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

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