Pediatric Basic Life Support 1) Prevent Cardiac Arrest 2) Early cardiopulmonary resuscitation (CPR) 3) Prompt access to the emergency response system 4) Rapid pediatric advanced life support (PALS) 5) Integrated post– cardiac arrest careBerg M D et al. Circulation 2010;122:S862-S875
Cardiopulmonary Arrest in children Asphyxial cardiac arrest is more common than VF cardiac arrest in infants and children Common cause of Cardiac Arrest in childred ; Bronchospasm / respiratory infection Burns Drowning Dysrhythmias Foreign Body Aspiration Gastroenteritis (vomiting and diarrhea) Sepsis Seizures Trauma
Cardiopulmonary Arrest in children Pediatric cardiopulmonary arrest results when respiratory failure or shock is not identified and treated in the early stages. Early recognition and intervention prevents deterioration to cardiopulmonary arrest and probable death.
Definitions of children and infants Child -> age 1 – 8 years (If Health care provider extended to Puberty) Infant -> age < 1 years Newborn -> age < 28 days Newly born -> within minute or hour after delivery
BLS Sequence for Public people Safety of Rescuer and Victim Assess Need for CPR Check for Response Check for Breathing Start Chest Compressions Open the Airway and Give Ventilations Coordinate Chest Compressions and Breathing Activate Emergency Response System
Assess the Need of CPRIf the victim is unresponsive and is not breathing (or only gasping), send someone to activate the emergency response system.
Pulse CheckHealthcare providers may take up to 10 seconds to attempt to feel for a pulse brachial in an infant carotid or femoral in a childSpecial Condition -> Inadequate Breathing With Pulse = rescue breath Bradycardia With Poor Perfusion = chest compression
Chest CompressionsTechnique for Infant -> Depth at least 1.5 Inches, Intermammary lineTwo – Finger Technique (1 Rescue) Two Thumb-encircling hands technique (2 Rescues)
Chest CompressionsTechnique for Child -> Depth at least 2 Inches, Lower half of sternum
Open Airways Public People -> Head Tilt - Chin Lift Health Care Providers -> Head Tilt – Chin Lift If Suspected C-Spine injury -> Jaw thrust
Defibrillation• Children with sudden witnessed collapse (eg, a child collapsing during an athletic event) are likely to have VF or pulseless VT and need immediate CPR and rapid defibrillation.• VF and pulseless VT are referred to as “shockable rhythms” because they respond to electric shocks (defibrillation).• Decrease (or attenuate) the delivered energy to make them suitable for infants and children <8 years of age• The AED will prompt the rescuer to re-analyze the rhythm about every 2 minutes
Defibrillation• Infant -> Prefer Manual Defibrillation / Pediatric dose attenuator• Age 1 – 8 years -> AED with a pediatric attenuator• Age > 8 years -> AED liked adult used Paddle Size -> Adult Size (> 10 kgs) and Pediatric size (<10 kgs) Energy -> Acceptable to use an initial dose of 2 to 4 J/kg not to exceed 10 J/kg or the adult maximum dose
Medications for Bradycardia Algorithm Medication Pediatrics Dose Adult Dose Remark Epinephrine 0.01 mg/kg 1 mg (1:1,000) May repeat every (0.1 mL/kg 1:10,000) 2 – 2.5 mg ET* 3–5 minutes ET* Maximum dose (about 2 cycles) 1 mg IV/IO; 2.5 mg ET Atropine 0.02 mg/kg IV/IO ET* 0.5 mg/dose Higher doses may Repeat once if Max 3 mg be used with needed (0.6 mg/dose = 5 organophosphate Minimum : 0.1 mg doses) poisoning Maximum : 0.5 mgEndotracheal Tube -> Flush with 5 mL of normal saline and follow with 5 ventilationsLEAN -> Lidocaine, Epinephrine, Atropine and Naloxone
Medications for Tachycardia AlgorithmMedication Pediatrics Dose Adult Dose RemarkAdenosine 1st dose: 0.1 mg/kg 6 mg IV as a rapid IV push Monitor ECG (maximum 6 mg) followed by a 20 mL saline Rapid IV/IO bolus 2nd dose: 0.2 flush; with flush mg/kg (maximum repeat if required as 12 mg IV 12 mg) pushAmiodarone 5 mg/kg IV/IO; may 150 mg given over 10 minutes slowly–over 20– repeat twice up to and repeated if necessary, 60 minutes 15 mg/kg followed by a 1 mg/min infusion Maximum single for 6 hours, followed by 0.5 dose 300 mg mg/min. Total dose over 24 hours should not exceed 2.2 g.
Medications for Tachycardia Algorithm Medication Pediatrics Dose Adult Dose RemarkProcainamine 15 mg/kg IV/IO 20 to 50 mg/min until Monitor ECG and infusion to total arrhythmia suppressed, blood pressure; Give maximum dose hypotension ensues, or slowly–over 30–60 of 17 mg/kg QRS prolonged by 50%, or minutes. Use caution total cumulative dose of when administering 17 mg/kg; or 100 mg every with other drugs that 5 minutes until conditions prolong QT (obtain described above are met expert consultation)
Reference The American Heart Association requests that this document be cited as follows: Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A,Hickey RW, Berg RA, Sutton RM, Hazinski MF. Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S862–S875 เอกสารประกอบงานประชุมวิชาการ Update in New CPR Guideline 2010 แนวทางปฏิบัตการช่วยฟืนคืนชีพ CPR 2010, คณะแพทยศาสตร์ ิ ้ มหาวิทยาลัยเชียงใหม่