Pediatric Resuscitation
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A 13-year-old female collapsed while playing soccer and required bystander CPR. EMS intubated and transferred the patient. The document then provides information on pediatric resuscitation including causes of cardiac arrest in children such as respiratory issues, shock, and metabolic conditions. It discusses the pediatric assessment triangle and ABCDE approach for pediatric patients.
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Pediatric Resuscitation
- 1. I Got You, Babe... Veronica Bonales, M.D. RMH PCMD HCEMCC - Paramedic Coordinator
- 2. AW 13 y.o. female playing soccer. Comes to the sidelines and complains of not feeling well then suddenly collapses. Bystander CPR is initiated. EMS arrives on scene, intubates and transfers the patient...
- 4. Pediatric Resuscitaion Numbers are bleak 27% of in-hospital cardiac arrests survive Survival to discharge only 6% Larger percentage of out-of-hospital cardiac arrests do not survive Some of the survivors are left seriously incapacitated
- 6. Baby Huey
- 7. Baby Ruth 9/49 created, appeared in “Casper” comic book then film 1950.
- 8. Pediatric Resuscitation Do pedis have heart attacks...? 5 - 15% Asphyxial arrest Progressive respiratory failure Shock
- 9. Pediatric Resuscitation Asphyxia Hypoxemia (low O2), hypercapnea (high CO2), acidosis (low pH) Leads to... Bradycardia, hypotension Leads to... Cardiac arrest
- 10. Pediatric Resuscitation Respiratory Issues Not ventilating Not oxygenating Or both...
- 11. Pediatric Resuscitaion Impending respiratory failure Increased respiratory rate Grunting, nasal flaring, retractions Poor respiratory effort Gasping, decreased breath sounds esp. with decreased mental status Cyanosis despite supplemental oxygen
- 12. Pediatric Resuscitaion Shock Inadequate blood flow and oxygen delivery to meet tissue metabolic demands...
- 13. Pediatric Resuscitaion Most common type of shock in children.... Hypovolemic
- 14. Pediatric Resuscitaion Shock Hypovolemic Cardiogenic Septic Anaphylactic Neurogenic
- 15. Pediatric Resuscitation Metabolic rates higher Require more energy and consume more oxygen Illness or stress accelerates
- 16. Pediatric Resuscitation Higher fluid requirement Newborn 70 - 80% water (adult 50 - 60%) Prone to dehydration (diarrhea, emesis, blood loss) Greater surface area to weight ratio 25% more total circulating blood volume per body weight
- 17. Pediatric Resuscitaion Compensated Shock Tachycardia Cool and pale distal extremities Delayed cap refill (>2 sec) Weak peripheral pulses Blood pressure....? Normal
- 18. Pediatric Resuscitation Greater capacity to increase heart rate Heart rate >160 bpm tachycardic Vessels “clamp down” Peripheral pulses will become thready and disappear before central pulses Skin color and cap refill important
- 19. Pediatric Resuscitaion Continuum Signs of end-organ damage Decreased mental status, decreased urine output, metabolic acidosis, tachypnea, poor central pulses, mottling
- 21. Pediatric Resuscitation With oxygen, pyruvate converts to acetyl CoA Without oxygen, pyruvate converts to lactate
- 22. Pediatric Resuscitaion Decompensated Shock Weak or absent peripheral pulses Weak central pulses Hypotension
- 23. Pediatric Resuscitaion Look at the patient not the number... Tachycardia - fever, pain, anxiety Bounding pulses in anaphylactic, septic and neurogenic shock
- 25. Baby Houseman
- 26. Baby Houseman Dirty Dancing 1987 Featured Jennifer Grey and Patrick Swayze Both hired because they had dance experience
- 28. “Nobody puts Baby in a corner...”
- 29. Pediatric Resuscitaion Upper Airway Diseases Croup/Asthma Epiglottitis (vaccination status) Foreign Body Aspiration Anaphylaxis Congenital Trauma Other Infections
- 34. Pediatric Resuscitaion Croup Most common upper airway problem Due to: Flu virus, RSV, Parainfluenza virus, Adenovirus Late fall/early winter
- 35. Pediatric Resuscitaion Usually affects infants and toddlers Cold symptoms 2 - 3 days Nasal congestion, hoarseness Tachypnea, low grade fever Worse at night Inflammation, edema of upper airways 58% stridor 94% barking or seal-like cough
- 36. Pediatric Resuscitaion Usually affects infants and toddlers Cold symptoms 2 - 3 days Nasal congestion, hoarseness Tachypnea, low grade fever Worse at night Inflammation, edema of upper airways 58% stridor 94% barking or seal-like cough
- 37. Pediatric Resuscitaion Asthma Most common chronic disease of childhood Admission rate for age <5 is higher than for all other age groups Mortality rising 1/2 of all deaths in pre-hospital setting Length of final attack < 2hr in 50% of deaths
- 38. Pediatric Resuscitaion Triggers lead to bronchial spasming, mucosal edema, increased secretions URI’s, exercise, cold air exposure, emotional stress, passive exposure to smoke, allergens
- 39. Pediatric Resuscitaion Symptoms: Tachypnea Tachycardia Retractions Wheezing or decreased breath sounds Normal or low O2 sats
- 40. Pediatric Resuscitaion Factors of Severe Attack Prior ICU admission or intubation >3 ED visits in a year >2 Hospital admissions in a year Use of >1 MDI canister in last month Use of rescue inhaler >Q4H Worsening symptoms despite aggressive home therapy
- 41. Pediatric Resuscitaion Signs of Severe Asthma Attack Altered appearance Exhaustion Inability to recline Interrupted speech Severe retractions Decreased air movement
- 42. Pediatric Resuscitaion ALOC Trauma, temperature AEIOUTIPS Infection Alcohol Psychogenic, poison Epilepsy, endocrine, Shock, space-occupying electrolytes lesion, SAH Insulin Opiates, overdose Uremia
- 43. Pediatric Resuscitaion Hypoglycemia Low glycogen stores in the liver Alcohol, accidental ingestion of anti-hyperglycemic agents, overmedication with insulin Inborn errors of metabolism
- 44. Pediatric Resuscitation Coma Hypoglycemia Hypothermia
- 45. Pediatric Resuscitation Coma Hypoglycemia Hypothermia
- 46. Pediatric Resuscitaion Ingestions Two peaks Toddlers - accidental Teens - intentional
- 47. One Pill Can Kill Theophylline Tricyclic antidepressants Clonidine (0.2mg, temporary reverse Narcan) Verapamil Propanolol Camphor Methyl salicylate (oil of wintergreen)
- 49. ...Baby One More Time
- 50. ...Baby One More Time Britney Spears’ debut album and hit in January 1999 Originally titled “Hit Me One More Time” and changed due to concerns about condoning domestic violence
- 52. Pediatric Resuscitaion First Always: Scene Safety
- 53. Pediatric Resuscitaion First Always: Scene Safety Does location provide clues? Where are you? Weapons, toys, objects Medications Witnesses
- 54. Pediatric Resuscitaion Look at the child... Listen to the parent...
- 55. Pediatric Resuscitation First Impression Pediatric Assessment Triangle Appearance Work of breathing Circulation to skin
- 56. Pediatric Resuscitation First Impression Pediatric Assessment Triangle Appearance Work of breathing Circulation to skin
- 58. Pediatric Resuscitation Appearance Tone Interactiveness Consolability Look/Gaze Speech/Cry
- 59. Pediatric Resuscitation Appearance Work of Breathing Tone Abnormal breath sounds Interactiveness Consolability Abnormal positioning Look/Gaze Retractions Speech/Cry Flaring
- 60. Pediatric Resuscitation Appearance Work of Breathing Tone Abnormal breath sounds Interactiveness Consolability Abnormal positioning Look/Gaze Retractions Speech/Cry Flaring • Circulation to Skin • Pallor, Mottling, Cyanosis
- 63. Pediatric Resuscitaion Disability AVPU Alert Voice Pain Unresponsive
- 64. Pediatric Resuscitation In the event of a code... Age + 16 divided by 4 = ETT size
- 65. Pediatric Resuscitation Broselow Tape Been in use over 12 years Height and weight based dosing Child must be laying flat
- 67. Pediatric Resuscitation • Vascular access • Peripheral IV • IO device in R leg • 20 ml/kg LR or NS • Rebolus until hemodynamically stable
- 70. AW Born with small Left Coronary Artery which was not located anatomically correct
- 72. Baby Ruth
- 73. Baby Ruth Invented in 1921, this famous bar had a rather “infamous” cameo in this 1980‘s golf movie...
- 75. Caddyshack
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