cardiopulmonary resuscitation shamiel salie paediatric intensive care unit red cross children’s...
TRANSCRIPT
Cardiopulmonary Resuscitation
Shamiel SaliePaediatric Intensive Care UnitRed Cross Children’s Hospital,University of Cape Town
BasicLifeSupport
SAFE approach
Are you alright?
Airway opening manoeuvres
Look, listen, feel
5 rescue breaths
Check pulseCheck for signs of circulation
CPR15 chest compressions
2 ventilations
Call emergency services
1 minute
Age Definitions:
• Newborn
• Infant - under 1 year
• Child - from 1 year to puberty
2005 BLS Changes:• Lay rescuers should start compressions for an
unresponsive child who is not breathing/moving
• Universal compression-ventilation ratio of 30:2 for the lone rescuer of infants, children and adults
• Increased evidence on the importance of uninterrupted chest compressions
Compression Compression TechniquesTechniques
Position: for all ages: compress the lower third of the sternum
number of hands:• In infants: two thumbs or two fingers
• in children: use one or two hands: depressing the sternum by approximately one third of the depth of the chest
Chest Compressions
• Push hard
• Push Fast
• Complete chest recoil
• Minimize interruptions
Calling for help!!Calling for help!!• Perform 5 cycles or about 2 minutes of CPR
before calling for help
• Indications for activating EMS before BLS by a lone rescuer are:– witnessed sudden collapse with no apparent
preceding morbidity– witnessed sudden collapse in a child with a known
cardiac abnormality
Choking
Assess
Ineffectivecough
Effectivecough
Conscious Unconscious
5 back blows Open airway
5 chest/abdothrusts
Assess andrepeat
5 rescue breaths
CPR 15:2Check for FB
Encouragecoughing
Support andassess
continuously
Universal Algorithm
Stimulate andassess response
Open airway
Check breathing
5 rescue breaths
Check pulseCheck for signs of circulation
CPR15 chest compressions
2 ventilations
Assessrhythm
Asystole andPEA
VF/VT
Asystole and PEA
Ventilate with highconcentration O2
Adrenaline10 mcg/kg IV or IO
Continue CPRIntubateIV/IO access
4 min CPR
Consider 4 Hs & 4 TsConsider alkalising agents
Check monitorevery 2 minutes
VF/VT
Neonatal Resuscitation
Drugs in Cardiac Arrest
• 10mcg/kg of adrenalin as the first and subsequent iv doses.
• high dose iv adrenalin is not recommended and may be harmful
• Insufficient evidence to recommend for or against the routine use of vasopressin in children
Route of drug delivery in ALSRoute of drug delivery in ALS
• where possible give drugs intra-vascularly rather than via the tracheal route
– lower adrenaline concentrations may produce transient beta adrenergic effects resulting in hypotension.
• Intra-osseous access is safe for fluid resuscitation and drug delivery.
Airway ManagementAirway Management
• guedel airways
• laryngeal airways
• Cuffed or uncuffed endotracheal tubes
Do children have Ventricular fibrillation?
Number of Defibrillating ShocksNumber of Defibrillating Shocks
• one shock rather than three “stacked” shocks
• Modern biphasic defibrillators have a high first shock efficacy
• Most patients have a non perfusing rhythm after successful defibrillation
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AED IN CHILDREN
• Age > 8 years• use adult AED
• Age 1-8 years• use paediatric pads /
settings if available (otherwise use adult mode)
• Age < 1 year• use only if
manufacturer instructions indicate it is safe
Fluid Resuscitation
• Boluses of fluid may be required to maintain systemic perfusion
• Crystalloids - ringers or normal saline
• Septic children may require in excess of 100ml/kg fluid resuscitation
Family Presence during Resuscitation
• Evidence suggests that the majority of parents would like to be present during resuscitation, that they gain a realistic understanding of the efforts made to save the child, and they subsequently show less anxiety and depression.
When do you start?
When do you stop?
• In the absence of reversible causes eg drowning with severe hypothermia, poisoning, prolonged CPR in children is unlikely to result in intact neurological survival.
• One should consider stopping resuscitation after 20 minutes.
Post Resuscitation Care
• Ventilate to normo-capnoea• Hypothermia for 12-24 hours post arrest may
be helpful, whilst hyperthermia should be treated aggressively
• Vaso-active drugs should be considered to improve haemodynamic status.
• Maintain normoglycaemia
Conclusions: • The 2005 guidelines minimizes the differences in the steps
and techniques of CPR used for infants, children and adults.
• Push hard, push fast, minimizing interruptions
• Respiratory failure and hypoxia is the commonest reason for paediatric arrests.
• There are usually warning signs of impending doom, and early and effective therapy will prevent cardiac arrest
Questions