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Ötvös Tamás m.d.
2013
Summary of changes since
2005
Lay rescuers have to start the CPR if the
patient doesn’t breath well for 10sec
 Healthcare...
Summary of changes since
2005


Compression technique:
 For infants:
○ 2 finger for single rescuer
○ 2 thumb encircling ...
Summary of changes since
2005


Defibrillation
 Modified or unmodified AED can be used

over the age 1 year
 Manual def...
Paediatric Basic Life
Support
Ensure the safety
 Check the responsiveness


 Gently stimulate and ask:”are you all righ...
Paediatric Basic Life
Support


Keep the airway open, check the
breathing for 10 sec
 If breathing, recovery position, g...
Paediatric Basic Life
Support


Asses circulation
 (no more than 10 sec)
 Look for signs of life (movement, coughing,

...
Paediatric Basic Life
Support


If there are no signs of life:
 Start chest compressions
 Combine with rescue breathing...
Paediatric Basic Life
Support


Continue CPR until:
 The child shows sign of life
 Further qualified help arrives
 You...
Paediatric Basic Life
Support


When to call Help?
 If there are 2 rescuers, one call help
 If there is 1 rescuer, afte...
Paediatric Advanced Life
Support










During CPR
Ensure high quality CPR: rate, depth, recoil
Plan actions be...
Paediatric Advanced Life
Support










Reversible causes(4H/4T)
Hypoxia
Hypovolaemia
Hypo-/hyperkalaemia/metab...
Drugs during CPR
Fluids
Isotonic crystalloids
 20ml/kg

Drugs during CPR
Adrenalin
0.01mg/kg
 Every 3-5 min

Drugs during CPR
Amiodarone
VF or pulseless VT
 After 3. shock give 5mg/kg
 After 5. shock give 5mg/kg
 Infusion pump (...
Drugs during CPR
Calcium
Hypocalcaemia
 Calcium channel blockers overdose
 Hypermagnesaemia
 Hyperkalaemia

Drugs during CPR
Glucose


Only in hypoglycaemia
Drugs during CPR
Magnesium
Hypomagnesaemia
 Torsade de Pointes

Drugs during CPR
Sodium bicarnonate
Do not give it routinely
 Hyperkalaemia
 Tricyclic antidepressant drug overdose

Special circumstances
Channelopathy (?)
 Blunt or penetrating trauma
(thoracotomy)
 Single ventricle

Post arrest management
Myocardial dysfunction (vasoactive
drugs)
 Temperature control (therapeutic
hypothermia 32-34 Cels...
Resuscitation of babies at
birth
Relatively few babies need any
resuscitation
 Majority require only assisted lung
aerati...
Classification to initial
assessment
Vigorous breathing or crying/good
tone/HR>100/min (no intervention)
 Breathing inade...
Apgar score
Airway
Neutral head position
 Suction not recommended (only if
there’s meconium in the airways)

Breathing
Circulatory support
After the lungs are inflated
 HR<60/min-start chest compressions
 Compression/Ventilation=3:1

Drugs
Adrenaline
Adequate ventilation and chest
compression but HR<60/min
 10-30ug/kg i.v.
 Tracheal route (not reccomended): ...
Bicarbonate
???
 1-2mmol/kg
 Not recommended

Fluids


10ml/kg bolus
When to stop CPR?

If there’s no detectable heart rate, after 1015 min
Specific questions
Normal temperature
 Meconium (use suction)
 Air or 100% O2 (in term infants start
ventilation with ai...
Cpr in childhood 2013
Cpr in childhood 2013
Cpr in childhood 2013
Cpr in childhood 2013
Cpr in childhood 2013
Cpr in childhood 2013
Cpr in childhood 2013
Cpr in childhood 2013
Cpr in childhood 2013
Cpr in childhood 2013
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Cpr in childhood 2013

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Transcript of "Cpr in childhood 2013"

  1. 1. Ötvös Tamás m.d. 2013
  2. 2. Summary of changes since 2005 Lay rescuers have to start the CPR if the patient doesn’t breath well for 10sec  Healthcare providers can add looking for pulse (carotid, brachial, femoral)  CV-ratio:   Lay rescuers 30:2  Professionals 15:2 (30:2)
  3. 3. Summary of changes since 2005  Compression technique:  For infants: ○ 2 finger for single rescuer ○ 2 thumb encircling for at least 2 rescuers  For older children: ○ 1 or 2 hand technique  Depth: 1/3 of the AP chest diameter  Compression rate: 100-120/min
  4. 4. Summary of changes since 2005  Defibrillation  Modified or unmodified AED can be used over the age 1 year  Manual defibrillators: 4Joule/kg  Antero-lateral or antero-posterior position  Airway:  Cuffed tubes are safe (except newborns)  Cricoid pressure (safe?)  Capnometry is recommended
  5. 5. Paediatric Basic Life Support Ensure the safety  Check the responsiveness   Gently stimulate and ask:”are you all right?”  Answering&moving: leave in position, check his condition and get help, re-assess Shout for help  Open the airways   Head tilt chin lift  Jaw thrust
  6. 6. Paediatric Basic Life Support  Keep the airway open, check the breathing for 10 sec  If breathing, recovery position, get help&re- assess  Absent of breathing ○ Remove any obvious airway obstruction ○ Give 5 initial rescue breaths
  7. 7. Paediatric Basic Life Support  Asses circulation  (no more than 10 sec)  Look for signs of life (movement, coughing, breathing)  Check the pulse (professionals) ○ >1 year-carotid or femoral ○ <1 year-brachial or femoral
  8. 8. Paediatric Basic Life Support  If there are no signs of life:  Start chest compressions  Combine with rescue breathing  Chest compressions:  100-120/min  The lower half of the sternum  1/3 deep of the AP chest diameter  >1 year: 1 or 2 hands technique  <1 year: 2fingers(alone) or encircling way
  9. 9. Paediatric Basic Life Support  Continue CPR until:  The child shows sign of life  Further qualified help arrives  You become exhausted
  10. 10. Paediatric Basic Life Support  When to call Help?  If there are 2 rescuers, one call help  If there is 1 rescuer, after 1 min CPR  In the case of a child with a witnessed, sudden collapse & the rescuer is alone (arrhytmia!!!)
  11. 11. Paediatric Advanced Life Support         During CPR Ensure high quality CPR: rate, depth, recoil Plan actions before interrupting CPR Give oxygen Vascular access (intravenous, intraosseous) Give adrenalin 3-5min Consider advanced airway&capnography Continuous chest compressions when intubated Correct reversible causes
  12. 12. Paediatric Advanced Life Support         Reversible causes(4H/4T) Hypoxia Hypovolaemia Hypo-/hyperkalaemia/metabolic Hypothermia Tension PTX Toxins Tamponade-cardiac Thromboembolism
  13. 13. Drugs during CPR Fluids Isotonic crystalloids  20ml/kg 
  14. 14. Drugs during CPR Adrenalin 0.01mg/kg  Every 3-5 min 
  15. 15. Drugs during CPR Amiodarone VF or pulseless VT  After 3. shock give 5mg/kg  After 5. shock give 5mg/kg  Infusion pump (dose?) 
  16. 16. Drugs during CPR Calcium Hypocalcaemia  Calcium channel blockers overdose  Hypermagnesaemia  Hyperkalaemia 
  17. 17. Drugs during CPR Glucose  Only in hypoglycaemia
  18. 18. Drugs during CPR Magnesium Hypomagnesaemia  Torsade de Pointes 
  19. 19. Drugs during CPR Sodium bicarnonate Do not give it routinely  Hyperkalaemia  Tricyclic antidepressant drug overdose 
  20. 20. Special circumstances Channelopathy (?)  Blunt or penetrating trauma (thoracotomy)  Single ventricle 
  21. 21. Post arrest management Myocardial dysfunction (vasoactive drugs)  Temperature control (therapeutic hypothermia 32-34 Celsius)  Glucose control 
  22. 22. Resuscitation of babies at birth Relatively few babies need any resuscitation  Majority require only assisted lung aeration  Minority need chest compressions 
  23. 23. Classification to initial assessment Vigorous breathing or crying/good tone/HR>100/min (no intervention)  Breathing inadequately/normal or reduced tone/HR<100/min (dry, mask ventilation, chest compressions possible)  Breathing inadequately/floppy/low heart rate(dry,mask ventilation, chest compressions,drugs) 
  24. 24. Apgar score
  25. 25. Airway Neutral head position  Suction not recommended (only if there’s meconium in the airways) 
  26. 26. Breathing
  27. 27. Circulatory support After the lungs are inflated  HR<60/min-start chest compressions  Compression/Ventilation=3:1 
  28. 28. Drugs
  29. 29. Adrenaline Adequate ventilation and chest compression but HR<60/min  10-30ug/kg i.v.  Tracheal route (not reccomended): 50100ug/kg 
  30. 30. Bicarbonate ???  1-2mmol/kg  Not recommended 
  31. 31. Fluids  10ml/kg bolus
  32. 32. When to stop CPR? If there’s no detectable heart rate, after 1015 min
  33. 33. Specific questions Normal temperature  Meconium (use suction)  Air or 100% O2 (in term infants start ventilation with air)  Time of cord clamping (1min, if CPR is not necessary)  LMA can be used 
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