Pediatric Resuscitation

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RMH Field Care Audit 08/15/12

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  • Pediatric Resuscitation

    1. 1. I Got You, Babe... Veronica Bonales, M.D. RMH PCMD HCEMCC - Paramedic Coordinator
    2. 2. AW13 y.o. female playing soccer. Comes to the sidelinesand complains of not feeling well then suddenlycollapses. Bystander CPR is initiated. EMSarrives on scene, intubates and transfers the patient...
    3. 3. PediatricResuscitation
    4. 4. Pediatric ResuscitaionNumbers are bleak 27% of in-hospital cardiac arrests survive Survival to discharge only 6% Larger percentage of out-of-hospital cardiac arrests do not survive Some of the survivors are left seriously incapacitated
    5. 5. Baby Huey
    6. 6. Baby Ruth9/49 created,appeared in “Casper”comic book then film1950.
    7. 7. Pediatric ResuscitationDo pedis have heart attacks...? 5 - 15%Asphyxial arrest Progressive respiratory failure Shock
    8. 8. Pediatric ResuscitationAsphyxia Hypoxemia (low O2), hypercapnea (high CO2), acidosis (low pH) Leads to... Bradycardia, hypotension Leads to... Cardiac arrest
    9. 9. Pediatric ResuscitationRespiratory Issues Not ventilating Not oxygenating Or both...
    10. 10. Pediatric ResuscitaionImpending respiratory failure Increased respiratory rate Grunting, nasal flaring, retractions Poor respiratory effort Gasping, decreased breath sounds esp. with decreased mental status Cyanosis despite supplemental oxygen
    11. 11. Pediatric ResuscitaionShock Inadequate blood flow and oxygen delivery to meet tissue metabolic demands...
    12. 12. Pediatric ResuscitaionMost common type of shock in children.... Hypovolemic
    13. 13. Pediatric ResuscitaionShock Hypovolemic Cardiogenic Septic Anaphylactic Neurogenic
    14. 14. Pediatric ResuscitationMetabolic rates higher Require more energy and consume more oxygen Illness or stress accelerates
    15. 15. Pediatric ResuscitationHigher fluid requirement Newborn 70 - 80% water (adult 50 - 60%) Prone to dehydration (diarrhea, emesis, blood loss) Greater surface area to weight ratio25% more total circulating blood volume per body weight
    16. 16. Pediatric ResuscitaionCompensated Shock Tachycardia Cool and pale distal extremities Delayed cap refill (>2 sec) Weak peripheral pulses Blood pressure....? Normal
    17. 17. Pediatric ResuscitationGreater capacity to increase heart rate Heart rate >160 bpm tachycardicVessels “clamp down” Peripheral pulses will become thready and disappear before central pulses Skin color and cap refill important
    18. 18. Pediatric ResuscitaionContinuum Signs of end-organ damage Decreased mental status, decreased urine output, metabolic acidosis, tachypnea, poor central pulses, mottling
    19. 19. Pediatric ResuscitationWith oxygen,pyruvate converts toacetyl CoAWithout oxygen,pyruvate converts tolactate
    20. 20. Pediatric ResuscitaionDecompensated Shock Weak or absent peripheral pulses Weak central pulses Hypotension
    21. 21. Pediatric ResuscitaionLook at the patient not the number... Tachycardia - fever, pain, anxiety Bounding pulses in anaphylactic, septic and neurogenic shock
    22. 22. Baby Houseman
    23. 23. Baby HousemanDirty Dancing 1987 Featured Jennifer Grey and Patrick Swayze Both hired because they had dance experience
    24. 24. “Nobody puts Baby in a corner...”
    25. 25. Pediatric ResuscitaionUpper Airway Diseases Croup/Asthma Epiglottitis (vaccination status) Foreign Body Aspiration Anaphylaxis Congenital Trauma Other Infections
    26. 26. Pediatric ResuscitaionPoiseuilles Law
    27. 27. Pediatric ResuscitaionPoiseuilles Law
    28. 28. Pediatric ResuscitaionPoiseuilles Law
    29. 29. Pediatric ResuscitaionPoiseuilles Law
    30. 30. Pediatric ResuscitaionCroup Most common upper airway problem Due to: Flu virus, RSV, Parainfluenza virus, Adenovirus Late fall/early winter
    31. 31. Pediatric ResuscitaionUsually affects infants and toddlersCold symptoms 2 - 3 daysNasal congestion, hoarsenessTachypnea, low grade feverWorse at nightInflammation, edema of upper airways58% stridor94% barking or seal-like cough
    32. 32. Pediatric ResuscitaionUsually affects infants and toddlersCold symptoms 2 - 3 daysNasal congestion, hoarsenessTachypnea, low grade feverWorse at nightInflammation, edema of upper airways58% stridor94% barking or seal-like cough
    33. 33. Pediatric ResuscitaionAsthma Most common chronic disease of childhood Admission rate for age <5 is higher than for all other age groups Mortality rising 1/2 of all deaths in pre-hospital setting Length of final attack < 2hr in 50% of deaths
    34. 34. Pediatric Resuscitaion Triggers lead to bronchial spasming, mucosal edema, increased secretions URI’s, exercise, cold air exposure, emotional stress, passive exposure to smoke, allergens
    35. 35. Pediatric ResuscitaionSymptoms: Tachypnea Tachycardia Retractions Wheezing or decreased breath sounds Normal or low O2 sats
    36. 36. Pediatric ResuscitaionFactors of Severe Attack Prior ICU admission or intubation >3 ED visits in a year >2 Hospital admissions in a year Use of >1 MDI canister in last month Use of rescue inhaler >Q4H Worsening symptoms despite aggressive home therapy
    37. 37. Pediatric ResuscitaionSigns of Severe Asthma Attack Altered appearance Exhaustion Inability to recline Interrupted speech Severe retractions Decreased air movement
    38. 38. Pediatric ResuscitaionALOC Trauma, temperatureAEIOUTIPS Infection Alcohol Psychogenic, poison Epilepsy, endocrine, Shock, space-occupying electrolytes lesion, SAH Insulin Opiates, overdose Uremia
    39. 39. Pediatric ResuscitaionHypoglycemia Low glycogen stores in the liver Alcohol, accidental ingestion of anti-hyperglycemic agents, overmedication with insulin Inborn errors of metabolism
    40. 40. Pediatric Resuscitation ComaHypoglycemia Hypothermia
    41. 41. Pediatric Resuscitation ComaHypoglycemia Hypothermia
    42. 42. Pediatric ResuscitaionIngestions Two peaks Toddlers - accidental Teens - intentional
    43. 43. One Pill Can KillTheophyllineTricyclic antidepressantsClonidine (0.2mg, temporary reverse Narcan)VerapamilPropanololCamphorMethyl salicylate (oil of wintergreen)
    44. 44. ...Baby One More Time
    45. 45. ...Baby One More TimeBritney Spears’ debutalbum and hit in January1999Originally titled “Hit MeOne More Time” andchanged due to concernsabout condoning domesticviolence
    46. 46. Pediatric Resuscitaion
    47. 47. Pediatric Resuscitaion First Always: Scene Safety
    48. 48. Pediatric Resuscitaion First Always: Scene Safety Does location provide clues? Where are you? Weapons, toys, objects Medications Witnesses
    49. 49. Pediatric ResuscitaionLook at the child... Listen to the parent...
    50. 50. Pediatric ResuscitationFirst ImpressionPediatric Assessment Triangle Appearance Work of breathing Circulation to skin
    51. 51. Pediatric ResuscitationFirst ImpressionPediatric Assessment Triangle Appearance Work of breathing Circulation to skin
    52. 52. Pediatric Resuscitation
    53. 53. Pediatric ResuscitationAppearance Tone Interactiveness Consolability Look/Gaze Speech/Cry
    54. 54. Pediatric ResuscitationAppearance Work of Breathing Tone Abnormal breath sounds Interactiveness Consolability Abnormal positioning Look/Gaze Retractions Speech/Cry Flaring
    55. 55. Pediatric ResuscitationAppearance Work of Breathing Tone Abnormal breath sounds Interactiveness Consolability Abnormal positioning Look/Gaze Retractions Speech/Cry Flaring • Circulation to Skin • Pallor, Mottling, Cyanosis
    56. 56. Pediatric ResuscitaionAirwayBreathingCirculationDisabilityExposure
    57. 57. Pediatric Resuscitation
    58. 58. Pediatric ResuscitaionDisability AVPU Alert Voice Pain Unresponsive
    59. 59. Pediatric ResuscitationIn the event of a code... Age + 16 divided by 4 = ETT size
    60. 60. Pediatric ResuscitationBroselow Tape Been in use over 12 years Height and weight based dosing Child must be laying flat
    61. 61. Pediatric Resuscitation
    62. 62. Pediatric Resuscitation• Vascular access • Peripheral IV • IO device in R leg• 20 ml/kg LR or NS • Rebolus until hemodynamically stable
    63. 63. Pediatric ResuscitationI/O delivery
    64. 64. Pediatric ResuscitationPhysiologyMechanismsToolsAny Questions...?
    65. 65. AWBorn with small LeftCoronary Arterywhich was not locatedanatomically correct
    66. 66. Baby Ruth
    67. 67. Baby RuthInvented in 1921, thisfamous bar had arather “infamous”cameo in this 1980‘sgolf movie...
    68. 68. Caddyshack
    69. 69. Thank You!!slideshare.net/docmonteyhcemsgroup.blogspot.comFacebook/docmontey

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