Pediatric Advanced Life Support

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Pediatric Advanced Life Support

  1. 1. P ediatric A dvanced L ife S upport By R2 張家穎
  2. 2. 小兒生命之鏈 預防措施 早期 CPR 早期求救 高級小兒救命術
  3. 3. Basic Life Support <ul><li>Pediatric assessment triangle </li></ul><ul><li>A ppearance, B reathing, C irculation </li></ul><ul><li>A irway </li></ul><ul><li>B reathing </li></ul><ul><li>C irculation </li></ul><ul><li>D : disability, differential diagnosis </li></ul><ul><li>E xposure. </li></ul>
  4. 4. Appearance BC <ul><li>T one </li></ul><ul><li>I nteractiveness </li></ul><ul><li>C onsolability </li></ul><ul><li>L ook/Gaze </li></ul><ul><li>S peech/Cry </li></ul><ul><li>    TICLS </li></ul>
  5. 5. A Breathing C <ul><li>Nasal flaring. </li></ul><ul><li>胸凹 </li></ul><ul><li>點頭式呼吸 </li></ul><ul><li>Use of accessory muscles. </li></ul>  12~18 Adolescent   20~30 Schooler   25~40 Toddler   30~60 Infant   40~60 Neonate   RR   AGE
  6. 6. AB Circulation <ul><li>Pink </li></ul><ul><li>Pale </li></ul><ul><li>Mottling skin. </li></ul><ul><li>Cyanosis. </li></ul><ul><li>Capillary refill time: normal <2 sec. </li></ul><ul><li>DBP: 70+ age *2 </li></ul>
  7. 7. C apillary refill time: Normal : <2 sec. SBP>90 60~140 >10 y/o DBP: 70+age*2 100~180 1~10 y/o SBP 50~90 80~200 Neonate DBP~ Gestational age Pre- maturity   BP   HR   AGE
  8. 8. 2nd assessment ABCDE
  9. 9. Airway BCDE <ul><li>建立呼吸道 </li></ul><ul><li>Nasal airway. Oral airway. </li></ul><ul><li>Endotracheal tube: </li></ul><ul><li>size: 4+ age/4. 比較小朋友的小指頭 </li></ul><ul><li>    depth: 12+ age/2. or endo size *3. </li></ul><ul><li>B.W.(Kg)+6 </li></ul><ul><li>LMA </li></ul>
  10. 11. A Breathing CDE <ul><li>Adequate ventilation. </li></ul><ul><li>Indications for endotracheal tube insertion: </li></ul><ul><li>Fail to keep patent airway. </li></ul><ul><li>Respiratory failure </li></ul><ul><li>Severe shock </li></ul><ul><li>GCS< 9 </li></ul><ul><li>IICP </li></ul>
  11. 12. AB Circulation DE~1 <ul><li>Chest compression. (HR<60) </li></ul>3:1=90:30 5:1=100:20 15:2 Ratio 胸壁厚度 1/2~1/3 胸壁厚度 1/2~1/3 4~5 cm Depth 兩手指 兩手環抱 , 以拇指壓 單手掌跟 兩手指互扣 Method 兩乳頭連線下一指幅 胸骨下半段 胸骨下半段 Position Brachial a. Umbilical a. Common carotid a. Common carotid a. Check pulse Newborn <8 y/o > 8 y/o
  12. 14. AB Circulation DE~2 <ul><li>HR: fast, slow, asystole </li></ul><ul><li>Fast: Stable </li></ul><ul><li>Unstable narrow: drug: adenosin: 0.1   0.2   0.2 mg/Kg </li></ul><ul><li>shock: synchronized shock: 0.5   1 J/Kg. </li></ul><ul><li>wide: synchronized shock: 0.5   1 J/Kg. </li></ul><ul><li>Slow: HR<60, 常因缺氧 , 低血壓或是酸血症所引起 . </li></ul><ul><li>  先弄好 ventilation/oxygenation </li></ul><ul><li>Chest compression </li></ul><ul><li>Bosmin use: 0.1 mg/Kg via endo. </li></ul><ul><li>0.01 mg/Kg via IV. </li></ul><ul><li>Pulse(-): VT/VF: unsynchronized shock: 2   4   4J/Kg. </li></ul><ul><li>PEA: 4H4T </li></ul>CCB is contraindicated!!! 電 電 電 藥 電 藥 電  xylocaine: 1mg/kg. amiodarone 5mg/kg.
  13. 16. AB Circulation DE~3 <ul><li>Fluid bolus: 10~20 ml/Kg NS or LR </li></ul><ul><li>Transfusion: after 3 times of fluid challenge. 10~15 ml/Kg. </li></ul><ul><li>Inotropics use: Dopamine </li></ul><ul><li>Dobutrex </li></ul><ul><li>Primacor </li></ul><ul><li>Levephed </li></ul>
  14. 17. ABC Disability E <ul><li>AVPU: A lert </li></ul><ul><li>V oice </li></ul><ul><li>P ain </li></ul><ul><li>U nresponsive </li></ul><ul><li>Protect brain- Keep vital signs stable first. </li></ul><ul><li>        Avoid hypotension. </li></ul><ul><li>hyperglycemia. </li></ul><ul><li>hyperthermia. </li></ul><ul><li>連續發作超過三十分鐘 , 而沒有恢復意識 , 即稱為癲間重積狀態 , mortality 達 10~15%. </li></ul>
  15. 18. ABCD Exposure
  16. 19. DOPE <ul><li>D: Displacement </li></ul><ul><li>O: Obstruction. </li></ul><ul><li>P: pneumothorax. </li></ul><ul><li>E: equipment failure. </li></ul>
  17. 20. Vascular acess.
  18. 21. Newborn management <ul><li>Oral suction. </li></ul><ul><li>擦乾擺位 . </li></ul><ul><li>PAT observation. </li></ul><ul><li>O2 supply and stimulation ( 摩擦背部 , 按摩腳底 ). </li></ul><ul><li>Positive pressure ventilation. </li></ul><ul><li>Chest compression. 3:1=90:30. </li></ul><ul><li>Endotracheal tube insertion. </li></ul><ul><li>On Umbilical vein and giving medication. </li></ul>If meconium presents ?
  19. 22. Trauma <ul><li>Usually multiple organ trauma. </li></ul><ul><li>FAST- subxiphoid, subcostal, suprapubic </li></ul><ul><li>Pneumothorax, hemothorax, pulmonary contussion. </li></ul>
  20. 23. <ul><li>Permissive hypotension. </li></ul><ul><li>Blood product transfusion: </li></ul><ul><li>PRBC: 10~15 ml/kg. </li></ul><ul><li>PLT: 10~15 ml/kg. if plt<50,000. </li></ul><ul><li>FFP: 10~15 ml/kg, if INR>1.5*. </li></ul><ul><li>Cryo: 10~15 ml/kg, if fibrinogen <0.8 g/l </li></ul><ul><li>Adequate urine output: </li></ul><ul><li>Infant: 2ml/kg/hr. </li></ul><ul><li>child: 1.5 ml/kg/hr. </li></ul><ul><li>adolescent: 0.5 ml/kg/hr. </li></ul>
  21. 24. ~The End~ Thanks for your at tension .

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