Transcript Paediatric Resuscitation Guidelines 2010 - Vula

Cardiopulmonary Resuscitation
Shamiel Salie
Paediatric Intensive Care Unit
Red Cross Children’s Hospital,
University of Cape Town
Basic
Life
Support
SAFE approach
Are you alright?
Airway opening manoeuvres
Look, listen, feel
5 rescue breaths
Check pulse
Check for signs of circulation
CPR
15 chest compressions
2 ventilations
1 minute
Call emergency services
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 Techniques
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!!
• 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
Ineffective
cough
Effective
cough
Conscious
Unconscious
5 back blows
Open airway
5 chest/abdo
thrusts
5 rescue breaths
Assess and
repeat
CPR 15:2
Check for FB
Encourage
coughing
Support and
assess
continuously
Universal
Algorithm
Stimulate and
assess response
Open airway
Check breathing
5 rescue breaths
Check pulse
Check for signs of circulation
CPR
15 chest compressions
2 ventilations
VF/VT
Assess
rhythm
Asystole and
PEA
Asystole and PEA
Ventilate with high
concentration O2
Continue CPR
Intubate
IV/IO access
Adrenaline
10 mcg/kg IV or IO
4 min CPR
Check monitor
every 2 minutes
Consider 4 Hs & 4 Ts
Consider alkalising agents
DC Shock 4J/kg
VF/VT
2 min CPR,
check monitor
Intubate, High flow O2
IV/IO access
DC Shock 4J/kg
2 min CPR,
check monitor
Intubate
IV/IO access
Adrenaline then
DC Shock 4J/kg
2 min CPR,
check monitor
Amiodarone then
DC Shock 4J/kg
2 min CPR,
check monitor
Adrenaline then
DC Shock 4J/kg
2 min CPR,
check monitor
DC Shock 4J/kg
2 min CPR,
check monitor
Adrenaline dose 10 mcg/kg
Consider
4 Hs
4 Ts
Consider
alkalising
agents
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 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 Management
• guedel airways
• laryngeal airways
• Cuffed or uncuffed endotracheal tubes
Do children have Ventricular
fibrillation?
Number 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
European Resuscitation Council
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