Cpr in childhood 2013
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Cpr in childhood 2013

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Cpr in childhood 2013 Cpr in childhood 2013 Presentation Transcript

  • 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 providers can add looking for pulse (carotid, brachial, femoral)  CV-ratio:   Lay rescuers 30:2  Professionals 15:2 (30:2)
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • Paediatric Basic Life Support  Continue CPR until:  The child shows sign of life  Further qualified help arrives  You become exhausted
  • 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!!!)
  • 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
  • Paediatric Advanced Life Support         Reversible causes(4H/4T) Hypoxia Hypovolaemia Hypo-/hyperkalaemia/metabolic Hypothermia Tension PTX Toxins Tamponade-cardiac Thromboembolism
  • 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 (dose?) 
  • 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 Celsius)  Glucose control 
  • Resuscitation of babies at birth Relatively few babies need any resuscitation  Majority require only assisted lung aeration  Minority need chest compressions 
  • 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) 
  • 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): 50100ug/kg 
  • 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 air)  Time of cord clamping (1min, if CPR is not necessary)  LMA can be used 