respiratory emergencies

• Respiratory distress

• Upper airway versus lower airways?

• Upper: stridor, inspiratory work of breathing

• Lower: wheeze/crackles, equal or expiratory work of breathing

• Both have tachypnea and retractions

• Possible interventions

• Clear the airway of secretions

• Oxygen

• Positive pressure

• Bag mask ventilation and intubation

Respiratory emergencies

• Additional ways to improve respiratory distress

• Treat fever

• Hydration (correct acidosis)

• Respiratory failure

• Respiratory rate slows

• Decreased level of consciousness

• Elevated CO2, hypoxia

• Higher risk for failure

• Younger infant

• Dehydrated/poor nutritional status

Respiratory emergencies

• VIDEO

• Review intubation technique

Pediatric intubation

• Tube size: age/4 + 3.5 for cuffed tube

• Equipment needed:

• Medications

• Bag and mask

• Laryngoscope

• Endotracheal tube

• Suction

• Oxygen

• Back up plan

Time to practice!

Station 1: BLS review

Station 2: Bag mask ventilation

Station 3: Intubation practice

Pediatric Resuscitation

Course Day Two

Welcome!

Day One

• Introduction

• Pediatric assessment

• Basic life support

• Respiratory interventions

• Review PALS cards

Day Two

• Team dynamics

• PALS algorithms

• Shock

• Cardiac arrest (types)

• Practice!

Communication is key

• Team approach

• Closed-loop communication

• Feedback and debrief

• VIDEO: team dynamics

PALS algorithms

• Shock

• Bradycardia

• Tachycardia with a pulse: SVT and sinus

• Cardiac arrest (no pulse)

• Ventricular tachycardia

• Ventricular fibrillation

• Pulseless electrical activity

Shock

• Types:

• Septic/distributive

• Hypovolemic

• Cardiogenic

• Key is evidence of end organ dysfunction (mental

status!)

• VIDEO: Shock emergencies

Treatment priorities

• Supplemental oxygen

• Glucose, IV access, close monitoring

• Volume expansion

• Empiric antibiotics

• Blood pressure management

Volume expansion

• PALS: 20 ml/kg, repeat 3-4 within 1 hour

• ETAT/WHO: 10-20 ml/kg in 30-60 minutes, then

reassess, may repeat 10 ml/kg

• Reassess for respiratory distress, hepatomegaly

Case 1

• 1 yo with fever, lethargy

• VIDEO #3

Cardiac arrythmias

• Supraventricular tachycardia

• Sinus tachycardia

• Sinus bradycardia

• Ventricular tachycardia

• Ventricular fibrillation

• Pulseless electrical activity

• Asystole

• VIDEO

Cardiac arrythmias

• Sinus bradycardia

Case 2

• 6 month old malnourished, respiratory distress,

decreased level of consciousness

• HR 45

• RR 8

• BP 40/18

Cardiac arrthymias

• Supraventricular tachycardia (NARROW)

Case 3

• 3 month old sudden onset lethargy

• Pulse is weak and fast

Cardiac arrythmias

• Ventricular tachycardia (WIDE)

Case 4

• 3 yo with chest pain, fatigue x 5 days, sudden loss of

consciousness

Cardiac arrthymias

• Ventricular fibrillation

Case 5

• 8 yo playing sports and collapsed

Cardiac arrthymias

• NO pulse

• Pulseless electrical activity

• CPR, epinephrine