Your SlideShare is downloading. ×
Autism Genetics
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Introducing the official SlideShare app

Stunning, full-screen experience for iPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Autism Genetics

375
views

Published on

Published in: Health & Medicine

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
375
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
12
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Pediatric Resuscitation
  • 2. Pediatric Cardiac Arrest Usually secondary to respiratory failure or arrest
  • 3. Most Important Intervention
    • Adequate oxygenation, ventilation
  • 4. Basic Life Support
    • Airway
      • Head-tilt/chin-lift method
      • Big tongue; Forward jaw displacement critical
      • Avoid extreme hyperextension
      • With possible neck injury, jaw thrust
  • 5. 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
  • 6. Basic Life Support
    • Breathing
      • Do NOT use demand valve on children
      • Ventilate infants, children every 3 seconds
  • 7. Basic Life Support
    • Circulation
      • Infants: brachial
      • Children: carotid
  • 8. Basic Life Support
    • Circulation
      • Infant chest compressions
        • 2 fingers
        • 1 finger width below nipple line
        • 1/2 - 1 inches
        • At least 100/minute
  • 9. Basic Life Support
    • Circulation
      • Child chest compressions
        • One hand
        • Lower half of sternum
        • 1 - 1.5 inches
        • 100/minute
  • 10. Basic Life Support
    • Circulation
      • Child CPR
        • Maintain continuous head tilt with hand on forehead
        • Perform chin lift with other hand while ventilating
  • 11. Best Sign of Effective Ventilation Chest Rise
  • 12. Best Sign of Effective Circulation Pulse with Each Compression
  • 13. Oxygen Therapy
    • Initiate ASAP
    • Do not delay BLS to obtain oxygen
  • 14. Oxygen Therapy
    • Use highest possible FiO 2
      • No risk in short term100% O 2
    • Humidify if possible
      • Avoids plugging airways, adjuncts
  • 15. Endotracheal Intubation Need to intubate is not same as need to ventilate!
  • 16. Endotracheal Intubation
    • Proper tube size
      • Same size as child’s little finger
      • Child > 1 year: [(Age + 16 ) / 4]
  • 17. Endotracheal Intubation
    • Children < 8 years old
      • Small tracheal diameter
      • Narrow cricoid ring
      • Uncuffed tubes
    • Infants, small children
      • Narrow, soft epiglottis
      • Straight blade
  • 18. Endotracheal Intubation
    • Attempts not >30 seconds
    • Bradycardia: oxygenate, ventilate
  • 19. Endotracheal Intubation
    • Avoid hyperextension
    • Use “sniffing position”
    • Lift up; do not pry back
  • 20. Endotracheal Intubation
    • Confirm placement by:
      • Seeing tube go through cords
      • Chest rise
      • Equal breath sounds
      • No sounds over epigastrium
      • CO 2 in exhaled air
  • 21. Endotracheal Intubation
    • Mark tube at corner of mouth
    • Avoid excessive head movement
    • Frequently reassess breath sounds
    • Ventilate to cause gentle chest rise
  • 22. Endotracheal Drugs Epinephrine, atropine, lidocaine
  • 23. 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
  • 24. Cricothyrotomy
    • Surgical contraindicated in children <12
    • Narrowing of trachea at cricoid ring makes procedure hazardous
    • Use needle technique only
  • 25. Vascular Access
    • Same reasons as adults
      • Drugs
      • Fluids
  • 26. Scalp Veins
    • No value in cardiac arrest
    • Useful in infants < 1 year old for maintenance fluids, drug route
  • 27. Scalp Veins
    • Rubber band for tourniquet
    • 21, 23 gauge butterfly
    • Attach syringe, flush needle before inserting
  • 28. Scalp Veins
    • Point needle in direction of blood flow
    • Leave syringe attached, inject 1cc saline after entering vein to check infiltration
  • 29. 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
  • 30. External Jugular
    • Life-threatening situations only
    • 22 gauge catheter
    • Restrain by wrapping in sheet
    • Extend head over end of table, rotate 90 0
    • If vein perforates, do not go to other side
      • Risk of paratracheal hematoma, airway obstruction
  • 31. Prevention of Fluid Overload
    • Avoid using bags over 250cc
    • Use mini-drip sets, Volutrols
    • Fluid resuscitation: 20cc/kg boluses
  • 32. Intraosseous Cannulation
    • Placement of cannula into long bone intramedullary canal (marrow space)
  • 33. Intraosseous Cannulation
    • Indication
      • Vascular access required
      • Peripheral site cannot be obtained
        • In two attempts, or
        • After 90 seconds
  • 34. Intraosseous Cannulation
    • Devices
      • 16 gauge hypodermic needle
      • Spinal needle with stylet
      • Bone marrow needle (preferred)
  • 35. Intraosseous Cannulation
    • Site
      • Anterior tibia
      • 1 - 3 cm below knee
      • Medial to tibial tuberosity
  • 36. Intraosseous Cannulation
    • Contraindications
      • Fractures
      • Osteogenesis imperfecta
      • Osteoporosis
      • Failed attempt on same bone
  • 37. Intraosseous Cannulation
    • Needle in place if:
      • Lack of resistance felt
      • Needle stands without support
      • Bone marrow aspirated
      • Infusion flows freely
  • 38. What can be put thru an IO? Anything that can be put through an IV!
  • 39. Remember…….
    • You don’t need a line to give drugs during a code.
    • Epinephrine, atropine, lidocaine can go down tube
  • 40. Defibrillation
    • 90% of pediatric cardiac arrest is
      • Asystole, or
      • Bradycardic PEA
    • Defibrillation seldom needed
  • 41. Defibrillation
    • Pediatric VF suggests
      • Electrolyte imbalances
      • Drug toxicity
      • Electrical injury
  • 42. 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
  • 43. Defibrillation
    • Energy Settings
      • Initial: 2 J/kg
      • Repeat: 4 J/kg
  • 44. Cardioversion
    • Cardiovert only if signs of decreased perfusion
    • Energy settings:
      • Initial: 0.5 - 1.0 J/kg
      • Repeat: 2.0 J/kg
  • 45. Cardioversion
    • Narrow-complex tachycardia, rate < 200
      • Usually sinus tachycardia
      • Look for treatable underlying cause
      • Do not cardiovert
  • 46. Cardioversion
    • Narrow-complex tachycardia, rate > 230
      • Usually supraventricular tachycardia
      • Frequently associated with congenital conduction abnormalities
  • 47. Cardioversion
    • Narrow-complex tachycardia, rate > 230
      • If hemodynamically stable, transport
      • Adenosine may be considered
  • 48. Cardioversion
    • Narrow-complex tachycardia, rate > 230
      • If hemodynamically unstable, cardiovert
      • If no conversion after two shocks, consider possibility rhythm is sinus tachycardia
  • 49. Drug Therapy
    • Epinephrine
      • Asystole, bradycardia PEA
      • Stimulates electrical/mechanical activity
  • 50. Drug Therapy
    • Epinephrine Dosage
      • IV or IO: 0.01 mg/kg 1:10,000
      • ET: 0.1 mg/kg 1:1000
  • 51. 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
  • 52. Drug Therapy
    • Most bradycardias respond to
      • Oxygen
      • Ventilation
    • For bradycardia 2 o to hypoxia/ischemia, preferred first drug is epinephrine