WHAT IS NEW IN PEDIATRIC CPR?

Abd El- Aal Elbahnasy, MD

American Heart Association Instructor

MOH, EGYPT

WHAT IS CPR.........????

Cardio pulmonary resuscitation is a series of steps used to establish artificial ventilation and circulation in the patient who is not breathing and has no pulse.

BLS for infant &children

Infant are less than

one year of age (except newborn)Childern are from one year

to puberty

WHEN YOU HAVE TO START CPR.......????

WHEN YOU HAVE TO START CPR.......????

American heart association new icon

Why do we do what we do

؟

CHAIN OF SURVIVAL

Adult

CHAIN OF SURVIVAL

Pediatrics

C-A-B NOT A-B-C

STEPS OF CPR

STEPS OF CPR

CHECK RESPONSE

• Gentle taping the foot of baby

• And call him baby baby……

No response

Activate emergency response

• If the infant not respond

Immediately call for help and get automated external defibrillator (AED)

pulse&Check breathing

• Look for chest rise • Hear agonal breathing

• Check pulse in brachial artery within 10 seconds

• Or pulse less than 60

No breathingAgonal breathing

No pulse or less than 60

Signs of poor perfusion

cool extrem

ities

Altered

mental status

Weak Pulse

Skin : pale

mottling then cyanosi

s

Start compression

One rescuer By two fingers at lower 1|2 of breast bone (sternum)

30 compression to 2 breaths

Depth about 4 cm

Two rescuer Encircle the chest by both hands

15 compression to 2 breaths

Switch every 2 minutes or 10 cycle

Infant: compress the sternum with 2 fingers placed just below the inter-mammary line Child: compress the lower half of the sternum at least one third of the AP diameter of the chest (2 inches) with one or two handsNote: do not compress

over the xiphoid or ribs

Compression depth

Infant at least one third of A P diameter of chest

or about4 cmChildren at least one third of A P diameter of chest

or about 5 cm

High quality C P R

Start chest compression within 10 second of recognitionPush hard about 4 cm, push fast

at least 100 compression in minuteAvoid interruption

Give effective breathAvoid excessive ventilation

Count out loud

CPR FROM EGYPT TO GHANA COUNTRY

Defibrillation• Defibrillators are either

manual or automated (AED).• AED can be used for infants

and children up to approximately 25 kg (8 years of age).

• In infants 1 year of age a manual defibrillator is preferred.

Two sizes of hand-held paddle

“Adult” size : 8 to 10 cm for children > 10 kg

( approximately 1 year)

“Infant” size :4-5 cm for infants < 10 kg

Place over the right side of the upper chest and the apex of the heart (to the left of the nipple over the left lower ribs) so the heart is between the two paddles.

Apply firm pressure

Defibrillation sequence

Defibrillation sequence

DEFIBRRILATION

The recommended first energy dose for defibrillation

is 2 J/kg.If second dose is required, it should be doubled to 4 J/kg.AED with pediatric attenuator is preferred for children < 8 years

of age.

For every minute defibrillation is

delayed after VF onset, the rate

of survival decreases by 7-

10%.

Performing CPR during this delay

interval slows the rate of

survival decline to 3-4% per

minute.REFERENCES

• Holmberg M, Holmberg S, Herlitz J. Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation. 2000; 44:7-17.

• Larsen MP, Eisenberg MS, Cummins RO et al. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med. 1993; 22:1652-8.

• Valenzuela TD, Roe DJ, Cretin S et al. Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation. 1997; 96:3308-13.

If you heard “you will forgot”

If you saw “you will remember”

If you did “you will become perfect”

SO you must practiceCPR

INFANT CPR WORKSHOP

TOMMORROWfriday 8:30 AM AUDITRUM HALL

AMERICAN HEART ASSOCIATION NEW GUIDELINES 2015

Take home message

Infant not small adultC A B not A B C nothing delay compression

HIGH QUALITY C P R is mandatoryCPR is so easy only you want 2 hands &trainingCPR before defibrillation improving outcomeYou must follow the new guidlines