Pediatric Resuscitation

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Presentation Transcript

Pediatric Resuscitation : 

Pediatric Resuscitation

Pediatric Cardiac Arrest : 

Pediatric Cardiac Arrest Usually secondary to respiratory failure or arrest

Most Important Intervention : 

Most Important Intervention Adequate oxygenation, ventilation

Basic Life Support : 

Basic Life Support Airway Head-tilt/chin-lift method Big tongue; Forward jaw displacement critical Avoid extreme hyperextension With possible neck injury, jaw thrust

Basic Life Support : 

Basic Life Support Breathing Look-Listen-Feel Limit to volume causing chest rise Children usually underventilated! Use BVM only if proficient Pedi BVM’s should not have pop-off valves

Basic Life Support : 

Basic Life Support Breathing Do NOT use demand valve on children Ventilate infants, children every 3 seconds

Basic Life Support : 

Basic Life Support Circulation Infants: brachial Children: carotid

Basic Life Support : 

Basic Life Support Circulation Infant chest compressions 2 fingers 1 finger width below nipple line 1/2 - 1 inches At least 100/minute

Basic Life Support : 

Basic Life Support Circulation Child chest compressions One hand Lower half of sternum 1 - 1.5 inches 100/minute

Basic Life Support : 

Basic Life Support Circulation Child CPR Maintain continuous head tilt with hand on forehead Perform chin lift with other hand while ventilating

Best Sign of Effective Ventilation : 

Best Sign of Effective Ventilation Chest Rise

Best Sign of Effective Circulation : 

Best Sign of Effective Circulation Pulse with Each Compression

Oxygen Therapy : 

Oxygen Therapy Initiate ASAP Do not delay BLS to obtain oxygen

Oxygen Therapy : 

Oxygen Therapy Use highest possible FiO2 No risk in short term100% O2 Humidify if possible Avoids plugging airways, adjuncts

Endotracheal Intubation : 

Endotracheal Intubation Need to intubate is not same as need to ventilate!

Endotracheal Intubation : 

Endotracheal Intubation Proper tube size Same size as child’s little finger Child > 1 year: [(Age + 16 ) / 4]

Endotracheal Intubation : 

Endotracheal Intubation Children < 8 years old Small tracheal diameter Narrow cricoid ring Uncuffed tubes Infants, small children Narrow, soft epiglottis Straight blade

Endotracheal Intubation : 

Endotracheal Intubation Attempts not >30 seconds Bradycardia: oxygenate, ventilate

Endotracheal Intubation : 

Endotracheal Intubation Avoid hyperextension Use “sniffing position” Lift up; do not pry back

Endotracheal Intubation : 

Endotracheal Intubation Confirm placement by: Seeing tube go through cords Chest rise Equal breath sounds No sounds over epigastrium CO2 in exhaled air

Endotracheal Intubation : 

Endotracheal Intubation Mark tube at corner of mouth Avoid excessive head movement Frequently reassess breath sounds Ventilate to cause gentle chest rise

Endotracheal Drugs : 

Endotracheal Drugs Epinephrine, atropine, lidocaine

Endotracheal Intubation : 

Endotracheal Intubation Drug administration Do not delay while attempting IV access Dilute with normal saline Stop compressions Inject through catheter passed beyond ETT Follow 10 rapid ventilations

Cricothyrotomy : 

Cricothyrotomy Surgical contraindicated in children <12 Narrowing of trachea at cricoid ring makes procedure hazardous Use needle technique only

Vascular Access : 

Vascular Access Same reasons as adults Drugs Fluids

Scalp Veins : 

Scalp Veins No value in cardiac arrest Useful in infants < 1 year old for maintenance fluids, drug route

Scalp Veins : 

Scalp Veins Rubber band for tourniquet 21, 23 gauge butterfly Attach syringe, flush needle before inserting

Scalp Veins : 

Scalp Veins Point needle in direction of blood flow Leave syringe attached, inject 1cc saline after entering vein to check infiltration

Hand, Arm, Foot Veins : 

Hand, Arm, Foot Veins 22 gauge catheter for smaller children Restrain extremity before attempting Incise overlying skin with 19 gauge needle Flush needle as with scalp vein technique

External Jugular : 

External Jugular Life-threatening situations only 22 gauge catheter Restrain by wrapping in sheet Extend head over end of table, rotate 900 If vein perforates, do not go to other side Risk of paratracheal hematoma, airway obstruction

Prevention of Fluid Overload : 

Prevention of Fluid Overload Avoid using bags over 250cc Use mini-drip sets, Volutrols Fluid resuscitation: 20cc/kg boluses

Intraosseous Cannulation : 

Intraosseous Cannulation Placement of cannula into long bone intramedullary canal (marrow space)

Intraosseous Cannulation : 

Intraosseous Cannulation Indication Vascular access required Peripheral site cannot be obtained In two attempts, or After 90 seconds

Intraosseous Cannulation : 

Intraosseous Cannulation Devices 16 gauge hypodermic needle Spinal needle with stylet Bone marrow needle (preferred)

Intraosseous Cannulation : 

Intraosseous Cannulation Site Anterior tibia 1 - 3 cm below knee Medial to tibial tuberosity

Intraosseous Cannulation : 

Intraosseous Cannulation Contraindications Fractures Osteogenesis imperfecta Osteoporosis Failed attempt on same bone

Intraosseous Cannulation : 

Intraosseous Cannulation Needle in place if: Lack of resistance felt Needle stands without support Bone marrow aspirated Infusion flows freely

What can be put thru an IO? : 

What can be put thru an IO? Anything that can be put through an IV!

Remember……. : 

Remember……. You don’t need a line to give drugs during a code. Epinephrine, atropine, lidocaine can go down tube

Defibrillation : 

Defibrillation 90% of pediatric cardiac arrest is Asystole, or Bradycardic PEA Defibrillation seldom needed

Defibrillation : 

Defibrillation Pediatric VF suggests Electrolyte imbalances Drug toxicity Electrical injury

Defibrillation : 

Defibrillation Paddle diameter: Infants: 4.5 cm Children: 8.0 cm Largest paddles that contact entire chest wall without touching If pediatric paddles unavailable, use adult paddles with A-P placement

Defibrillation : 

Defibrillation Energy Settings Initial: 2 J/kg Repeat: 4 J/kg

Cardioversion : 

Cardioversion Cardiovert only if signs of decreased perfusion Energy settings: Initial: 0.5 - 1.0 J/kg Repeat: 2.0 J/kg

Cardioversion : 

Cardioversion Narrow-complex tachycardia, rate < 200 Usually sinus tachycardia Look for treatable underlying cause Do not cardiovert

Cardioversion : 

Cardioversion Narrow-complex tachycardia, rate > 230 Usually supraventricular tachycardia Frequently associated with congenital conduction abnormalities

Cardioversion : 

Cardioversion Narrow-complex tachycardia, rate > 230 If hemodynamically stable, transport Adenosine may be considered

Cardioversion : 

Cardioversion Narrow-complex tachycardia, rate > 230 If hemodynamically unstable, cardiovert If no conversion after two shocks, consider possibility rhythm is sinus tachycardia

Drug Therapy : 

Drug Therapy Epinephrine Asystole, bradycardia PEA Stimulates electrical/mechanical activity

Drug Therapy : 

Drug Therapy Epinephrine Dosage IV or IO: 0.01 mg/kg 1:10,000 ET: 0.1 mg/kg 1:1000

Drug Therapy : 

Drug Therapy Atropine 0.02 mg/kg IV or IO Double ET dose Minimum dose: 0.1 mg to avoid paradoxical bradycardia Maximum single dose: Child: 0.5 mg Adolescent: 1mg

Drug Therapy : 

Drug Therapy Most bradycardias respond to Oxygen Ventilation For bradycardia 2o to hypoxia/ischemia, preferred first drug is epinephrine

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