3/4/2019

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Pediatric Arrests: What can we do to save

a life?

Strive to ReviveMarch 8th, 2019

Landon A. Jones, MDMedical Director, Assistant Professor

Makenna David Pediatric Emergency Center

University of KentuckyDepartment of Emergency Medicine &

Pediatrics

Disclosures

I have no relevant financial relationships to disclose.

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Disclosures

I have no relevant financial relationships to disclose.

I DON’T believe in “see one, do one, teach one” method. I

learn best from “watch one, botch one.”

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My Hope . . . Learn from Me

The Reality . . . . .

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Pediatric codes are SUPER scary.

And for whatever reason . . .

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18 years, 0

days

18 years, 0

days

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17 years,

364 days

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17 years,

364 days

How do we begin to address this scary

situation?

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Simplify it.

Simplify it.

Prehospital

Arrest

1Arresting

Airway

2

Arresting Access

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4 year old boy found unresponsive by family.

CPR started within 3 minutes by a bystander.

Simplify it.

Prehospital

Arrest

1Arresting

Airway

2

Arresting Access

3

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As an EMS provider, you arrive at the scene to

find this . . .

You’re awesome and start high quality CPR

immediately.

Decision Time: ET Intubation? (Yes or

No)

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Potential factors Influencing n ET Intubation vs BVM

Story

Resources

Access

Safety

Distance

Comfort

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It is NOT a failure bringing

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It is NOT a failure bringing in a NON-intubated,

adequately oxygenated pediatric arrest patient by

BVM.

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Similar Results

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It is NOT a failure bringing in a NON-intubated,

adequately oxygenated pediatric arrest patient by

BVM.

It is NOT a failure bringing

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It is NOT a failure bringing in a NON-intubated,

adequately oxygenated pediatric arrest patient by

BVM.It is NOT a failure bringing in a NON-intubated,

adequately oxygenated pediatric arrest patient by

BVM.

Simplify it.

Prehospital

Arrest

1Arresting

Airway

2

Arresting Access

3

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Arresting Airway

What size ET tube do I need?

You make the decision to intubate.

Picking an ET Tube

16 + Age (in yrs)

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Picking an ET Tube

Age (in yrs)4

4+

116 + Age (in

Picking an ET Tube

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Maybe you had to BVM the child for a while before

you intubated.

And you (without looking) know that the kid’s tummy

would look like this on XR.

What do you

see?

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Lots of Bowel Gas

from Bagging

What size NG do you need?

Maybe you had to BVM the child for a while before

you intubated.

And you (without looking) know that the kid’s tummy

would look like this on XR.

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Pediatric Tubes

1x ET Tube Size

1x ET Tube Size

2x NG tube Size

Pediatric Tubes

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2x NG tube Size

3x ET Tube Depth

Pediatric Tubes

1x ET Tube Size

2x NG tube Size

3x ET Tube Depth

4x Biggest Chest Tube

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10F

15 cm

20F

Pediatric Tubes

1x ET Tube Size

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What I should have done with a belly full of air . . .

Decompress the Stomach with an NG

One of My Screw Ups

Decompress the Stomach with an NG

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Allows for Improved Diaphragmatic

Excursion

Decompress the Stomach with an NG

Decompress the Stomach with an NG

Allows for Improved Diaphragmatic

Excursion

Identifies the Esophagus

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. . . continuing with the Arresting Airway

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ijciis.org

Intubation Preparation

Intubation Preparation

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airwayjedi.com

Intubation Preparation

airwayjedi.com

Intubation Preparation

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What I should have done to facilitate a

successful intubation. . .

Placed a Shoulder Roll

Another of My Goof Ups

Pre - Intubation Positioning

Basically, this maneuver is a shoulder roll.

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Don’t forget a shoulder roll to make your life

easier when intubating a young child.

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Simplify it.

Prehospital

Arrest

1Arresting

Airway

2

Arresting Access

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Intravenous (IV)

Interosseous (IO)

What methods are available to administer resuscitation

meds/fluids?

Hypodermoclysis (Subcutaneous)

Arresting Access

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Every time I’ve

used this, I’ve

wished it had been

10 minutes

earlier.

Something I Could Have Done Better

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youtube.com

4 year old boy arresting. We’ve done everything we

can think of . .

. . . . . and he’s still arresting.

Our Case

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. . . I need help from my PICU colleague Dr.

Erin Powell.

It is NOT a failure bringing in a NON-intubated,

adequately oxygenated pediatric arrest patient by

BVM.

Take Home Points

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It is NOT a failure bringing in a NON-intubated,

adequately oxygenated pediatric arrest patient by

BVM.Simplify your arresting

airway with easy multiplication and a

shoulder roll.

Points

It is NOT a failure bringing in a NON-intubated,

adequately oxygenated pediatric arrest patient by

BVM.Simplify your arresting

airway with easy multiplication and a

shoulder roll.

Don’t be afraid to pull the trigger on the IO.

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Pediatric Arrests: What can we do to save

a life?

Strive to ReviveMarch 8th, 2019

Landon A. Jones, MDMedical Director, Assistant Professor

Makenna David Pediatric Emergency Center

University of KentuckyDepartment of Emergency Medicine &

Pediatrics

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