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Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
Dissecting the Medical Issues in Pediatric Drowning
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Dissecting the Medical Issues in Pediatric Drowning

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Transcript

  • 1. Pediatric Submersion Peter Antevy MD Davie Fire Rescue, Medical Director American Ambulance, Medical Director Miramar Fire Rescue, Asst. Medical Director Broward College EMS, Medical Director JDCH, Pediatric Emergency Medicine
  • 2. Pediatric Submersion Disclosure• Pediatric Emergency Standards, Inc. – Founder and CEO – Consulting – Pediatric Resuscitation System
  • 3. Pediatric Submersion
  • 4. Pool Danger 4
  • 5. Pediatric Drowning Objectives• Allan’s Story• Broselow Demo• Where are kids resuscitated• Epinephrine administration• Hypothermia?• Oxygen (too much vs. too little)• ABC vs. CAB
  • 6. A Day at the Beach
  • 7. Pediatric Submersion Prevention Rescue Medical
  • 8. A Similar StoryPregnancy Delivery Life
  • 9. Pediatric Drowning Allan’s Story
  • 10. Pediatric Drowning Allan is down• Recognize - Understand - React• Will you step in?• Can you control your adrenaline surge?• Will you do something wrong? Do you know the physiology?
  • 11. Pediatric Drowning Allan is down• Rescue arrives in 4 minutes• Child found blue and without a pulse• CPR ensues• Child transported rapidly to Joe DiMaggio Children’s Hospital He is unconscious
  • 12. Pediatric Drowning Allan is down• ED Arrival – Copious amounts of emesis – Moderate respiratory distress – O2 Sat of 92% on 100% non-rebreather – Minutes later he vomits a frothy pink fluid What is happening?
  • 13. Pediatric Drowning ED Management• Placed on a ventilator• Labs suggest significant illness – Oxygen starvation – Elevated Acid levels• IV medications & fluid• Transferred to PICU
  • 14. Pediatric Drowning PICU Course• Severe lung swelling at 12 hours• Significant brain swelling over 24 hours• Tracheostomy and Gastrostomy tubes• Multiple specialists involved• 3 month hospitalization
  • 15. Pediatric Drowning A Mothers Reflection• Initial explanation did not sink in• I was told he didn’t drown, so I thought he’d be OK• They asked if I want to disconnect the ventilator at 48 hours• Things sunk in at 3 weeks
  • 16. Pediatric Drowning Allan’s Story
  • 17. Pediatric Drowning Allan
  • 18. “Pool’s Gold” • 3 year old male • Submerged in pool
  • 19. Pediatric DrowningLet’s Start from the Beginning You are the Paramedic
  • 20. Pediatric Drowning Timeline ChildChild falls poolside EMS EDinto pool No Pulse Arrival Arrival The Variables - CPR on Scene - Resus location - Epinephrine 911 Call - when & where 0 5 min 13 min 22 min Why is Epinephrine Important?
  • 21. PALS UPDATE Epinephrine10 mL
  • 22. PALS UPDATE Epinephrine • CPR • Epinephrine10 mL
  • 23. Epi in Cardiac Arrest
  • 24. Epi in Cardiac Arrest 11.3 6 1.3 0.6 Epi No Epi Epi No Epi
  • 25. Pediatric Drowning Critical Minutes Early • CPR • Epinephrine10 mL
  • 26. Pediatric Drowning Submersion Time
  • 27. Pediatric Drowning CPR Duration
  • 28. Pediatric Drowning ER Resuscitation• Prolonged resuscitation (ACLS >25 min) of warm water pediatric drowning victims is NOT indicated• The longest ED CPR with a good neurologic outcome was 12 minutes
  • 29. Pediatric Drowning Bystander CPR• Family members performed CPR in 20% of cases• 65 received bystander CPR prior to paramedic arrival• 41/63 breathing and with pulses when EMS arrived• All 41 survived to hospital dischargeSirbaugh (Ann Emerg Med, 1999)
  • 30. Pediatric Drowning Timeline ChildChild falls poolside EMS EDinto pool No Pulse Arrival Arrival 911 Call 0 5 min 13 min 22 min 9 Minutes
  • 31. Pediatric Drowning Back to the Scene Paramedic Arrival
  • 32. Putting the Tape to the Test What Really Happens?
  • 33. ACADEMIC EMERGENCY MEDICINE 2012; 19:37–47• Incorrect Weight Estimates• Incorrect Broselow Tape Use• Drug Calculation Errors - mg to mL conversion - Wrong mg/kg dose for route - Math difficult under stress• IV/IM/IN doses of same drug different depending on route
  • 34. Ambulance Personnel Perceptions of Near Misses and Adverse Events in Pediatric Patients Cushman October/December 2010, Volume 14 Number 4. 61 Events 12 Peds 8 2 2 Normal Injury Death
  • 35. Family Presence IT’S NOT THEM IT’S YOU
  • 36. Is Epinephrine 1:10,000 IV given to pediatric patientsduring out of hospital cardiac arrest?
  • 37. Epinephrine Pediatric Cardiac Arrest100.0 75.0 50.0 25.0 32% 28% 0% EPI EPI EPI 0 Region 1 Region 2 Region 3 n = 2500 n = 100 n = 200
  • 38. Customizing Resuscitation
  • 39. Pediatric Drowning Back Even Further The 911 Phone Call
  • 40. Early• CPR• Epinephrine
  • 41. If a 6 Year Old Can Do It KILOGRAMS
  • 42. Pediatric Drowning Allan’s Story
  • 43. Bondi Beach Rescue“Not So Good” CPR on Scene
  • 44. Pediatric Drowning Treatment This could be you!
  • 45. PALS UPDATE Infant CPR
  • 46. PALS UPDATE Child CPR
  • 47. Pediatric Drowning CPR• Lift chin Give 2 breaths• Check for a pulse• Chest compressions : 100 times per minute – 30:2 if one rescuer – 15:2 if 2 rescuers• Remember the BeeGees….or Queen
  • 48. CPR “to the beat”
  • 49. Pediatric Drowning Hypothermia
  • 50. Pediatric Drowning Hypothermia UpdateWhat is the latest research on hypothermia in pediatrics?
  • 51. Pediatric Drowning Oxygen It’s Good, Right?
  • 52. Pediatric Drowning ABC or CABA B C D O2 O2
  • 53. 5170 Peds Non-Cardiac Cardiac OK Cause of Cause of Arrest Arrest Hands Only 8.9% vs 9.9%71% Totals 29%
  • 54. 5170 Peds Conventional Hands Only CPR CPR7.2% Survival 1.6%
  • 55. Pediatric Drowning Take Home Points• Look at Every Step With a Microscope – 911 Call – CPR Early (Family and EMS) – Resuscitation ON SCENE (2 minutes then move) – Epinephrine ON SCENE (My 6 YO knows the dose!) – Customize Resuscitation – Limit Oxygen Toxicity – Airway Breathing Circulation (NOT CAB)• Waiting on Hypothermia Data
  • 56. Thank You! Peter Antevy MD 954-707-2692pantevy@mhs.net Handtevy.com
  • 57. Pediatric Submersion Peter Antevy MD Davie Fire Rescue, Medical Director American Ambulance, Medical Director Miramar Fire Rescue, Asst. Medical Director Broward College EMS, Medical Director JDCH, Pediatric Emergency Medicine

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