PALS guidelines 2015 - CPR in children

1. CARDIOPULMONARY RESUSCITATION
(CPR)
IN
PEDIATRIC PRACTICE
DR.M.SUCINDAR
ASST. PROF
DEPT. OF PEDIATRICS
SLIMS

2. WHY LEARN CPR ?
 When a person has a cardiac arrest, survival
depends on immediately getting CPR from
someone nearby.
 Almost 90 percent of people who die from
cardiac arrest in the out-of-hospital setting.
 CPR, especially if performed in the first few
minutes of cardiac arrest, can double or triple a
person’s chance of survival.

3. LEADING CAUSES OF DEATH
 Congenital
malformations
 Complications of
prematurity
 SIDS
 Injury
INFANTS CHILDREN

4. PEDIATRIC CARDIAC ARREST
 PBLS – Pediatric Basic Life Support
 PALS – Pediatric Advanced Life Support

5. PEDIATRIC CHAIN OF SURVIVAL

6. PEDIATRIC CHAIN OF SURVIVAL
 Prevention of cardiac
arrest
 Perform early CPR
 Active Emergency
response system
 Advanced life support
 Post resuscitation
care
PBLS PALS

7. PATHWAYS TO CARDIAC ARREST

8. RECOGNITION OF CARDIAC ARREST
 1. Absence of signs of cardio respiratory
function
No movement
No breathing or
No response to rescue breaths
No pulse
 2. Arrest rhythm on the cardiac monitor (Note:
Monitoring is not mandatory for recognition of
cardiac arrest)

9. INITIATION OF CPR
 To decrease the time
to initiation of chest
compressions and
reduce “no blood flow”
time.
 Time to first
ventilation is delayed
by only approximately
6 seconds.

10.  Provide CPR even when the unresponsive victim
has occasional gasps.
 Conventional CPR (chest compressions and
rescue breaths) should be provided for pediatric
cardiac arrests.
 Compression-only CPR is effective in patients
with a primary cardiac event, if rescuers are
unwilling or unable to deliver breaths, AHA
recommend rescuers perform compression-only
CPR for infants and children in cardiac arrest.

15. PALS
2015

16. PALS
2015

17. REVERSIBLE CAUSES
 6 H’s and 5 T’s

18. RESCUE BREATHING

19. BAG-MASK VENTILATION

20. CHEST COMPRESSIONS
 RATE:
 100 to 120 / min
 DEPTH:
 (≥ 1/3 of anteroposterior
diameter of chest)
 Infants – 1.5 inches (4 cm)
 Children – 2 inches (5 cm)
 Adolescents – at least 2 inches
(5 cm) but not greater than
2.4 inches (6 cm).

21. CHEST COMPRESSIONS IN INFANT

22. CHEST COMPRESSIONS IN INFANT

23. CHEST COMPRESSIONS IN CHILDREN

24. AUTOMATED EXTERNAL
DEFIBRILLATOR (AED)
 < 8 yrs; < 25 kg
 AED with dose
attenuator

25. MANUAL DEFIBRILLATOR
 The recommended
first energy dose for
defibrillation is 2
J/kg.
 If a second dose is
required, it should be
doubled to 4 J/kg.
 Subsequent doses 4
J/kg up to maximum
of 10 J/kg.

26. PLACEMENT OF PADS OR PADDLES
 Children (>1 yr; >10 kg – adult size)
 Right upper chest below the clavicle
 Lateral to the left nipple below the axilla
 Infants (<1 yr; <10kg – infant size)
 Sternum below the mammary line
 Back between two scapulae

27. EPINEPHRINE
 IO/IV dose:
 0.01 mg/kg (0.1ml/kg),
1:10000 concentration
 Endotracheal dose:
 0.1 mg/kg, 1:1000
concentration

28.  IO/IV dose:
 5 mg/kg bolus
 Repeat up to 2 times
for refractory VF /
Pulseless VT
 IO/IV dose:
 1 mg/kg loading dose
 Maintenance: 20 – 50
mcg/kg/min infusion
AMIODARONE LIDOCAINE

29. “HIGH QUALITY CPR”
 Push “Fast” (100 – 120 / min).
 Push “Hard” (≥ 1/3 of anteroposterior diameter of
chest).
 Allow complete chest recoil.
 Minimize interruptions in chest compressions.
 Rotate compressor every 2 min or sooner if fatigued.
 If no advance airway, 30:2 compression-ventilation
ratio (single rescuer); 15:2 compression-ventilation
ratio (multiple rescuers).
 If advance airway, compression rate of 100 – 120 / min,
1 breath every 6 seconds (10 breaths/min).
 Avoid excessive ventilations.

30. MCQ’S

31.  How many cycles of CPR are recommended in 2
min duration?
 A) 2
 B) 3
 C) 4
 D) 5

32.  What is the maximum depth of chest
compressions in adolescents during CPR?
 A) 3 cm
 B) 4 cm
 C) 5 cm
 D) 6 cm

33.  Which of the following arhythmia is referred to
as “shockable rhythm”?
 A) Asystole
 B) Pulseless VT
 C) Pulseless electrical activity
 D) Bradyarhythmia

34.  What is the ECG diagnosis?
 A) Supraventricular tachycardia
 B) Ventricular tachycardia
 C) Ventricular fibrillation
 D) Asystole

35.  What is the first energy dose of defibrillation?
 A) 1 J/Kg
 B) 2 J/Kg
 C) 3 J/Kg
 D) 4 J/Kg

36.  What is the dose of IV epinephrine in CPR?
 A) 0.1 mg/kg of 1:10000
 B) 0.1 mg/kg of 1:1000
 C) 0.01 mg/kg of 1:10000
 D) 0.01 mg/kg of 1:1000