This document summarizes pediatric basic and advanced life support. It outlines 5 key steps for pediatric basic life support: 1) prevent cardiac arrest, 2) early CPR, 3) prompt emergency response, 4) rapid pediatric advanced life support, and 5) integrated post-cardiac arrest care. Common causes of cardiac arrest in children include respiratory issues, burns, drowning, dysrhythmias, foreign body aspiration, gastroenteritis, sepsis, seizures, and trauma. The document also provides details on assessments, CPR techniques, airway management, defibrillation, and medications for cardiac arrest, bradycardia, and tachycardia in pediatric patients.

1. PEDIATRICS
BASIC & ADVANCE LIFE SUPPORT
Ext.Sorawit Boonyathee

2. Pediatric Basic Life Support

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

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

18. Pediatric Advance Life Support

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

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

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)

27. Question ?

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
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