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PEDIATRICS BASIC & ADVANCE LIFE SUPPORT
Ext.Sorawit Boonyathee
Pediatric Basic Life Support
Pediatric Basic Life Support
1) Prevent Cardiac Arrest 2) Early cardiopulmonary resuscitation (CPR) 3) Prompt access to the emergency response system 4) Rapid pediatric advanced life support (PALS) 5) Integrated post– cardiac arrest care
Berg M D et al. Circulation 2010;122:S862-S875
Cardiopulmonary Arrest in children
Asphyxial cardiac arrest is more common than VF cardiac arrest in infants and children
Common cause of Cardiac Arrest in childred ; Bronchospasm / respiratory infection
Burns
Drowning
Dysrhythmias
Foreign Body Aspiration
Gastroenteritis (vomiting and diarrhea)
Sepsis
Seizures
Trauma
Cardiopulmonary Arrest in children
Pediatric cardiopulmonary arrest results when respiratory failure or shock is not identified and treated in the early stages.
Early recognition and intervention prevents deterioration to cardiopulmonary arrest and probable death.
Cardiopulmonary Arrest in children
- Upper airway obstruction
- Lower airway obstruction
- Lung tissue disease / infection
- Disorders of breathing
Respiratory Failure
- Hypovolemic (most common)
- Distributive: septic, anaphylactic
- Cardiogenic
- Obstructive
Hypotensive Shock
Cardiopulmonary Failure
Arrest
Definitions of children and infants
Child -> age 1 – 8 years (If Health care provider extended to Puberty)
Infant -> age < 1 years
Newborn -> age < 28 days
Newly born -> within minute or hour after delivery
BLS Sequence for Public people
Safety of Rescuer and Victim
Assess Need for CPR
Check for Response
Check for Breathing
Start Chest Compressions
Open the Airway and Give Ventilations
Coordinate Chest Compressions and Breathing
Activate Emergency Response System
Assess the Need of CPR
If the victim is unresponsive and is not breathing (or only gasping), send someone to activate the emergency response system.
Pulse Check
Healthcare providers may take up to 10 seconds to attempt to feel for a pulse brachial in an infant
carotid or femoral in a child Special Condition -> Inadequate Breathing With Pulse = rescue breath Bradycardia With Poor Perfusion = chest compression
Chest Compressions
Technique for Infant -> Depth at least 1.5 Inches, Intermammary line
Two – Finger Technique (1 Rescue) Two Thumb-encircling hands technique (2 Rescues)
Chest Compressions
Technique for Child -> Depth at least 2 Inches, Lower half of sternum
Open Airways
Public People -> Head Tilt - Chin Lift
Health Care Providers -> Head Tilt – Chin Lift
If Suspected C-Spine injury -> Jaw thrust
Defibrillation
• Children with sudden witnessed collapse (eg, a child collapsing during an athletic event) are likely to have VF or pulseless VT and need immediate CPR and rapid defibrillation.
• VF and pulseless VT are referred to as “shockable rhythms” because they respond to electric shocks (defibrillation).
• Decrease (or attenuate) the delivered energy to make them suitable for infants and children <8 years of age
• The AED will prompt the rescuer to re-analyze the rhythm about every 2 minutes
Defibrillation
• Infant -> Prefer Manual Defibrillation / Pediatric dose attenuator • Age 1 – 8 years -> AED with a pediatric attenuator • Age > 8 years -> AED liked adult used
Paddle Size -> Adult Size (> 10 kgs) and Pediatric size (<10 kgs) Energy -> Acceptable to use an initial dose of 2 to 4 J/kg not to
exceed 10 J/kg or the adult maximum dose
Pediatric Advance Life Support
Medications for Cardiac Arrest Algorithm
Medication Pediatrics Dose Adult Dose Remark
Epinephrine 0.01 mg/kg (0.1 mL/kg 1:10,000) ET* Maximum dose
1 mg IV/IO; 2.5 mg ET
1 mg (1:1,000) 2 – 2.5 mg ET*
May repeat every 3–5 minutes
(about 2 cycles)
Amiodarone 5 mg/kg IV/IO; may repeat twice up
to 15 mg/kg Maximum single
dose 300 mg
1st dose 300 mg Bolus,
2nd dose: 150 mg
Monitor ECG and blood pressure
Caution in Prolong QT
Endotracheal Tube -> Flush with 5 mL of normal saline and follow with 5 ventilations LEAN -> Lidocaine, Epinephrine, Atropine and Naloxone
Treatable Causes of Cardiac Arrest
H's T's
Hypoxia Toxins
Hypovolemia Tamponade (cardiac)
Hydrogen ion (acidosis) Tension pneumothorax
Hypo-/hyperkalemia Thrombosis, pulmonary
Hypothermia Thrombosis, coronary
Medications for Bradycardia Algorithm
Medication Pediatrics Dose Adult Dose Remark
Epinephrine 0.01 mg/kg (0.1 mL/kg 1:10,000) ET* Maximum dose
1 mg IV/IO; 2.5 mg ET
1 mg (1:1,000) 2 – 2.5 mg ET*
May repeat every 3–5 minutes
(about 2 cycles)
Atropine 0.02 mg/kg IV/IO ET* Repeat once if
needed Minimum : 0.1 mg Maximum : 0.5 mg
0.5 mg/dose Max 3 mg
(0.6 mg/dose = 5 doses)
Higher doses may be used with
organophosphate poisoning
Endotracheal Tube -> Flush with 5 mL of normal saline and follow with 5 ventilations LEAN -> Lidocaine, Epinephrine, Atropine and Naloxone
Medications for Tachycardia Algorithm
Medication Pediatrics Dose Adult Dose Remark
Adenosine 1st dose: 0.1 mg/kg (maximum 6 mg)
2nd dose: 0.2 mg/kg (maximum
12 mg)
6 mg IV as a rapid IV push followed by a 20 mL saline
flush; repeat if required as 12 mg IV
push
Monitor ECG Rapid IV/IO bolus
with flush
Amiodarone 5 mg/kg IV/IO; may repeat twice up to
15 mg/kg Maximum single
dose 300 mg
150 mg given over 10 minutes and repeated if necessary,
followed by a 1 mg/min infusion for 6 hours, followed by 0.5 mg/min. Total dose over 24
hours should not exceed 2.2 g.
slowly–over 20–60 minutes
Medications for Tachycardia Algorithm
Medication Pediatrics Dose Adult Dose Remark
Procainamine 15 mg/kg IV/IO infusion to total maximum dose
of 17 mg/kg
20 to 50 mg/min until arrhythmia suppressed, hypotension ensues, or
QRS prolonged by 50%, or total cumulative dose of
17 mg/kg; or 100 mg every 5 minutes until conditions described above are met
Monitor ECG and blood pressure; Give slowly–over 30–60
minutes. Use caution when administering
with other drugs that prolong QT (obtain expert consultation)
Question ?
Reference
The American Heart Association requests that this document be cited as follows: Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A,Hickey RW, Berg RA, Sutton RM, Hazinski MF. Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S862–S875
เอกสารประกอบงานประชุมวิชาการ Update in New CPR Guideline 2010 แนวทางปฏิบัตกิารช่วยฟืน้คืนชีพ CPR 2010, คณะแพทยศาสตร์ มหาวิทยาลัยเชียงใหม่