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Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
Pediatric Advanced Life Support
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Pediatric Advanced Life Support

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  • 1. P ediatric A dvanced L ife S upport By R2 張家穎
  • 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. Basic Life Support
    • Pediatric assessment triangle
    • A ppearance, B reathing, C irculation
    • A irway
    • B reathing
    • C irculation
    • D : disability, differential diagnosis
    • E xposure.
  • 4. Appearance BC
    • T one
    • I nteractiveness
    • C onsolability
    • L ook/Gaze
    • S peech/Cry
    •     TICLS
  • 5. A Breathing C
    • Nasal flaring.
    • 胸凹
    • 點頭式呼吸
    • Use of accessory muscles.
      12~18 Adolescent   20~30 Schooler   25~40 Toddler   30~60 Infant   40~60 Neonate   RR   AGE
  • 6. AB Circulation
    • Pink
    • Pale
    • Mottling skin.
    • Cyanosis.
    • Capillary refill time: normal <2 sec.
    • DBP: 70+ age *2
  • 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. 2nd assessment ABCDE
  • 9. Airway BCDE
    • 建立呼吸道
    • Nasal airway. Oral airway.
    • Endotracheal tube:
    • size: 4+ age/4. 比較小朋友的小指頭
    •     depth: 12+ age/2. or endo size *3.
    • B.W.(Kg)+6
    • LMA
  • 10.  
  • 11. A Breathing CDE
    • Adequate ventilation.
    • Indications for endotracheal tube insertion:
    • Fail to keep patent airway.
    • Respiratory failure
    • Severe shock
    • GCS< 9
    • IICP
  • 12. AB Circulation DE~1
    • Chest compression. (HR<60)
    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
  • 13.  
  • 14. AB Circulation DE~2
    • HR: fast, slow, asystole
    • Fast: Stable
    • Unstable narrow: drug: adenosin: 0.1   0.2   0.2 mg/Kg
    • shock: synchronized shock: 0.5   1 J/Kg.
    • wide: synchronized shock: 0.5   1 J/Kg.
    • Slow: HR<60, 常因缺氧 , 低血壓或是酸血症所引起 .
    •   先弄好 ventilation/oxygenation
    • Chest compression
    • Bosmin use: 0.1 mg/Kg via endo.
    • 0.01 mg/Kg via IV.
    • Pulse(-): VT/VF: unsynchronized shock: 2   4   4J/Kg.
    • PEA: 4H4T
    CCB is contraindicated!!! 電 電 電 藥 電 藥 電  xylocaine: 1mg/kg. amiodarone 5mg/kg.
  • 15.  
  • 16. AB Circulation DE~3
    • Fluid bolus: 10~20 ml/Kg NS or LR
    • Transfusion: after 3 times of fluid challenge. 10~15 ml/Kg.
    • Inotropics use: Dopamine
    • Dobutrex
    • Primacor
    • Levephed
  • 17. ABC Disability E
    • AVPU: A lert
    • V oice
    • P ain
    • U nresponsive
    • Protect brain- Keep vital signs stable first.
    •         Avoid hypotension.
    • hyperglycemia.
    • hyperthermia.
    • 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%.
  • 18. ABCD Exposure
  • 19. DOPE
    • D: Displacement
    • O: Obstruction.
    • P: pneumothorax.
    • E: equipment failure.
  • 20. Vascular acess.
  • 21. Newborn management
    • Oral suction.
    • 擦乾擺位 .
    • PAT observation.
    • O2 supply and stimulation ( 摩擦背部 , 按摩腳底 ).
    • Positive pressure ventilation.
    • Chest compression. 3:1=90:30.
    • Endotracheal tube insertion.
    • On Umbilical vein and giving medication.
    If meconium presents ?
  • 22. Trauma
    • Usually multiple organ trauma.
    • FAST- subxiphoid, subcostal, suprapubic
    • Pneumothorax, hemothorax, pulmonary contussion.
  • 23.
    • Permissive hypotension.
    • Blood product transfusion:
    • PRBC: 10~15 ml/kg.
    • PLT: 10~15 ml/kg. if plt<50,000.
    • FFP: 10~15 ml/kg, if INR>1.5*.
    • Cryo: 10~15 ml/kg, if fibrinogen <0.8 g/l
    • Adequate urine output:
    • Infant: 2ml/kg/hr.
    • child: 1.5 ml/kg/hr.
    • adolescent: 0.5 ml/kg/hr.
  • 24. ~The End~ Thanks for your at tension .

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