2. • It’s the lifesaving technique useful in emergencies where
a child’s breathing or heartbeat is stopped.
• Two separate levels of skills and medical care have
been defined in the context of CPR: basic life support
(BLS) and advanced life support (ALS)
3. Outcome of CPR
• Rapid and effective CPR is associated with successful
return of spontaneous circulation and neurologically
intact survival in children following cardiopulmonary
arrest
• Bystander resuscitation may have the greatest impact for
out of hospital respiratory arrest, because survival rates
>70% have been reported with good neurological
outcome.
• Overall about 6-15% of children who suffer an out of
hospital cardiac arrest response to resuscitation survive
but many suffer serious permanent brain injury as a
result of their arrest.
4. Continue…
• Result of in hospital resuscitation are better with an over
all survival of 27%
• Pediatric patients with pulseless arrest has 34% survival
to discharge while infants and children with pulse but
poor perfusion and bradycardia has the best survival rate
(64%)
6. Goals of CPR
1. To restore spontaneous circulation before the point of
irreversibility is reached
2. treating the underlying cause and enhancing the
degree of neurological recovery
8. Respiratory Arrest
• This may be result of following:
• Drowning
• Foreign body in throat
• Drug overdose
• Suffocation
• Accident, injury
• Coma
• Epiglottis paralysis.
9. • To maximize survival and intact neurological status in
post resuscitation stage, early reorganization of the
cardiac arrest and strict adherence to the BLS is
necessary.
• The sequence of BLS is
a. Assessment
b. Circulation
c. Airway
d. Breathing
11. Assessment
A rapid assessment of the child’s overall respiratory and
circulatory status should be completed with in the first few
seconds.
A. Airway
• Clear
• Patent
• Able to maintain
B. Breathing
• Rate
• Mechanic
• Air entry
• Color
C. Circulation
• Heart rate
• blood pressure
• CRT
• Peripheral pulse
CNS perfusion
• AVPU
• GCS
12. Circulation
Place of compression
Lower half of the
sternum
Depth of compression
One third to half of
the antero-posterior of
the chest
Rate of compression
At least 100/m in
infant
At least 80 /m in
children
Position of patient
Lying supine and
hard and flat surface
13. Chest compression in infant <1 year
1- Two finger technique
• Place two fingers of one hand
vertically over the sternum just
bellow the inter mammary line
(between the two nipples)
• Place other hand under the infant
supporting the body and head and
the other hand perform
compression
• Compress the chest
– Rate least 100 min
– Depth 4 cm (1.5 inch)
• When possible change CPR
operator every 2 min
14. Chest compression in infant <1 year……..
1- Two thumb technique
• the infant chest is encircled with
both hands, fingers are spread
around the thorax and the thumbs
brought together over the lower half
of the sternum
• the sternum is compress with the
thumbs and the thorax with the
fingers for counter pressure
• Compress the chest
– Rate least 100 min
– Depth 4 cm (1.5 inch)
15. Chest compression in children (1-8yr)
the heel of one hand
should be placed over
lower half of sternum
avoiding pressure over
xiphoid with fingers lifted
above the chest wall to
prevent compression of rib
cage.
16. Chest compression for children older than 8yr
• This is achieved by placing heel of
one hand over the lower half of
sternum and heel of the other hands
over the first hand
• interlocking the fingers of both
hands with fingers lifted above the
chest wall
• for one health care provider the
compression/ ventilation ratio should
be 30:2 for all age group
• for two rescuer the compression/
ventilation ratio should be 30:2 for all
adult and 15:2 for infants and
children up to the start of puberty.
17.
18. OPEN AIRWAY
Head tilt and chine lift
If the child is unresponsive and
trauma is not suspected this
maneuver should be used
Method
One hand is placed the child
forehead and gently tilted back
The same time finger of the
other hand on the lower jaw for
lifting
Note
This maneuver should not
use in suspected trauma
21. Breathing
• Bag and mask ventilation
remains the preferred
technique for emergency
ventilation during the initial
steps of resuscitation
• For infants and children <8yr
of age ventilation bag of
minimum valium 450-500 ml
should be used to deliver
adequate amount of tidal
valium
• Neonatal size bag (250 ml)
may be used for preterm
neonates.
22.
23. Pediatric advanced life support (PALS)
If a patient does not
respond to initial CPR,
further interventions are
required. And in cases
where initial interventions
are successful in
restoring a perfusing
rhythm, the patient may
still require ALS (i.e.,
airway, medications and
further evaluation) to
optimize outcome
24. Defibrillation
• VF can be the cause of
sudden collapse or
may develop during
resuscitation attempts
• VF and pulseless VT
are referred as
shockable rhythms
because they respond
to electric shocks
(defibrillation)
• 2J/kg → 4J/kg → not
exeed 10J/kg
28. Position of ETT
• Auscultation of breath sounds in both axillae
• Absence of breath sounds over the stomach area
• Symmetrical chest expansion with positive pressure
breaths
• Improvement in color, heart rate and perfusion
• Improvement in oxygenation as measured by pulse
oximeter
• After stabilization the precise location of ET tube may be
checked by radiography
29. Advantage of endotracheal intubation
• Provide a secure and stable airway for oxygenation and
ventilation
• Protect the airway against gross aspiration
• Allow removal of secretions
• Reduce dead space
• help avoid gastric distention
• Provide route for drug delivery
• Allow hyperventilation in patient with raised ICP
30. Con…..
When endotracheal intubation is ineffective ???
• ETT is to small
• Inadequate size or poor compression of the resuscitation
bag is giving inadequate tidal volume
• Poor compliance of lung or airway obstruction may
require higher pressure to be applied
• ET tube is blocked
• Lungs are being compressed from out side
31. Con….
When a patient with ETT shows sudden deterioration
one of the following condition should be looked for which
can be remembered by the acronym DOPE
• D- displacement
• O- obstruction
• P- pneumothorax
• E- equipment failure
32. Fluid therapy
• Shock 20cc/kg saline or ringer’s lactate up to
60cc/kg
Large vein
Large syringe
By push
Crystalloids
• Blood transfusion in sever hemorrhagic shock
• Intravenous glucose if suspected hypoglycemia
