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Pediatric advanced life support
1. The document discusses guidelines for pediatric resuscitation from the International Liaison Committee on Resuscitation, including techniques for positioning, airway management, chest compressions, defibrillation, and post-resuscitation care. 2. Key recommendations include a compression to ventilation ratio of 15:2 for healthcare providers performing two-rescuer CPR, initial and subsequent doses of epinephrine at 10 mcg/kg, and consideration of induced hypothermia and tight glucose control for comatose children after resuscitation. 3. Factors that may indicate further resuscitative efforts are futile include most cardiac arrests associated with blunt trauma or septic shock, while certain characteristics like icy
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Pediatric advanced life support
- 1. Reanimaç Reanimação cardiopulmonar nacriança 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. Paediatric basic andadvanced life support International Liaison Committee on Resuscitation Resuscitation (2005) 67, 271—291 The ILCOR Paediatric Task Force Reviewed 45 topics related to paediatric resuscitation.
- 4. Causas Hipoxemia Choque Acidose metabólica/respiratória
- 5. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 6. Healthcare professionals mayalso check for a pulse but should proceed with CPR if they cannot feel a pulse within 10 s or are uncertain if a pulse is present Resuscitation (2005) 67, 271—291
- 10. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 11. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 12. Conhecimentos básicos Técnica(PALS/CRN) Unidade (UTIped, UTIneo, PS) Fonte de O2 Aspirador Material de reanimação COT, máscaras, ambus
- 13. Suporte de vida Identificação da PCR Pedir ajuda Posicionar o paciente Desobstruir vias aéreas Ventilação (ambu) Massagem cardíaca externa Acesso venoso Drogas
- 14. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 15. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 16. Posicionamento/Via aérea Decúbitodorsal sobre superfície rígida Cabeça em posição mediana Leve extensão da cabeça Laringe anterior e cefalizada Reanimador na cabeceira do paciente
- 19. Ventilação Definir padrãorespiratório (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)
- 20. For children requiringairway control or ventilation for short periods, bag valve-mask (BVM) ventilation produces equivalent Survival rates compared with ventilation with tracheal intubation. Resuscitation (2005) 67, 271—291
- 22. Until additional evidenceis published, we support healthcare providers’ use of 100% oxygen during resuscitation (when available). Resuscitation (2005) 67, 271—291
- 23. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 24. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 26. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 27. Circulação Pulsos centraise frequência cardíaca Choque ? Compressão torácica Lactentes < 6 meses Dois dedos Mãos circundando o tórax Abaixo da linha intermamilar, linha média sobre o esterno
- 28. The two thumbencircling hands chest compression technique with thoracic squeeze is the preferred technique for two-rescuer infant CPR. The two-finger technique is recommended for one-rescuer infant CPR to facilitate rapid transition between compression and ventilation to minimise interruptions in chest compressions. Resuscitation (2005) 67, 271—291
- 31. 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)
- 32. Both the one-and two-hand techniques for chest compressions in children are acceptable provided that rescuers 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 same technique (i.e. two hand) for adult and child compressions. Resuscitation (2005) 67, 271—291
- 34. 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)
- 35. Evidence was presentedthat the ratio should be higher than 5:1, but the optimal ratio was not identified The scientific evidence was sparse, and it was difficult to arrive at consensus Compression—ventilation ratio greater than 15:2 came from mathematical 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
- 36. For healthcare providersperforming two- rescuer CPR, a compression—ventilation ratio of 15:2 is recommended. When an advanced airway is established (e.g. a tracheal tube, Combitube, or laryngealmask airway (LMA)), ventilations are given without interrupting chest compressions. Resuscitation (2005) 67, 271—291
- 37. The ILCOR PaediatricTask Force Emphasis on the quality of CPR is increased: ‘‘Push hard, push fast, minimise interruptions; allow full chest recoil, and don’t hyperventilate’’.
- 38. Acesso venoso Técnica Via venosa periférica Bolus de SF 0,9% 5 ml Via venosa central Intra-óssea ( = EV) Flebotomia (cirurgião) Via COT
- 39. Acesso venoso ? Cânula orotraqueal Atropina Naloxone Epinefrina Lidocaína
- 40. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 41. Epinefrina Único comeficácia clínica comprovada Catecolamina endógena Alfa = vasoconstrição Beta = inotropismo + Pressão de perfusão
- 43. Children in cardiacarrest 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 not recommended and may be harmful, particularly in asphyxia. High-dose adrenaline may be considered in exceptional circumstances (e.g. - blocker overdose). Resuscitation (2005) 67, 271—291
- 44. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 45. VF may bethe cause of cardiac arrest in up to 7% to 15% of infants and children. The treatment of choice for paediatric VF/pulseless VT is prompt defibrillation, although the optimum dose is unknown. For manual defibrillation, we recommend an initialdose of 2 J /kg If this dose does not terminate VF, subsequent doses should be 4 J /kg Resuscitation (2005) 67, 271—291
- 46. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 47. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 49. A sobrevida após(PCR) pré-hospitalar é, em média, de aproximadamente 3 a 17% na maioria dos estudos, e os sobreviventes, freqüentemente, ficam portadores de seqüelas neurológicas graves Arq Bras Cardiol volume 70, (nº 5), 1998
- 50. One of themost difficult challenges in CPR is to decide the point at which further resuscitative efforts are futile. Unfortunately, there are no simple guidelines Certain characteristics suggest that resuscitation should be continued (e.g. ice water drowning, witnessed VF arrest), and others suggest that further resuscitative efforts will be futile (e.g. most cardiac arrests associated with blunt trauma or septic shock) Resuscitation (2005) 67, 271—291
- 51. Should consider whetherto discontinue resuscitative efforts after 15—20 min of CPR Relevant considerations include the cause of the arrest, preexisting conditions, whether the arrest was witnessed, duration of untreated cardiac arrest (no flow), effectiveness and duration of CPR (low flow), prompt availability of extracorporeal life support for a reversible disease process, and associated special circumstances (e.g. icy water drowning, toxic drug exposure). Resuscitation (2005) 67, 271—291
- 53. Postresuscitation care •potential benefitsof induced hypothermia on brain preservation •preventing or aggressively treating hyperthermia •glucose control •vasoactive drugs in supporting haemodynamic function Resuscitation (2005) 67, 271—291
- 54. Postresuscitation care Hyperventilation aftercardiac arrest may be harmful and should be avoided The target of postresuscitation ventilation is normocapnoea Resuscitation (2005) 67, 271—291
- 55. Postresuscitation care Induction ofhypothermia (32 ◦C—34 ◦C) for 12—24 h should be considered in children who remain comatose after resuscitation from cardiac arrest Should prevent hyperthermia and treat it aggressively in infants and children resuscitated from cardiac arrest Resuscitation (2005) 67, 271—291
- 56. Pediatric Advanced LifeSupport Simone Rugolotto, MD Nanjing, China, March 2006
- 57. Postresuscitation care The combined effects of hypoglycaemia and hypoxia/ischaemia on the immature brain (neonatal animals) appears more deleterious than the effect of either insult alone Four retrospective studies of human neonatal asphyxia show an association between hypoglycaemia and subsequent brain injury Resuscitation (2005) 67, 271—291
- 58. Postresuscitation care Shouldcheck glucose concentration during cardiac arrest and monitor it closely afterward with the goal of maintaining normoglycaemia Glucose-containing fluids are not indicated during CPR unless hypoglycaemia is present Resuscitation (2005) 67, 271—291