Pediatric advanced life support

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Pediatric advanced life support

  1. 1. ReanimaçReanimação cardiopulmonar na criança crianç Antonio Souto acasouto@bol.com.br Médico coordenador Pediá Unidade de Medicina Intensiva Pediátrica Unidade de Medicina Intensiva Neonatal Hospital Padre Albino ní Professor de Pediatria nível II Faculdades Integradas Padre Albino Catanduva / SP
  2. 2. Paediatric basic and advanced life supportInternational Liaison Committee on ResuscitationResuscitation (2005) 67, 271—291The ILCOR Paediatric Task ForceReviewed 45 topics related to paediatric resuscitation.
  3. 3. Causas Hipoxemia Choque Acidose metabólica/respiratória
  4. 4. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  5. 5. Healthcare professionals may alsocheck for a pulse but should proceed with CPR if they cannot feel a pulsewithin 10 s or are uncertain if a pulse is present Resuscitation (2005) 67, 271—291
  6. 6. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  7. 7. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  8. 8. Conhecimentos básicos Técnica (PALS/CRN) Unidade (UTIped, UTIneo, PS) Fonte de O2 Aspirador Material de reanimação COT, máscaras, ambus
  9. 9. Suporte de vida Identificação da PCR Pedir ajuda Posicionar o paciente Desobstruir vias aéreas Ventilação (ambu) Massagem cardíaca externa Acesso venoso Drogas
  10. 10. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  11. 11. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  12. 12. Posicionamento/Via aérea Decúbito dorsal sobre superfície rígida Cabeça em posição mediana Leve extensão da cabeça Laringe anterior e cefalizada Reanimador na cabeceira do paciente
  13. 13. Ventilação Definir padrão respiratório (efetivo?) Definir suporte respiratório O2 = 100% Ambu-máscara/COT Máscara ajustada adequadamente Ventilação 1 a 1,5 seg (distensão gástrica) ~ 10 x por minuto 2:15(30) (Contar em voz alta)
  14. 14. For children requiring airway control orventilation for short periods, bag valve-mask (BVM) ventilation produces equivalentSurvival rates compared with ventilation with tracheal intubation. Resuscitation (2005) 67, 271—291
  15. 15. Until additional evidence is published, we support healthcare providers’ use of100% oxygen during resuscitation (when available). Resuscitation (2005) 67, 271—291
  16. 16. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  17. 17. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  18. 18. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  19. 19. Circulação Pulsos centrais e frequência cardíaca Choque ? Compressão torácica Lactentes < 6 meses Dois dedos Mãos circundando o tórax Abaixo da linha intermamilar, linha média sobre o esterno
  20. 20. The two thumben circling hands chestcompression technique with thoracic squeeze is the preferred technique for two-rescuer infant CPR. The two-finger technique is recommended for one-rescuerinfant CPR to facilitate rapid transition between compression and ventilation to minimise interruptions in chest compressions. Resuscitation (2005) 67, 271—291
  21. 21. Circulação Lactentes > 6 meses a 8 anos Região hipotenar da mão 2 dedos acima do ap.xifóide, linha média sobre o esterno Comprimir o tórax de 2 a 4 cm ~ 120 x por minuto 2:15(30)
  22. 22. Both the one- and two-hand techniques for chest compressions in children are acceptable provided thatrescuers compress over the lower part of the sternum to a depth of approximately one-third the anterior-posterior diameter of the chest. To simplify education, rescuers can be taught the sametechnique (i.e. two hand) for adult and child compressions. Resuscitation (2005) 67, 271—291
  23. 23. Circulação Crianças > 8 anos Técnica de adultos 2 mãos 2 dedos acima do ap.xifóide, linha média sobre o esterno Comprimir o tórax de 3 a 5 cm ~ 120 x por minuto 2:15 (30)
  24. 24. Evidence was presented that the ratio should be higher than 5:1, but the optimal ratio was not identifiedThe scientific evidence was sparse, and it was difficult to arrive atconsensusCompression—ventilation ratio greater than 15:2 came frommathematical models.Benefit of simplifying training for lay rescuers •single ratio for infants, children, and adults •increase the number of bystanders who will learn, remember, and perform CPR. Resuscitation (2005) 67, 271—291
  25. 25. For healthcare providers performing two-rescuer CPR, a compression—ventilation ratio of 15:2 is recommended. When an advanced airway is established (e.g. a tracheal tube, Combitube, orlaryngealmask airway (LMA)), ventilations are given without interrupting chest compressions. Resuscitation (2005) 67, 271—291
  26. 26. The ILCOR Paediatric Task ForceEmphasis on the quality of CPR is increased:‘‘Push hard, push fast, minimise interruptions; allow full chest recoil, and don’t hyperventilate’’.
  27. 27. Acesso venoso Técnica Via venosa periférica Bolus de SF 0,9% 5 ml Via venosa central Intra-óssea ( = EV) Flebotomia (cirurgião) Via COT
  28. 28. Acesso venoso ? Cânula orotraqueal Atropina Naloxone Epinefrina Lidocaína
  29. 29. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  30. 30. Epinefrina Único com eficácia clínica comprovada Catecolamina endógena Alfa = vasoconstrição Beta = inotropismo + Pressão de perfusão
  31. 31. Children in cardiac arrest should be given 10 mcg/kg of adrenaline as the first and subsequent intravascular doses.Routine use of high-dose (100 mcg/kg) intravascular adrenaline is notrecommended and may be harmful, particularly in asphyxia. High-doseadrenaline may be considered in exceptional circumstances (e.g. -blocker overdose). Resuscitation (2005) 67, 271—291
  32. 32. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  33. 33. VF may be the cause of cardiac arrest in up to 7% to 15% of infants and children.The treatment of choice for paediatric VF/pulseless VT is promptdefibrillation, although the optimum dose is unknown.For manual defibrillation, we recommend an initialdose of 2 J /kgIf this dose does not terminate VF, subsequent doses should be 4 J /kg Resuscitation (2005) 67, 271—291
  34. 34. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  35. 35. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  36. 36. A sobrevida após (PCR) pré-hospitalar é, em média, de aproximadamente 3 a 17% na maioriados estudos, e os sobreviventes, freqüentemente,ficam portadores de seqüelas neurológicas graves Arq Bras Cardiol volume 70, (nº 5), 1998
  37. 37. One of the most difficult challenges in CPR is to decide the point at which further resuscitative efforts are futile.Unfortunately, there are no simple guidelinesCertain characteristics suggest that resuscitation should be continued (e.g. icewater drowning, witnessed VF arrest), and others suggest that furtherresuscitative efforts will be futile (e.g. most cardiac arrests associated withblunt trauma or septic shock) Resuscitation (2005) 67, 271—291
  38. 38. Should consider whether to discontinue resuscitative efforts after 15—20 min of CPRRelevant considerations include the cause of the arrest, preexisting conditions,whether the arrest was witnessed, duration of untreated cardiac arrest (noflow), effectiveness and duration of CPR (low flow), prompt availability ofextracorporeal life support for a reversible disease process, and associatedspecial circumstances (e.g. icy water drowning, toxic drug exposure). Resuscitation (2005) 67, 271—291
  39. 39. Postresuscitation care•potential benefits of induced hypothermia on brainpreservation•preventing or aggressively treating hyperthermia•glucose control•vasoactive drugs in supporting haemodynamic function Resuscitation (2005) 67, 271—291
  40. 40. Postresuscitation careHyperventilation after cardiac arrest may be harmful andshould be avoided The target of postresuscitation ventilation is normocapnoea Resuscitation (2005) 67, 271—291
  41. 41. Postresuscitation careInduction of hypothermia (32 ◦C—34 ◦C) for 12—24 hshould be considered in children who remain comatoseafter resuscitation from cardiac arrest Should prevent hyperthermia and treat it aggressively in infants and children resuscitated from cardiac arrest Resuscitation (2005) 67, 271—291
  42. 42. Pediatric Advanced Life Support Simone Rugolotto, MD Nanjing, China, March 2006
  43. 43. Postresuscitation careThe combined effects of hypoglycaemia andhypoxia/ischaemia on the immature brain (neonatalanimals) appears more deleterious than the effect of eitherinsult alone Four retrospective studies of human neonatal asphyxia show an association between hypoglycaemia and subsequent brain injury Resuscitation (2005) 67, 271—291
  44. 44. Postresuscitation care Should check glucose concentration during cardiac arrest and monitor it closely afterward with the goal of maintaining normoglycaemiaGlucose-containing fluids are not indicated during CPRunless hypoglycaemia is present Resuscitation (2005) 67, 271—291

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