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Pediatric resusitation
- 1. Done by : AlYaqdhan Al Atbi, MD EM resident R 1
- 2. Systemic approachto critically ill child Cardiac arrest Septic shock Respiratory failure SIDS Outline
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- 8. Cardiac Arrest: cessation of blood circulation resulting from absent of mechanical activity Not responsive , not breathing , no pulse . Prognosis : In-hospital V.S out-hospital Shockable V.s Non shockable Cardiac arrest
- 9. SIDS <6 months Trauma > 6months Reversible causes: etiologies T’sH’s Tension pneumothoraxHypovolemia TemponadeHypoxia ToxnisHydrogen Thrombosis pulmonaryHypoglycemia Thrombosis coronaryHypo/hyperkalemia hypothermia
- 10. Signs: Unresponsiveness No breathing or only gasping no pulse Rhythms: Shockable : Plusless VT , and VF Non shockable : PEA and Asystole Recogntion of Cardiac arrest
- 11. Compression Rate? Single 30:2 ; two rescuers 15:2 Advance airway: 1breath every 6-8sec Type of compression? Circumferential Vs chest compression Depth? At least 1/3 of the AP diameter (5cm) BLS review
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- 13. Trauma: “Improperresuscitation (fluids )is a major cause of preventable pediatric trauma death” Dykes et al 1989 Possible causes of arrest in trauma ?? Which sequance you will follow?? ABCDE or CAB Pediatric cardiac arrest : special circumstances
- 14. Drowning : Consider cervical spine injury Hypothermia : Difficult to know when to terminate resuscitation Core temp should be > 30C CPR can be extended for > 2 hours if hypothermic Pediatric cardiac arrest : special circumstances
- 15. Neonates, infants,and children are primarily dependent on HR for maintenance of CO. Bradycardia and hypo perfusion signs critically ill child HR < 60/min with hypoperfusion proper oxygenation and ventilation CPR Bradycardia in pediatrics
- 17. Sepsis isthe leading cause of death in peads High mortality rate 10% Septic shock is : Simultaneous presence of SIRS Documented or suspected infection Cardiovascular failure (Low BP or need introps despite resuscitation with 40ml/kg of crystalloids)
- 18. Hypotension formula (systolicBP below) : 70mmHg + { child age in years*2} mmHg Adjunct Inx: CBC, Lactate, ABG, coagulation , glucose , U&E, Ca US
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- 21. Respiratory failureis more common in peads than cardiac arrest Effective Rx of Respiratory failure prevents cardiac arrest. Physiology: Lung surface area Respirator mechanism Accessory muscles Airways Cellular oxygenation
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- 24. Airway: Openairway (head tilt-chin left, jaw thrust) Clear airway (suction , remove foreign body) Consider OPA or NPA Breathing : Monitor SpO2 O2 supplement Consider ventilation with bag-mask device Prepare for ETT Circulation: Monitor HR, BP , rhythme IV access Initial Management of respiratory distress or failure
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- 26. leading causeof death in infants. 8% of deaths in children < 1yr Rare in children <1months and >1 year of age. Common risk factor : PRON SLEEPING Inx: Bloods and urine Autopsy and postpartum genetic testing: channalopathy Psychosocial consideration: Direct , clear terms Greev Sudden Infantile death syndrome
- 27. Excellent CPRis the foundation for successful resuscitation from cardiac arrest. Bradycardia with hypoperfusion (prearrest state) and chest compressions may improve survival. Rapid administration of isotonic fluids is the initial step in resuscitation for all forms of pediatric shock. The diagnosis of septic shock in children is primarily clinical Respiratory failure in children is more common than cardiac arrest and is the most important pathophysiologic cause of cardiac arrest Home message
- 28. Rosen PALSprovider Manual Refferances
Editor's Notes
- #9 Rate of survival to hospital discharge is higher if carrdiac arrest at hospital 33% Compared with out side hospital 6% Shockable 34 V.s Non shockable 24
- #14 Causes of arrest in Trauma : Hypoxia due to respiatory arrest , airway obsturction or tracheal injury Severe brain injury with CVS collapse Cervical spinal injury Tension pneumothorax, Temponade , massive hmorrhage.
- #16 Conversely, illnesses or injuries resulting in negative chronotropy (e.g., heart block, toxicity from beta-blockers or calcium channel blockers) tend to result in more profound shock and hypoperfusion in children than in adults with similar processes.
- #19 Fever is among the most common A study from a pediatric ED examining children with fever, tachycardia, and tachypnea found that altered mental status (as judged by attending physicians) was present in 19% of children, AMS has less specifity for septic shock 85%
- #20 Hypoglycenia: Poor glycogen store Rx: 10ml/kg of 5% dextros; 2ml/kg of 25%dextrose Hypocalcemia Fluids: Isotonic crystalloids (NS or Lactated ringer)>> 60ml/kg over 15min Vasopressor: Normotensive: dopamin Warm shock : noradernaline Cold shock : epinephrine Corticosteroids: Adrenal insufficincy common in peads CORTICUS trial in adult >> no beneifit in septic shock In peads : not conclsive Dose 2mg/kg bolus After initial resuscitation re evaluate : HR , BP and perfusion NorEpi for warms shock because : potent alpha receptors vasoconstrictor (Increase SVR) and good Iontropic effect Normotensive septic shock: dopamin Is dose dependent : low increase renal and hepatic blood flow , moderate increase cardiac contractility , high increase SVR If no response (poor perfusion ) start epinephrine
- #22 Small surface area: less gase change and high chance of alveolar hypoventilation in acute illness