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Updates of 2015 PALSUpdates of 2015 PALS
guidelinesguidelines
Marwa Elhady
lecturer of pediatrics
Faculty of medicine for ...
‫تعالى‬ ‫قال‬‫جميعا‬ ‫الناس‬ ‫أحيا‬ ‫فكأنما‬ ‫أحياها‬ ‫)ومن‬ : )‫تعالى‬ ‫قال‬‫جميعا‬ ‫الناس‬ ‫أحيا‬ ‫فكأنما‬ ‫أحياها‬ ‫)وم...
IntroductionIntroduction
Objectives
What is
CPR??
What is
CPR??
overview on
CPR 2015
overview on
CPR 2015
Explanations
& N...
Introduction:
Start CPR ImmediatelyStart CPR Immediately
Brain damage starts in 4-6 minutes
Brain damage is certain after 10
minutes
Bet...
Checking Vital SignsChecking Vital Signs
A – Airway
Open the airway
Head tilt chin lift
B – Check For Breathing
Look, list...
Mouth to Mouth Barrier DevicesMouth to Mouth Barrier Devices
Shields Masks
After giving breaths…
Locate proper hand position for chest
compressions
C – Chest compression
Checking for CPRChecking for CPR
EffectivenessEffectiveness
Does chest rise and
fall with rescue
breaths?
Have a second
re...
1- Ensure chest compression of
adequate rate
2- Chest compression of adequate depth
3-Allow full chest recoil in between
c...
Old
BLS 2010
BLS 2015 (1 rescue)BLS 2015 (1 rescue)
BLS 2015 (2 rescue)BLS 2015 (2 rescue)
Basic Life Support
BLS
Basic Life Support
BLS
ITEM 2015 ( UPDATE( 2010 ( Old ) Explanation
New
algorithms
Two algorithms
for 1-Rescuer and
Multiple-Rescuers
Handheld ce...
ITEM 2015 ( UPDATE(
as 2010 ( Old)
Explanation
C-A-B
Sequence
Chest compression first
CPR should begin with 30
compression...
ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Chest
Compression
Depth
depress the chest
at least 1/3 the
anteroposterior
dia...
ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Chest
Compression
Rate
Use the
recommended
adult chest
compression
rate of 100...
ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Compression
-Only CPR
rescue breaths
and chest
compressions
should be
provided...
 Reaffirming the C-A-B sequence as the preferred
sequence for pediatric CPR
 New algorithms for 1-rescuer and multiple-r...
Pediatric Advanced life support
PALS
Pediatric Advanced life support
PALS
• Fluid resuscitation in febrile illness
• Atropine use before tracheal intubation
• Use of amiodarone and lidocaine in sh...
ITEM 2015 (UPDATE( Explanation
Fluid
Resuscitation
Early, rapid IV administration
of isotonic fluids for septic
shock.
(20...
ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Atropine for
ETT
no evidence
support routine
use of atropine
as a
premedicatio...
ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Invasive
hemodynamic
monitoring
during CPR
If invasive
hemodynamic
monitoring ...
ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
antiarrhythmic
medications
for shock
refractory VF
or pulseless VT
Amiodarone
...
ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Vasopressors
for
Resuscitation
It is
reasonable to
give
epinephrine
during car...
ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
ECPR
Compared
With
Standard
Resuscitation
ECPR may be
considered for
children ...
ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Targeted
Temperature
Management
For comatose
children
maintain
either 5 days
n...
ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Intra-arrest
and Post-
arrest
Prognostic
Factors
Multiple
factors should
be co...
ITEM 2015 (UPDATE( Explanation
Post–Cardiac
Arrest Fluids
and Inotropes
fluids and
inotropes/vasopressors
should be used t...
ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Post–Cardiac
Arrest Pao2
and Paco2
avoid
Hypoxemia.
titrate oxygen
administrat...
 Restrictive fluid volumes in febrile illness.
 Routine use of atropine as a premedication for emergency
ETT in non-neon...
Updates of 2015 PALS guidlines
Updates of 2015 PALS guidlines
Updates of 2015 PALS guidlines
Updates of 2015 PALS guidlines
Updates of 2015 PALS guidlines
Updates of 2015 PALS guidlines
Updates of 2015 PALS guidlines
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Updates of 2015 PALS guidlines

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this powepoint describe changes between 2010 and 2015 guidlines for BLS, PALS in pediatric age group

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Updates of 2015 PALS guidlines

  1. 1. Updates of 2015 PALSUpdates of 2015 PALS guidelinesguidelines Marwa Elhady lecturer of pediatrics Faculty of medicine for girls Al-Azhar University 2016
  2. 2. ‫تعالى‬ ‫قال‬‫جميعا‬ ‫الناس‬ ‫أحيا‬ ‫فكأنما‬ ‫أحياها‬ ‫)ومن‬ : )‫تعالى‬ ‫قال‬‫جميعا‬ ‫الناس‬ ‫أحيا‬ ‫فكأنما‬ ‫أحياها‬ ‫)ومن‬ : )
  3. 3. IntroductionIntroduction Objectives What is CPR?? What is CPR?? overview on CPR 2015 overview on CPR 2015 Explanations & New studies Explanations & New studies overview on CPR 2010 overview on CPR 2010 2015 AHA Guidelines update for CPR & BLS for pediatric in comparison with 2010 Summary of High-Quality CPR Components for BLS Providers in pediatrics Summary of High-Quality CPR Components for BLS Providers in pediatrics
  4. 4. Introduction:
  5. 5. Start CPR ImmediatelyStart CPR Immediately Brain damage starts in 4-6 minutes Brain damage is certain after 10 minutes Better chance of survival Without CPR SO
  6. 6. Checking Vital SignsChecking Vital Signs A – Airway Open the airway Head tilt chin lift B – Check For Breathing Look, listen and feel for breathing No longer than 10 seconds If the victim is not breathing, give two breaths (1 second or longer)
  7. 7. Mouth to Mouth Barrier DevicesMouth to Mouth Barrier Devices Shields Masks
  8. 8. After giving breaths… Locate proper hand position for chest compressions C – Chest compression
  9. 9. Checking for CPRChecking for CPR EffectivenessEffectiveness Does chest rise and fall with rescue breaths? Have a second rescuer check pulse while you give compressions
  10. 10. 1- Ensure chest compression of adequate rate 2- Chest compression of adequate depth 3-Allow full chest recoil in between compressions 4-Minimizing interruptions of chest compressions 5- Avoid excessive ventilation Components of high quality CPR
  11. 11. Old BLS 2010
  12. 12. BLS 2015 (1 rescue)BLS 2015 (1 rescue)
  13. 13. BLS 2015 (2 rescue)BLS 2015 (2 rescue)
  14. 14. Basic Life Support BLS Basic Life Support BLS
  15. 15. ITEM 2015 ( UPDATE( 2010 ( Old ) Explanation New algorithms Two algorithms for 1-Rescuer and Multiple-Rescuers Handheld cellular telephones with speakers allow single rescuer to activate an emergency response while beginning CPR One algorithm for one or Multiple- Rescuers CPR have been separated to better guide rescuers
  16. 16. ITEM 2015 ( UPDATE( as 2010 ( Old) Explanation C-A-B Sequence Chest compression first CPR should begin with 30 compressions (if 1 rescuer) or 15 compressions (if 2 rescuer) rather 2 breaths Beginning CPR by compressions rather than breaths (C-A-B rather than A-B-C). leads to a shorter delay to 1st compression providing vital blood flow to heart & brain.
  17. 17. ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Chest Compression Depth depress the chest at least 1/3 the anteroposterior diameter in pediatric approximately 1.5 inches (4 cm) in infants to 2 inches (5 cm) in children Max limit is 2.4 inches (6 cm) as adult compress at least 1/3 of the anteroposterior diameter of the chest No maximum limit Studies showed that compressions deeper than 2.4 inches (6 cm) is harmful.
  18. 18. ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Chest Compression Rate Use the recommended adult chest compression rate of 100 to 120/min for infants and children Push at a rate of at least 100 compressions per minute. To maximize educational consistency and retention, pediatric experts adopted the same recommendation for compression rate as is made for adult BLS.
  19. 19. ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Compression -Only CPR rescue breaths and chest compressions should be provided But if rescuers are unwilling or unable to deliver breaths compression- only CPR can be effective in patients with cardiac arrest. Optimal CPR includes both compressions and ventilations When cardiac etiology was present, outcomes were similar whether conventional or compression- only CPR was provided. compressions alone are preferable to no CPR.
  20. 20.  Reaffirming the C-A-B sequence as the preferred sequence for pediatric CPR  New algorithms for 1-rescuer and multiple-rescuer pediatric HCP with use of cell phone  Establishing an upper limit of 6 cm for chest compression depth in an adolescent  Mirroring the adult BLS recommended chest compression rate of 100 to 120/min  Strongly reaffirming that compressions and ventilation are needed for pediatric BLS. Summary of Key Issues and Major Changes
  21. 21. Pediatric Advanced life support PALS Pediatric Advanced life support PALS
  22. 22. • Fluid resuscitation in febrile illness • Atropine use before tracheal intubation • Use of amiodarone and lidocaine in shock- refractory VF/pVT • TTM after resuscitation from cardiac arrest in infants and children • Post–cardiac arrest management of blood pressure. updates are provided about:
  23. 23. ITEM 2015 (UPDATE( Explanation Fluid Resuscitation Early, rapid IV administration of isotonic fluids for septic shock. (20 mL/kg) If febrile illness with limited access to critical care resources (ie, MV and inotropics) administration of bolus IV fluids with extreme caution, as it may be harmful. In resource- limited settings, excessive fluid boluses to febrile children may lead to complications where the appropriate equipment and expertise might not be present to effectively address them.
  24. 24. ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Atropine for ETT no evidence support routine use of atropine as a premedication to in ER pediatric intubations. Considered in situations with increased risk of bradycardia. atropine 0.1 mg IV was recommended to prevent bradycardia Recent evidence is conflicting Recent studies did use atropine doses less than 0.1 mg without an increase in the likelihood of arrhythmias.
  25. 25. ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Invasive hemodynamic monitoring during CPR If invasive hemodynamic monitoring is in place at the time of a cardiac arrest in a child, use it to guide CPR quality. Chest compressing to a specific systolic blood pressure target has not been studied in humans but may improve outcomes in animals. Recent evidence of improved outcome when CPR technique was adjusted on the basis of invasive hemodynamic monitoring.
  26. 26. ITEM 2015 (UPDATE( 2010 ( Old ) Explanation antiarrhythmic medications for shock refractory VF or pulseless VT Amiodarone or lidocaine is equally acceptable for the treatment of shock- refractory VF or pulseless VT in children Amiodarone was recommended for shock refractory VF or pulselessVT. Lidocaine can be given if amiodarone is not available. Recent evidence that lidocaine was associated with higher rates of survival compared with amiodarone,.
  27. 27. ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Vasopressors for Resuscitation It is reasonable to give epinephrine during cardiac arrest Epinephrine should be given for pulseless cardiac arrest. Recent evidence that epinephrine was associated with improved ROSC and survival in cardiac arrest
  28. 28. ITEM 2015 (UPDATE( 2010 ( Old ) Explanation ECPR Compared With Standard Resuscitation ECPR may be considered for children with underlying cardiac conditions who have an IHCA, provided appropriate protocols, expertise, and equipment are available. Extracorporeal life support should be considered only for children in cardiac arrest refractory to standard resuscitation attempts, with a potentially reversible cause of arrest. One retrospective registry review showed better outcome with ECPR for patients with cardiac disease than for those with non cardiac disease.
  29. 29. ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Targeted Temperature Management For comatose children maintain either 5 days normothermia (36°C -37.5°C) or Initial 2 days hypothermia (32°C - 34°C) followed by 3 days normothermia Therapeutic hypothermia (32°C to 34°C) may be considered for children who remain comatose after resuscitation from cardiac arrest. Recent evidence show no difference in functional outcome at 1 year between use therapeutic hypothermia (32°C to 34°C) or normothermia (36°C to 37.5°C)
  30. 30. ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Intra-arrest and Post- arrest Prognostic Factors Multiple factors should be considered to predict outcomes of cardiac arrest. And for decision to continue or terminate resuscitation. Practitioners should consider multiple variables to prognosticate outcomes and use judgment to titrate efforts appropriately. No single intra- arrest or post– cardiac arrest variable has been found that reliably predicts favorable or poor outcomes
  31. 31. ITEM 2015 (UPDATE( Explanation Post–Cardiac Arrest Fluids and Inotropes fluids and inotropes/vasopressors should be used to maintain a systolic blood pressure above the fifth percentile for age. Intra-arterial pressure monitoring should be used to continuously monitor blood pressure and identify and treat hypotension. children who had hypotension had worse survival and worse neurologic outcome
  32. 32. ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Post–Cardiac Arrest Pao2 and Paco2 avoid Hypoxemia. titrate oxygen administration to achieve (sat. > 94%). target PaCO2 appropriate for each patient. Avoid hypercapnia or hypocapnia. maintain an oxyhemoglobin saturation of 94% or greater. No recommendations were made about PaCO2. normoxemia associated with improved outcome compared with hyperoxemia Worse patient outcomes associated with hypocapnia.
  33. 33.  Restrictive fluid volumes in febrile illness.  Routine use of atropine as a premedication for emergency ETT in non-neonates is controversial.  If invasive arterial blood pressure monitoring is already in place, use it to adjust CPR.  Epinephrine continues to be recommended as a vasopressor in pediatric cardiac arrest  fluids and inotropes used to maintain a systolic blood pressure above the fifth percentile for age.  Maintain O2 sat >94%, Avoid hype or hypocapnia.  Therapeutic hypothermia have no advantage than normothermia  ECPR is considered in children with cardiac disease Summary of Key Issues and Major Changes

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