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PEDIATRICS
BASIC & ADVANCE LIFE SUPPORT




                               Ext.Sorawit Boonyathee
Pediatric Basic Life Support
Pediatric Basic Life Support



           1)      Prevent Cardiac Arrest
           2)      Early cardiopulmonary resuscitation (CPR)
           3)      Prompt access to the emergency response system
           4)      Rapid pediatric advanced life support (PALS)
           5)      Integrated post– cardiac arrest care

Berg M D et al. Circulation 2010;122:S862-S875
Cardiopulmonary Arrest in children
   Asphyxial cardiac arrest is more common than VF cardiac arrest in
    infants and children
   Common cause of Cardiac Arrest in childred ;
     Bronchospasm / respiratory infection
     Burns
     Drowning
     Dysrhythmias
     Foreign Body Aspiration
     Gastroenteritis (vomiting and diarrhea)
     Sepsis
     Seizures
     Trauma
Cardiopulmonary Arrest in children
   Pediatric cardiopulmonary arrest results when respiratory
    failure or shock is not identified and treated in the early stages.
   Early recognition and intervention prevents deterioration to
    cardiopulmonary arrest and probable death.
Cardiopulmonary Arrest in children

   - Upper airway obstruction                   - Hypovolemic (most common)
   - Lower airway obstruction                   - Distributive: septic, anaphylactic
   - Lung tissue disease / infection            - Cardiogenic
   - Disorders of breathing                     - Obstructive


            Respiratory Failure                             Hypotensive Shock


                                  Cardiopulmonary Failure


                                          Arrest
Definitions of children and infants
   Child -> age 1 – 8 years
             (If Health care provider extended to Puberty)
   Infant -> age < 1 years
   Newborn -> age < 28 days
   Newly born -> within minute or hour after delivery
BLS Sequence for Public people

        Safety of Rescuer and Victim
        Assess Need for CPR
        Check for Response
        Check for Breathing
        Start Chest Compressions
        Open the Airway and Give Ventilations
        Coordinate Chest Compressions and Breathing
        Activate Emergency Response System
Assess the Need of CPR




If the victim is unresponsive and is not breathing (or only gasping),
     send someone to activate the emergency response system.
Pulse Check




Healthcare providers may take up to 10 seconds to attempt to feel for a pulse
                             brachial in an infant
                         carotid or femoral in a child
Special Condition -> Inadequate Breathing With Pulse = rescue breath
                      Bradycardia With Poor Perfusion = chest compression
Chest Compressions



Technique for Infant -> Depth at least 1.5 Inches, Intermammary line




Two – Finger Technique (1 Rescue)    Two Thumb-encircling hands technique
                                                  (2 Rescues)
Chest Compressions



Technique for Child -> Depth at least 2 Inches, Lower half of sternum
Open Airways
   Public People -> Head Tilt - Chin Lift
   Health Care Providers -> Head Tilt – Chin Lift
     If   Suspected C-Spine injury -> Jaw thrust
Defibrillation



• Children with sudden witnessed collapse (eg, a child collapsing
  during an athletic event) are likely to have VF or pulseless VT and
  need immediate CPR and rapid defibrillation.
• VF and pulseless VT are referred to as “shockable rhythms” because
  they respond to electric shocks (defibrillation).
• Decrease (or attenuate) the delivered energy to make them suitable
  for infants and children <8 years of age
• The AED will prompt the rescuer to re-analyze the rhythm about
  every 2 minutes
Defibrillation



• Infant -> Prefer Manual Defibrillation / Pediatric dose attenuator
• Age 1 – 8 years -> AED with a pediatric attenuator
• Age > 8 years -> AED liked adult used

 Paddle Size -> Adult Size (> 10 kgs) and Pediatric size (<10 kgs)
 Energy -> Acceptable to use an initial dose of 2 to 4 J/kg not to
  exceed 10 J/kg or the adult maximum dose
Pediatric Advance Life Support
Medications for Cardiac Arrest Algorithm
    Medication           Pediatrics Dose         Adult Dose              Remark

    Epinephrine            0.01 mg/kg           1 mg (1:1,000)      May repeat every
                      (0.1 mL/kg 1:10,000)     2 – 2.5 mg ET*          3–5 minutes
                      ET* Maximum dose                               (about 2 cycles)
                           1 mg IV/IO;
                            2.5 mg ET
    Amiodarone           5 mg/kg IV/IO;        1st dose 300 mg       Monitor ECG and
                      may repeat twice up            Bolus,           blood pressure
                           to 15 mg/kg        2nd dose: 150 mg      Caution in Prolong
                        Maximum single                                      QT
                          dose 300 mg
Endotracheal Tube -> Flush with 5 mL of normal saline and follow with 5 ventilations
LEAN -> Lidocaine, Epinephrine, Atropine and Naloxone
Treatable Causes of Cardiac Arrest

           H's                       T's
         Hypoxia                    Toxins
       Hypovolemia           Tamponade (cardiac)
  Hydrogen ion (acidosis)   Tension pneumothorax
   Hypo-/hyperkalemia       Thrombosis, pulmonary
       Hypothermia           Thrombosis, coronary
Medications for Bradycardia Algorithm
    Medication           Pediatrics Dose         Adult Dose              Remark

    Epinephrine            0.01 mg/kg           1 mg (1:1,000)      May repeat every
                      (0.1 mL/kg 1:10,000)     2 – 2.5 mg ET*          3–5 minutes
                      ET* Maximum dose                               (about 2 cycles)
                           1 mg IV/IO;
                           2.5 mg ET
      Atropine        0.02 mg/kg IV/IO ET*       0.5 mg/dose        Higher doses may
                         Repeat once if           Max 3 mg            be used with
                             needed           (0.6 mg/dose = 5      organophosphate
                       Minimum : 0.1 mg             doses)              poisoning
                       Maximum : 0.5 mg
Endotracheal Tube -> Flush with 5 mL of normal saline and follow with 5 ventilations
LEAN -> Lidocaine, Epinephrine, Atropine and Naloxone
Medications for Tachycardia Algorithm
Medication     Pediatrics Dose            Adult Dose                Remark

Adenosine  1st dose: 0.1 mg/kg    6 mg IV as a rapid IV push     Monitor ECG
            (maximum 6 mg)        followed by a 20 mL saline   Rapid IV/IO bolus
               2nd dose: 0.2                flush;                with flush
            mg/kg (maximum repeat if required as 12 mg IV
                  12 mg)                     push
Amiodarone 5 mg/kg IV/IO; may 150 mg given over 10 minutes slowly–over 20–
           repeat twice up to     and repeated if necessary,     60 minutes
                 15 mg/kg      followed by a 1 mg/min infusion
            Maximum single       for 6 hours, followed by 0.5
               dose 300 mg        mg/min. Total dose over 24
                                hours should not exceed 2.2 g.
Medications for Tachycardia Algorithm
 Medication    Pediatrics Dose            Adult Dose                  Remark

Procainamine    15 mg/kg IV/IO        20 to 50 mg/min until       Monitor ECG and
               infusion to total    arrhythmia suppressed,      blood pressure; Give
               maximum dose          hypotension ensues, or      slowly–over 30–60
                 of 17 mg/kg       QRS prolonged by 50%, or     minutes. Use caution
                                    total cumulative dose of    when administering
                                   17 mg/kg; or 100 mg every    with other drugs that
                                   5 minutes until conditions    prolong QT (obtain
                                    described above are met     expert consultation)
Question ?
Reference
   The American Heart Association requests that this document be
    cited as follows: Berg MD, Schexnayder SM, Chameides L,
    Terry M, Donoghue A,Hickey RW, Berg RA, Sutton RM, Hazinski
    MF. Part 13: pediatric basic life support: 2010 American Heart
    Association Guidelines for Cardiopulmonary Resuscitation and
    Emergency Cardiovascular Care. Circulation. 2010;122(suppl
    3):S862–S875
   เอกสารประกอบงานประชุมวิชาการ Update in New CPR Guideline
    2010 แนวทางปฏิบัตการช่วยฟืนคืนชีพ CPR 2010, คณะแพทยศาสตร์
                        ิ         ้
    มหาวิทยาลัยเชียงใหม่

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Pediatrics basic and advance life support

  • 1. PEDIATRICS BASIC & ADVANCE LIFE SUPPORT Ext.Sorawit Boonyathee
  • 3. Pediatric Basic Life Support 1) Prevent Cardiac Arrest 2) Early cardiopulmonary resuscitation (CPR) 3) Prompt access to the emergency response system 4) Rapid pediatric advanced life support (PALS) 5) Integrated post– cardiac arrest care Berg M D et al. Circulation 2010;122:S862-S875
  • 4. Cardiopulmonary Arrest in children  Asphyxial cardiac arrest is more common than VF cardiac arrest in infants and children  Common cause of Cardiac Arrest in childred ;  Bronchospasm / respiratory infection  Burns  Drowning  Dysrhythmias  Foreign Body Aspiration  Gastroenteritis (vomiting and diarrhea)  Sepsis  Seizures  Trauma
  • 5. Cardiopulmonary Arrest in children  Pediatric cardiopulmonary arrest results when respiratory failure or shock is not identified and treated in the early stages.  Early recognition and intervention prevents deterioration to cardiopulmonary arrest and probable death.
  • 6. Cardiopulmonary Arrest in children - Upper airway obstruction - Hypovolemic (most common) - Lower airway obstruction - Distributive: septic, anaphylactic - Lung tissue disease / infection - Cardiogenic - Disorders of breathing - Obstructive Respiratory Failure Hypotensive Shock Cardiopulmonary Failure Arrest
  • 7. Definitions of children and infants  Child -> age 1 – 8 years (If Health care provider extended to Puberty)  Infant -> age < 1 years  Newborn -> age < 28 days  Newly born -> within minute or hour after delivery
  • 8. BLS Sequence for Public people Safety of Rescuer and Victim Assess Need for CPR Check for Response Check for Breathing Start Chest Compressions Open the Airway and Give Ventilations Coordinate Chest Compressions and Breathing Activate Emergency Response System
  • 9.
  • 10. Assess the Need of CPR If the victim is unresponsive and is not breathing (or only gasping), send someone to activate the emergency response system.
  • 11. Pulse Check Healthcare providers may take up to 10 seconds to attempt to feel for a pulse brachial in an infant carotid or femoral in a child Special Condition -> Inadequate Breathing With Pulse = rescue breath Bradycardia With Poor Perfusion = chest compression
  • 12. Chest Compressions Technique for Infant -> Depth at least 1.5 Inches, Intermammary line Two – Finger Technique (1 Rescue) Two Thumb-encircling hands technique (2 Rescues)
  • 13. Chest Compressions Technique for Child -> Depth at least 2 Inches, Lower half of sternum
  • 14. Open Airways  Public People -> Head Tilt - Chin Lift  Health Care Providers -> Head Tilt – Chin Lift  If Suspected C-Spine injury -> Jaw thrust
  • 15. Defibrillation • Children with sudden witnessed collapse (eg, a child collapsing during an athletic event) are likely to have VF or pulseless VT and need immediate CPR and rapid defibrillation. • VF and pulseless VT are referred to as “shockable rhythms” because they respond to electric shocks (defibrillation). • Decrease (or attenuate) the delivered energy to make them suitable for infants and children <8 years of age • The AED will prompt the rescuer to re-analyze the rhythm about every 2 minutes
  • 16. Defibrillation • Infant -> Prefer Manual Defibrillation / Pediatric dose attenuator • Age 1 – 8 years -> AED with a pediatric attenuator • Age > 8 years -> AED liked adult used  Paddle Size -> Adult Size (> 10 kgs) and Pediatric size (<10 kgs)  Energy -> Acceptable to use an initial dose of 2 to 4 J/kg not to exceed 10 J/kg or the adult maximum dose
  • 17.
  • 19.
  • 20. Medications for Cardiac Arrest Algorithm Medication Pediatrics Dose Adult Dose Remark Epinephrine 0.01 mg/kg 1 mg (1:1,000) May repeat every (0.1 mL/kg 1:10,000) 2 – 2.5 mg ET* 3–5 minutes ET* Maximum dose (about 2 cycles) 1 mg IV/IO; 2.5 mg ET Amiodarone 5 mg/kg IV/IO; 1st dose 300 mg Monitor ECG and may repeat twice up Bolus, blood pressure to 15 mg/kg 2nd dose: 150 mg Caution in Prolong Maximum single QT dose 300 mg Endotracheal Tube -> Flush with 5 mL of normal saline and follow with 5 ventilations LEAN -> Lidocaine, Epinephrine, Atropine and Naloxone
  • 21. Treatable Causes of Cardiac Arrest H's T's Hypoxia Toxins Hypovolemia Tamponade (cardiac) Hydrogen ion (acidosis) Tension pneumothorax Hypo-/hyperkalemia Thrombosis, pulmonary Hypothermia Thrombosis, coronary
  • 22.
  • 23. Medications for Bradycardia Algorithm Medication Pediatrics Dose Adult Dose Remark Epinephrine 0.01 mg/kg 1 mg (1:1,000) May repeat every (0.1 mL/kg 1:10,000) 2 – 2.5 mg ET* 3–5 minutes ET* Maximum dose (about 2 cycles) 1 mg IV/IO; 2.5 mg ET Atropine 0.02 mg/kg IV/IO ET* 0.5 mg/dose Higher doses may Repeat once if Max 3 mg be used with needed (0.6 mg/dose = 5 organophosphate Minimum : 0.1 mg doses) poisoning Maximum : 0.5 mg Endotracheal Tube -> Flush with 5 mL of normal saline and follow with 5 ventilations LEAN -> Lidocaine, Epinephrine, Atropine and Naloxone
  • 24.
  • 25. Medications for Tachycardia Algorithm Medication Pediatrics Dose Adult Dose Remark Adenosine 1st dose: 0.1 mg/kg 6 mg IV as a rapid IV push Monitor ECG (maximum 6 mg) followed by a 20 mL saline Rapid IV/IO bolus 2nd dose: 0.2 flush; with flush mg/kg (maximum repeat if required as 12 mg IV 12 mg) push Amiodarone 5 mg/kg IV/IO; may 150 mg given over 10 minutes slowly–over 20– repeat twice up to and repeated if necessary, 60 minutes 15 mg/kg followed by a 1 mg/min infusion Maximum single for 6 hours, followed by 0.5 dose 300 mg mg/min. Total dose over 24 hours should not exceed 2.2 g.
  • 26. Medications for Tachycardia Algorithm Medication Pediatrics Dose Adult Dose Remark Procainamine 15 mg/kg IV/IO 20 to 50 mg/min until Monitor ECG and infusion to total arrhythmia suppressed, blood pressure; Give maximum dose hypotension ensues, or slowly–over 30–60 of 17 mg/kg QRS prolonged by 50%, or minutes. Use caution total cumulative dose of when administering 17 mg/kg; or 100 mg every with other drugs that 5 minutes until conditions prolong QT (obtain described above are met expert consultation)
  • 28. Reference  The American Heart Association requests that this document be cited as follows: Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A,Hickey RW, Berg RA, Sutton RM, Hazinski MF. Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S862–S875  เอกสารประกอบงานประชุมวิชาการ Update in New CPR Guideline 2010 แนวทางปฏิบัตการช่วยฟืนคืนชีพ CPR 2010, คณะแพทยศาสตร์ ิ ้ มหาวิทยาลัยเชียงใหม่