This document discusses resuscitation in children. It defines resuscitation and notes that the age of the victim guides treatment decisions. Discriminating based solely on age is inadequate, as there is no single parameter separating infants, children, and adults. Factors like size, illness, and rescuer strength should also be considered. The document then discusses various aspects of pediatric resuscitation, including airway management, breathing, chest compressions, defibrillation, and foreign body removal. It emphasizes the importance of ventilation for children and the need to tailor treatment based on the victim's age.
This document provides guidelines for pediatric resuscitation and cardiac arrest. It outlines the key interventions for basic life support including airway management, breathing, and circulation techniques. It also discusses oxygen therapy, endotracheal intubation, vascular access methods, defibrillation and cardioversion procedures, and drug therapies including epinephrine and atropine. The guidelines emphasize adequate oxygenation and ventilation as the most important interventions, and that intravenous access is not required to administer certain drugs like epinephrine during cardiac arrest.
This document outlines the principles and organization of a critical care unit. It discusses the importance of anticipation, early detection, collaborative practice, communication, and infection prevention. It recommends that critical care units have a single entry/exit, be located near emergency rooms and operating theaters, and have spacious corridors for patient transport. The document also provides guidance on bed strength, bed space requirements, necessary medical equipment, and staffing ratios for critical care units.
This document discusses oxygen therapy for pediatric COVID-19 patients. It outlines the indications for oxygen therapy including hypoxemia and shock. It then describes the various oxygen delivery systems and methods including nasal cannulas, masks, tents, and positive pressure ventilation. Factors determining the appropriate method are also discussed. The document provides guidance on dosage, monitoring response, and managing complications of oxygen therapy.
The document discusses guidelines for organizing a critical care unit. Some key points covered are:
- A critical care unit should have 6-14 beds and be divided into pods of 10-15 beds each with dedicated staff.
- The unit should be located with easy access to emergency, operating rooms, and diagnostic departments. It should have sufficient space for patient transfer and equipment.
- Recommended floor space is 125-150 square feet per patient or 300 square feet for private rooms. Additional space is needed for staff areas.
- Essential equipment includes ventilators, monitors, infusion pumps, defibrillators, beds, and supplies for patient care and medication storage. Staff must be trained on equipment use and maintenance
The document discusses mechanical ventilation and various ventilation modes. It describes how mechanical ventilators work using positive or negative pressure to maintain oxygen delivery. Some key ventilation modes discussed include CPAP which maintains continuous elevated airway pressure, PEEP which applies positive pressure at the end of expiration, and SIMV which provides mandatory breaths at set intervals allowing spontaneous breathing in between.
1. The document provides guidelines for performing pediatric CPR for infants, including the steps for 1-rescuer and 2-rescuer infant CPR.
2. It also outlines the steps for performing CPR on children and infants, including giving 30 chest compressions followed by 2 rescue breaths in a ratio of 30:2.
3. The document describes when to use an AED during CPR and provides brief descriptions of drugs that may be used during resuscitation attempts.
This document summarizes oxygen therapy in pediatrics. It discusses the indications for oxygen therapy including conditions like pneumonia, asthma, and heart failure. Methods of oxygen delivery include low-flow devices like nasal cannulas and face masks, and high-flow devices like Venturi masks and CPAP/BiPAP. Detection of hypoxemia can be done through clinical evaluation, pulse oximetry, and blood gas analysis. The document also covers treatment considerations like flow rates, interfaces, and humidification needs. Potential complications of oxygen therapy include CO2 narcosis.
This document provides guidelines for pediatric resuscitation and cardiac arrest. It outlines the key interventions for basic life support including airway management, breathing, and circulation techniques. It also discusses oxygen therapy, endotracheal intubation, vascular access methods, defibrillation and cardioversion procedures, and drug therapies including epinephrine and atropine. The guidelines emphasize adequate oxygenation and ventilation as the most important interventions, and that intravenous access is not required to administer certain drugs like epinephrine during cardiac arrest.
This document outlines the principles and organization of a critical care unit. It discusses the importance of anticipation, early detection, collaborative practice, communication, and infection prevention. It recommends that critical care units have a single entry/exit, be located near emergency rooms and operating theaters, and have spacious corridors for patient transport. The document also provides guidance on bed strength, bed space requirements, necessary medical equipment, and staffing ratios for critical care units.
This document discusses oxygen therapy for pediatric COVID-19 patients. It outlines the indications for oxygen therapy including hypoxemia and shock. It then describes the various oxygen delivery systems and methods including nasal cannulas, masks, tents, and positive pressure ventilation. Factors determining the appropriate method are also discussed. The document provides guidance on dosage, monitoring response, and managing complications of oxygen therapy.
The document discusses guidelines for organizing a critical care unit. Some key points covered are:
- A critical care unit should have 6-14 beds and be divided into pods of 10-15 beds each with dedicated staff.
- The unit should be located with easy access to emergency, operating rooms, and diagnostic departments. It should have sufficient space for patient transfer and equipment.
- Recommended floor space is 125-150 square feet per patient or 300 square feet for private rooms. Additional space is needed for staff areas.
- Essential equipment includes ventilators, monitors, infusion pumps, defibrillators, beds, and supplies for patient care and medication storage. Staff must be trained on equipment use and maintenance
The document discusses mechanical ventilation and various ventilation modes. It describes how mechanical ventilators work using positive or negative pressure to maintain oxygen delivery. Some key ventilation modes discussed include CPAP which maintains continuous elevated airway pressure, PEEP which applies positive pressure at the end of expiration, and SIMV which provides mandatory breaths at set intervals allowing spontaneous breathing in between.
1. The document provides guidelines for performing pediatric CPR for infants, including the steps for 1-rescuer and 2-rescuer infant CPR.
2. It also outlines the steps for performing CPR on children and infants, including giving 30 chest compressions followed by 2 rescue breaths in a ratio of 30:2.
3. The document describes when to use an AED during CPR and provides brief descriptions of drugs that may be used during resuscitation attempts.
This document summarizes oxygen therapy in pediatrics. It discusses the indications for oxygen therapy including conditions like pneumonia, asthma, and heart failure. Methods of oxygen delivery include low-flow devices like nasal cannulas and face masks, and high-flow devices like Venturi masks and CPAP/BiPAP. Detection of hypoxemia can be done through clinical evaluation, pulse oximetry, and blood gas analysis. The document also covers treatment considerations like flow rates, interfaces, and humidification needs. Potential complications of oxygen therapy include CO2 narcosis.
This document discusses assessing and managing dehydration in children. It defines dehydration and lists common causes like gastroenteritis and burns. The assessment of dehydration is difficult but involves factors like weight loss, skin turgor, tears, and urine output. Dehydration is classified as mild, moderate, or severe based on these clinical signs. Oral rehydration solution is given to rehydrate children and recipes for making ORS are provided.
The document discusses central venous pressure (CVP) monitoring. It aims to explain what CVP is, the purposes and indications for monitoring it, the equipment needed, nursing roles and responsibilities, potential complications, and how to interpret CVP readings. Specifically, CVP refers to the blood pressure in the right atrium and is monitored using a catheter placed in the jugular or subclavian vein. CVP provides information about a patient's fluid balance, circulating blood volume, and right heart function. Nurses must understand how to set up monitoring equipment properly and know that abnormal CVP readings should be considered in the full clinical context of the patient.
CPR in pediatric practice - Dr.M.SucindarSucindar M
This document discusses pediatric cardiopulmonary resuscitation (CPR). It notes that CPR, especially when performed within the first few minutes of cardiac arrest, can double or triple a person's chance of survival. The leading causes of death in infants are congenital malformations, complications of prematurity, SIDS, and injury, while in children they are congenital malformations, complications of prematurity, and injury. Pediatric CPR follows the PBLS (Pediatric Basic Life Support) and PALS (Pediatric Advanced Life Support) protocols. The pediatric chain of survival includes prevention, early CPR, emergency response, advanced life support, and post-resuscitation care. The document then outlines the specific
Tracheostomy care and suctioning are high-risk procedures that require adherence to evidence-based guidelines to avoid complications, even for experienced nurses. Tracheostomy patients are at risk for airway issues and infection both in intensive care and general units. Skilled nursing care through proper suctioning technique, emergency preparation, trach site care, and securing the trach tube can prevent complications.
There are numerous types of brain surgery. The type used is based on the area of the brain and the condition being treated.
Brain surgery is a critical and complicated process. The type of brain surgery done depends highly on the condition being treated.
Intracranial surgery refers to various medical procedures that involve repairing structural problems in the brain.
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Defibrillation uses electrical shocks to restore a normal heart rhythm. It is used for ventricular fibrillation and asystole. Biphasic defibrillators are preferred over monophasic as they cause less damage and have higher success rates. Defibrillators include automated external defibrillators for public use, semi-automated defibrillators for paramedics, and implantable defibrillators. Adhesive patches are now commonly used instead of paddles. Defibrillation procedures involve assessing rhythm, applying pads or paddles, delivering shock, and resuming CPR if needed. Causes of failure include patient condition, prolonged arrest, inadequate CPR, and technical issues.
This document provides guidance on pediatric advanced life support (PALS). It discusses respiratory and circulatory failure, which often lead to cardiac arrest in children. Asphyxial cardiac arrest caused by lack of oxygen is more common than primary cardiac issues. Shock is also a common precursor and progresses from compensated to decompensated states. Foreign body airway obstruction, drowning, and hypothermia/hyperthermia are covered. The document provides detailed guidance on airway management, ventilation, vascular access, defibrillation, and the management of arrhythmias like tachycardia and bradycardia in a pediatric setting.
This document provides an overview of paediatric emergency management. It discusses cardiopulmonary resuscitation procedures for children and outlines management of common paediatric emergencies like drowning, burns, falls, and foreign body ingestion. Specific conditions covered in more depth include near-drowning, burn classifications and estimations, and treatment plans for minor and major burns. The document aims to equip medical professionals with knowledge of stabilizing critically ill children and preventing long-term complications from emergency situations.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
CVP monitoring involves inserting a catheter into a large central vein and connecting it to a pressure monitoring device to measure central venous pressure. CVP provides information about right ventricular function and intravascular volume status. It is used to guide fluid resuscitation and assess the effectiveness of treatments for conditions like heart failure. Key steps in CVP monitoring include positioning the patient supine, zeroing the monitoring device at the level of the right atrium, and observing pressure waveforms and readings to evaluate volume status and cardiac function. Nurses are responsible for assessing the catheter site for complications and maintaining the sterility and function of the CVP monitoring system.
A baby girl born at 38 weeks was diagnosed with hydrocephalus after birth. She underwent a ventriculoperitoneal shunt placement surgery at 8 days old to drain excess cerebrospinal fluid from her brain ventricles into her abdomen. The surgery involved placing a catheter from her brain ventricle into her abdomen, with a valve to regulate fluid flow. Precautions were taken due to her young age, including maintaining her body temperature. She was placed under general anesthesia and monitored closely after the surgery for potential complications like infection.
Nurses role in arterial puncture and abg analysisStephy Stanly
The document discusses arterial blood gas analysis and interpretation. It provides information on equipment and procedures for arterial blood sampling and analysis. Normal ranges are provided for pH, PCO2, PO2, oxygen saturation, and HCO3. Types of acid-base imbalances are explained including compensated and uncompensated respiratory and metabolic acidosis and alkalosis. Examples of arterial blood gas results are given and their acid-base interpretations.
This document discusses umbilical venous catheters used in neonates, including three case studies. It outlines complications that can arise from malpositioning of the catheter tip, such as perforation of blood vessels, ascites, cardiac issues, and liver damage. Predicting the proper insertion length is difficult and radiography is not always reliable in confirming tip location. The recommendation is that further research is needed to determine the best length of insertion and that repeated imaging may help ensure the tip remains in the correct position.
Endotracheal intubation involves placing a flexible plastic tube into the trachea to maintain an open airway or administer drugs. It is used to administer oxygen, remove secretions, ventilate the lungs, and treat respiratory failure. Indications include CNS depression, neuromuscular disease, chest injuries, airway obstruction, and aspiration risk. The procedure requires a laryngoscope, ET tube, suction equipment, and securing the tube once placed to ventilate the lungs. Complications can include injury and intubation in the wrong airway.
The doctor would perform a chest tube drainage procedure to remove fluid from the patient's right hemothorax. A chest tube would be inserted through the thorax and connected to suction to drain fluid and air from the pleural space, preventing further fluid or air buildup and helping the lung re-expand. The nurse's responsibilities would include properly caring for and monitoring the chest tube drainage system.
Stroke is a medical condition where blood supply to part of the brain is decreased, causing loss of brain function. It is a leading cause of death and disability. There are two main types - ischemic (caused by clots) and hemorrhagic (caused by bleeding). Risk factors include hypertension, heart disease, smoking, diabetes and obesity. Prevention involves controlling risk factors through lifestyle changes and medications. Anyone experiencing symptoms like weakness or numbness on one side of the body should seek immediate medical attention.
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Increased intracranial pressure is defined as cerebrospinal fluid pressure greater than 15 mm Hg.
Infections
Tumors
Stroke
Aneurysm
Epilepsy
Seizures
Hydrocephalus
Hypertensive brain injury
Hypoxemia
Meningitis
Due to etiological factors
Components of ICP is disturbed- brain tissue, CSF, blood volume
An increase in the volume of ANY ONE component must be accompanied by a reciprocal decrease in one of the other components.
When this volume-pressure relationship becomes unbalanced, ICP increases.
The document summarizes new guidelines for pediatric resuscitation. Key recommendations include simplifying airway opening techniques for lay rescuers, using a single compression-to-ventilation ratio of 30:2 for single rescuers, and emphasizing the importance of continuous chest compressions with limited interruptions. It also discusses appropriate use of automated external defibrillators for children of different ages, drug administration routes, and indicators for when to stop resuscitation efforts.
Respiratory Physiotherapy for Cerebral PalsyRachaelHinton
This presentation discusses respiratory physiotherapy for patients with cerebral palsy. While cerebral palsy does not directly cause lung issues, impaired motor function can lead to respiratory complications. Physiotherapy aims to prevent mucus buildup through techniques like postural drainage, percussion, and assisted coughing. Assessment is individualized based on factors like age, function, and capacity. The goal is to optimize quality of life through a combination of airway clearance techniques and addressing overall health needs.
This document discusses assessing and managing dehydration in children. It defines dehydration and lists common causes like gastroenteritis and burns. The assessment of dehydration is difficult but involves factors like weight loss, skin turgor, tears, and urine output. Dehydration is classified as mild, moderate, or severe based on these clinical signs. Oral rehydration solution is given to rehydrate children and recipes for making ORS are provided.
The document discusses central venous pressure (CVP) monitoring. It aims to explain what CVP is, the purposes and indications for monitoring it, the equipment needed, nursing roles and responsibilities, potential complications, and how to interpret CVP readings. Specifically, CVP refers to the blood pressure in the right atrium and is monitored using a catheter placed in the jugular or subclavian vein. CVP provides information about a patient's fluid balance, circulating blood volume, and right heart function. Nurses must understand how to set up monitoring equipment properly and know that abnormal CVP readings should be considered in the full clinical context of the patient.
CPR in pediatric practice - Dr.M.SucindarSucindar M
This document discusses pediatric cardiopulmonary resuscitation (CPR). It notes that CPR, especially when performed within the first few minutes of cardiac arrest, can double or triple a person's chance of survival. The leading causes of death in infants are congenital malformations, complications of prematurity, SIDS, and injury, while in children they are congenital malformations, complications of prematurity, and injury. Pediatric CPR follows the PBLS (Pediatric Basic Life Support) and PALS (Pediatric Advanced Life Support) protocols. The pediatric chain of survival includes prevention, early CPR, emergency response, advanced life support, and post-resuscitation care. The document then outlines the specific
Tracheostomy care and suctioning are high-risk procedures that require adherence to evidence-based guidelines to avoid complications, even for experienced nurses. Tracheostomy patients are at risk for airway issues and infection both in intensive care and general units. Skilled nursing care through proper suctioning technique, emergency preparation, trach site care, and securing the trach tube can prevent complications.
There are numerous types of brain surgery. The type used is based on the area of the brain and the condition being treated.
Brain surgery is a critical and complicated process. The type of brain surgery done depends highly on the condition being treated.
Intracranial surgery refers to various medical procedures that involve repairing structural problems in the brain.
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Defibrillation uses electrical shocks to restore a normal heart rhythm. It is used for ventricular fibrillation and asystole. Biphasic defibrillators are preferred over monophasic as they cause less damage and have higher success rates. Defibrillators include automated external defibrillators for public use, semi-automated defibrillators for paramedics, and implantable defibrillators. Adhesive patches are now commonly used instead of paddles. Defibrillation procedures involve assessing rhythm, applying pads or paddles, delivering shock, and resuming CPR if needed. Causes of failure include patient condition, prolonged arrest, inadequate CPR, and technical issues.
This document provides guidance on pediatric advanced life support (PALS). It discusses respiratory and circulatory failure, which often lead to cardiac arrest in children. Asphyxial cardiac arrest caused by lack of oxygen is more common than primary cardiac issues. Shock is also a common precursor and progresses from compensated to decompensated states. Foreign body airway obstruction, drowning, and hypothermia/hyperthermia are covered. The document provides detailed guidance on airway management, ventilation, vascular access, defibrillation, and the management of arrhythmias like tachycardia and bradycardia in a pediatric setting.
This document provides an overview of paediatric emergency management. It discusses cardiopulmonary resuscitation procedures for children and outlines management of common paediatric emergencies like drowning, burns, falls, and foreign body ingestion. Specific conditions covered in more depth include near-drowning, burn classifications and estimations, and treatment plans for minor and major burns. The document aims to equip medical professionals with knowledge of stabilizing critically ill children and preventing long-term complications from emergency situations.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
CVP monitoring involves inserting a catheter into a large central vein and connecting it to a pressure monitoring device to measure central venous pressure. CVP provides information about right ventricular function and intravascular volume status. It is used to guide fluid resuscitation and assess the effectiveness of treatments for conditions like heart failure. Key steps in CVP monitoring include positioning the patient supine, zeroing the monitoring device at the level of the right atrium, and observing pressure waveforms and readings to evaluate volume status and cardiac function. Nurses are responsible for assessing the catheter site for complications and maintaining the sterility and function of the CVP monitoring system.
A baby girl born at 38 weeks was diagnosed with hydrocephalus after birth. She underwent a ventriculoperitoneal shunt placement surgery at 8 days old to drain excess cerebrospinal fluid from her brain ventricles into her abdomen. The surgery involved placing a catheter from her brain ventricle into her abdomen, with a valve to regulate fluid flow. Precautions were taken due to her young age, including maintaining her body temperature. She was placed under general anesthesia and monitored closely after the surgery for potential complications like infection.
Nurses role in arterial puncture and abg analysisStephy Stanly
The document discusses arterial blood gas analysis and interpretation. It provides information on equipment and procedures for arterial blood sampling and analysis. Normal ranges are provided for pH, PCO2, PO2, oxygen saturation, and HCO3. Types of acid-base imbalances are explained including compensated and uncompensated respiratory and metabolic acidosis and alkalosis. Examples of arterial blood gas results are given and their acid-base interpretations.
This document discusses umbilical venous catheters used in neonates, including three case studies. It outlines complications that can arise from malpositioning of the catheter tip, such as perforation of blood vessels, ascites, cardiac issues, and liver damage. Predicting the proper insertion length is difficult and radiography is not always reliable in confirming tip location. The recommendation is that further research is needed to determine the best length of insertion and that repeated imaging may help ensure the tip remains in the correct position.
Endotracheal intubation involves placing a flexible plastic tube into the trachea to maintain an open airway or administer drugs. It is used to administer oxygen, remove secretions, ventilate the lungs, and treat respiratory failure. Indications include CNS depression, neuromuscular disease, chest injuries, airway obstruction, and aspiration risk. The procedure requires a laryngoscope, ET tube, suction equipment, and securing the tube once placed to ventilate the lungs. Complications can include injury and intubation in the wrong airway.
The doctor would perform a chest tube drainage procedure to remove fluid from the patient's right hemothorax. A chest tube would be inserted through the thorax and connected to suction to drain fluid and air from the pleural space, preventing further fluid or air buildup and helping the lung re-expand. The nurse's responsibilities would include properly caring for and monitoring the chest tube drainage system.
Stroke is a medical condition where blood supply to part of the brain is decreased, causing loss of brain function. It is a leading cause of death and disability. There are two main types - ischemic (caused by clots) and hemorrhagic (caused by bleeding). Risk factors include hypertension, heart disease, smoking, diabetes and obesity. Prevention involves controlling risk factors through lifestyle changes and medications. Anyone experiencing symptoms like weakness or numbness on one side of the body should seek immediate medical attention.
Craniotomy
A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.
During open brain surgery, it is done to remove tumors, clip off an aneurysm, drain blood or fluid from an infection & remove abnormal brain tissue
Decompressive craniectomy
It is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury, stroke and other conditions associated with raised intracranial pressure.
Increased intracranial pressure is defined as cerebrospinal fluid pressure greater than 15 mm Hg.
Infections
Tumors
Stroke
Aneurysm
Epilepsy
Seizures
Hydrocephalus
Hypertensive brain injury
Hypoxemia
Meningitis
Due to etiological factors
Components of ICP is disturbed- brain tissue, CSF, blood volume
An increase in the volume of ANY ONE component must be accompanied by a reciprocal decrease in one of the other components.
When this volume-pressure relationship becomes unbalanced, ICP increases.
The document summarizes new guidelines for pediatric resuscitation. Key recommendations include simplifying airway opening techniques for lay rescuers, using a single compression-to-ventilation ratio of 30:2 for single rescuers, and emphasizing the importance of continuous chest compressions with limited interruptions. It also discusses appropriate use of automated external defibrillators for children of different ages, drug administration routes, and indicators for when to stop resuscitation efforts.
Respiratory Physiotherapy for Cerebral PalsyRachaelHinton
This presentation discusses respiratory physiotherapy for patients with cerebral palsy. While cerebral palsy does not directly cause lung issues, impaired motor function can lead to respiratory complications. Physiotherapy aims to prevent mucus buildup through techniques like postural drainage, percussion, and assisted coughing. Assessment is individualized based on factors like age, function, and capacity. The goal is to optimize quality of life through a combination of airway clearance techniques and addressing overall health needs.
Basic life support (BLS) involves immediate assistance provided to an injured or ill person until further medical help arrives. BLS aims to provide oxygen to the heart and brain, sustain tissue function, preserve life, and make the victim comfortable. It includes chest compressions, rescue breathing, use of an AED, and treating choking. The American Heart Association provides BLS guidelines including recognition of respiratory emergencies, high-quality chest compressions for various age groups, and "Chain of Survival" protocols for cardiac arrest. BLS algorithms detail life-saving steps for one- and two-rescuer situations involving infants, children, and adults. Proper airway management, rescue breathing, and relief of choking are also essential
This document discusses neonatal resuscitation and the physiologic changes that occur at birth. It covers topics like fetal circulation, oxygenation, the transition at delivery, signs of a compromised newborn, resuscitative steps including providing warmth, clearing the airway, stimulation and ventilation. Positive pressure ventilation techniques like bag-mask ventilation are described. The importance of anticipating resuscitation needs, preparing appropriately, and understanding the heart rate response to determine next steps is emphasized. Maintaining normal body temperature and oxygen saturation targets are also addressed.
This document discusses the cardiac evaluation of newborns and provides guidance on differentiating normal from abnormal cardiovascular findings. It notes that congenital heart defects are common but can be difficult to diagnose in newborns. A thorough physical exam including inspection, palpation, auscultation and vital signs is important to detect abnormalities. Common congenital heart defects that could present in newborns are described.
This document discusses paediatric trauma. It notes that trauma is a leading cause of death and disability in childhood. Unique characteristics of paediatric trauma include a higher risk of airway obstruction and respiratory complications compared to circulatory issues. Proper airway management is especially important, using appropriately sized equipment. Fluid resuscitation should be carefully monitored for adequacy, and hypothermia prevented. Outcomes depend on factors like response to CPR and presence of fixed pupils.
2014 guilleminault towards restoration of continuous nasal breathing as ultim...Claire Ferrari
This document discusses the treatment of pediatric obstructive sleep apnea and aims to establish continuous nasal breathing as the ultimate treatment goal. It reviews how adenotonsillectomy is often an initial treatment but has decreasing long-term benefits, and suggests this may be because normal nasal breathing is not fully restored. The document discusses experimental and clinical evidence that chronic oral breathing can negatively impact craniofacial growth and airway development over time. It proposes that completely treating sleep disordered breathing in children means normalizing nasal breathing during sleep.
The normal-range-of-heart-rate-at-birth-in-a-healthy-term-neonate-a-critical-...soad shedeed
The normal range of heart rate in healthy newborns at birth is not well established due to inconsistent measurement methods and lack of documentation in the first few minutes after birth. The heart rate is important to determine if resuscitation is needed. However, methods like auscultation with a stethoscope and palpating the umbilical cord pulse are inaccurate and do not provide real-time documentation. Doppler ultrasound provides an accurate, documented measurement from birth and could help establish a reliable normal range to guide decisions about resuscitation. Further research is needed to understand factors like delayed cord clamping and positioning that influence heart rate during transition at birth.
- Respiratory disorders are the most common cause of admission to special care nurseries for both term and preterm infants. Pediatricians often encounter newborn infants with respiratory distress.
- Causes of respiratory distress include failure of transition from fetal to extra-uterine environment, prematurity/surfactant deficiency, and meconium aspiration syndrome. The diagnosis can sometimes be challenging, especially in differentiating from cardiac diseases.
- Referral to a tertiary perinatal-neonatal center is important for conditions like congenital diaphragmatic hernia, other congenital malformations, or delivery of very low birth weight infants that may require fetal or early neonatal intervention.
Neonatal resuscitation involves a series of actions to assist newborns having difficulty transitioning from the womb to outside world. It has evolved over time from techniques like chest compressions to modern practices like providing positive pressure ventilation and supplemental oxygen. International guidelines developed by ILCOR provide evidence-based recommendations for newborn resuscitation. These guidelines are updated every 5 years based on the latest research findings. The goal of newborn resuscitation is to quickly establish breathing and a heart rate above 60 beats per minute through airway management, ventilation, chest compressions and medications if needed. Hypothermia prevention and treatment of hypoglycemia are also important aspects of newborn care after resuscitation.
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
The document discusses pediatric resuscitation, including the chain of survival, causes of cardiac arrest in children, basic life support sequences, advanced life support, and neonatal resuscitation guidelines. It notes that rapid bystander CPR and access to emergency services are key to survival for children experiencing cardiac arrest. For newborns, the document outlines assessing respiration, heart rate, muscle tone and gestational age to determine if resuscitation is required, with steps including warming, clearing airways, and ventilation or compressions if needed. Endotracheal intubation may be used during resuscitation of newborns when other methods are ineffective or for procedures like suctioning meconium.
The physiologic principles and basic steps of newborn resuscitation remain the same regardless of location of birth. Ventilation of the lungs is the initial priority to resuscitate most babies. Once adequate ventilation is ensured, additional information about the baby's history should be obtained to guide further interventions. Resuscitation in the NICU can be more complicated than in the delivery room due to underlying conditions in critically ill infants. The appropriate resuscitation guidelines to follow depend on the likely etiology of the acute event.
- Neonates have immature organ systems that require special consideration for anesthesia and surgery. Their respiratory, cardiovascular, and renal systems are underdeveloped and they have reduced liver function.
- Due to their high metabolic needs and limited reserve, neonates are prone to hypoxia, bradycardia, hypoglycemia, and fluid/electrolyte imbalances under anesthesia if not carefully monitored and supported.
- Regional or minimal sedation techniques may be preferable to general anesthesia in neonates to reduce risks of apnea, hypotension, hypothermia and other complications.
Basic life support is a course run by American Heart Association that teaches about handling cardiac arrest in Out of Hospital and In Hospital Situations. This Presentation covers important aspects of the same.
This document summarizes guidelines for pediatric cardiopulmonary resuscitation (CPCR) presented by Dr. Sunil Mokashi. It discusses differences between pediatric and adult cardiac arrest, including causes and rhythms. It provides guidance on basic life support techniques for infants and children, including chest compression methods and ventilation ratios. The document also reviews pulseless arrest algorithms, including defibrillation doses and use of epinephrine. Pediatric bradycardia and tachycardia treatment are also summarized. The presentation aims to outline best practices for resuscitation of children in both pre-hospital and hospital settings.
Neonates and young infants have significant anatomical and physiological differences compared to older children and adults. Their airways are smaller and more easily obstructed. Lung compliance is reduced due to fewer, smaller alveoli. Cardiac output is higher to compensate for the increased metabolic rate, relying more on heart rate than stroke volume. Renal function is immature, with reduced creatinine clearance. Thermoregulation is less effective due to a larger surface area to weight ratio. Pharmacokinetics are altered by differences in size, organ maturation, and water content, requiring different drug dosing compared to adults.
This document provides information about pediatric cardiopulmonary resuscitation (CPR). It discusses why CPR is important for children, describing basic life support techniques including airway management, breathing, and circulation. It outlines pediatric CPR procedures such as chest compressions for infants and children. The document also reviews potential complications of CPR and important post-resuscitation care activities like monitoring and nursing interventions to address risks such as altered respiratory patterns or fluid imbalances. Family presence during resuscitation is also addressed.
This document provides guidance on evaluating and managing critically ill pediatric patients in the emergency department. It discusses:
1) Using the Pediatric Assessment Triangle (PAT) model to rapidly assess patients, focusing on appearance, work of breathing, and circulation.
2) Age-specific vital sign ranges that are important to consider.
3) Common causes of respiratory failure, shock, and cardiopulmonary arrest in pediatric patients.
4) The importance of anticipating deterioration and having rapid vascular access for fluid resuscitation or medications when needed.
This document discusses gas laws and the behavior of gases. It covers topics like gas pressure, temperature, Boyle's law, Charles' law, the three states of matter, diffusion and effusion of gases, Dalton's law of partial pressures, Henry's law, the ideal gas law, laminar and turbulent gas flow, and the clinical implications of gas behavior. Key points include that gas pressure is caused by molecular collisions, Boyle's law states that pressure and volume are inversely proportional at constant temperature, and Charles' law relates volume and temperature changes at constant pressure.
1. Mu opioid receptors mediate positive reinforcement following direct or indirect activation and are central to understanding addiction. Recent data from native neurons confirms that mu receptor signaling is strongly dependent on the agonist.
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2. Definition of resuscitation
Is : an act or process of resuscitating someone or
something:
A medical : the act or an instance of reviving
someone from apparent death or from
unconsciousness.
is : the act or an instance of restoring someone or
something to an active or flourishing state
3. Age Definitions: What Defines an
Infant, Child, and Adult?
The age of the victim is currently the primary
characteristic that guides decisions for application
of resuscitation sequences and techniques.
Discrimination on the basis of age alone is
inadequate.
Further, any single age delineation of the “child”
versus the “adult” is arbitrary because there is no
single parameter that separates the infant from
the child from the adult.
The following factors should be considered.
4. cont
There is consensus that the age cut-off for infants
should be at approximately 1 year. In general,
cardiac compression can be accomplished using
one hand for victims up to the age of
approximately 8 years.
However, variability in the size of the victim or the
size and strength of the rescuer can require use
of the two-handed “adult” compression technique
for cardiac compression.
5. cont
For instance, the chronically ill infant may be
sufficiently small to enable compression using
circular hand technique, and a 6- or 7-year-old
may be too large for the one-hand compression
technique.
A small rescuer may need to use two hands to
effectively compress the chest of a child victim.
6. cont
The resuscitation of children differs from that of
adults in a number of important ways. For
example, the most common cause of primary
cardiac arrest in adults is coronary artery disease,
whereas respiratory failure and shock are more
common causes among children and infants;
hypoxemia, hypercapnia, and acidosis
subsequently lead to bradycardia, hypotension,
and secondary cardiac arrest in children.
7. cont
After resuscitation, survival to discharge may be
greater among children and adolescents than in
infants or adults.
The survival rate without devastating neurologic
sequelae in children varies by age, ranging from
1% to 2% in infants and young children to 11% for
adolescents in whom a shockable rhythm is more
common; survival rates as high as 30% have
been seen after sudden out-of-hospital witnessed
ventricular fibrillation.
8. cont
The best chance for a good outcome is to recognize
impending respiratory failure or shock and intervene
to prevent the development of cardiopulmonary
arrest.
Age-related differences are important considerations
when treating children.
An appropriate drug dose for a 6-month-old infant
may be excessive for a 1-month-old newborn but
inadequate for a 5-year-old child.
Other aspects of resuscitation, such as endotracheal
tube size, tidal volumes, cardiac compression rates,
and respiratory rates, vary with a child's age.
9. cont
Equipment selection and medication dosing are
based on age and body weight. Valuable time can
be lost in weight estimation, dosage calculations,
and equipment selection.
Emergency personnel must be able to find the
proper equipment rapidly. Equipment can be
stored on shelves or in drawers labeled by age
and weight, or a system of color codes can be
used in which color-coded shelves, carts, or
equipment organizers correspond to specific
length categories as illustrated in
10. The Physiology of Cardiopulmonary
Resuscitation
Outcomes after cardiac arrest remain poor more
than a half a century after closed chest
cardiopulmonary resuscitation (CPR) was first
described. This review article is focused on recent
insights into the physiology of blood flow to the
heart and brain during CPR.
Over the past 20 years, a greater understanding
of heart–brain–lung interactions has resulted in
novel resuscitation methods and technologies
that significantly improve outcomes from cardiac
arrest.
This article highlights the importance of attention
to CPR quality, recent approaches to regulate
11. cont
intrathoracic pressure to improve cerebral and
systemic perfusion, and ongoing research related
to the ways to mitigate reperfusion injury during
CPR. Taken together, these new approaches in
adult and pediatric patients provide an innovative,
physiologically based road map to increase
survival and quality of life after cardiac arrest.
12. BASIC LIFE SUPPORT
The American Heart Association Guidelines use
the following age group delineations: newborn, 1
month or less in age; infant, 1 month to 1 year of
age; and child, 1 year of age to the onset of
puberty.
As in adults, the priorities of resuscitation are
airway, oxygenation, ventilation, and shock
management.
13. Cont
An important change in the 2010 American Heart
Association Guidelines is the order of basic life
support assessment.
Instead of using ABC (airway, breathing,
circulation) as a mnemonic, the American Heart
Association recommends CAB, emphasizing the
importance of chest compressions beginning as
rapidly as possible
14. cont
Reasons for this change in approach include the
following: starting with chest compressions
reduces the delay to the start of the first
compression; all rescuers can start chest
compressions immediately, because airway
management requires manipulation and
positioning of the patient; and simplifying the
basic life support resuscitation approach is
consistent for ...
15. cont
Ideally the sequence of resuscitation should be
determined by the most likely cause of the arrest.
In the newly born infant this will be most likely
related to respiratory failure.
In the older infant and child it may be related to
progression of respiratory failure, shock, or
neurological dysfunction.
16. cont
In general, pediatric pre hospital arrest has been
characterized as hypoxic, hypercarbic arrest with
respiratory arrest preceding asystolic cardiac
arrest.
Therefore, a focus on early ventilation and early
CPR (rather than early emergency medical
services [EMS] activation and/or defibrillation)
appears to be warranted.
17. cont
Early effective oxygenation and ventilation must
be established as quickly as possible.
Primary dysrhythmic cardiac arrest may occur
and should particularly be considered in patients
with underlying cardiac disease or history
consistent with myocarditis.
18. Resuscitation Sequence/EMS
Activation
Local response intervals, dispatcher training, and
EMS protocols may dictate the sequence of early
life support interventions.
In addition, the sequence of resuscitation actions
must consider the most likely causes of arrest in
the victim.
19. cont
Respiratory failure and/or trauma may be the
primary etiologies of cardiopulmonary arrest in
victims aged 40 years or younger,68 with a
relatively low incidence of primary ventricular
fibrillation (VF).
One critical issue in determining the sequence of
interventions is whether the primary cause of
arrest is due to a cardiac or respiratory etiology.
The probability of successful resuscitation based
on that etiology is another important unresolved
resuscitation question
20.
21. Determination of
Responsiveness
Unresponsiveness mandates assessment and
support of airway and breathing. Infants and
patients with suspected cervical spinal injury
should not be shaken to assess responsiveness.
22. Airway
Consensus continues to support use of the head
tilt–chin lift or the jaw thrust (the jaw thrust
especially when cervical spine instability or neck
trauma is suspected) to open the airway.
Other maneuvers, such as the tongue–jaw lift,
may be considered if initial ventilation is
unsuccessful despite repositioning of the head.
The most common cause of airway obstruction in
the unconscious pediatric victim is the tongue.
23. cont
Although the use of a tongue–jaw lift and visual
mouth inspection prior to ventilation of any
unconscious infant may be considered if foreign
body airway obstruction is strongly suspected,
there are no data to support the delay of
attempted ventilation in all victims.
24. cont
Although the use of a tongue–jaw lift and visual
mouth inspection prior to ventilation of any
unconscious infant may be considered if foreign
body airway obstruction is strongly suspected,
there are no data to support the delay of
attempted ventilation in all victims. CPR.
25. Breathing
There is general consensus regarding the
technique for rescue breathing for infants and
children.
The current recommendations for initial number
of attempted breaths, however, vary from 2 to 5.
There are no data to support any specific number
of initial breaths.
There was agreement that a minimum of 2
breaths be attempted.
The rationale for attempting to deliver more than
2 initial ventilations includes the need to provide
effective ventilation for pediatric victims based
upon the likely hypoxic ,
26. cont
hypercarbic etiology of arrest, suspected inability
of the lay rescuer to establish effective ventilation
with only 2 attempts, and clinical impressions that
more than 2 breaths may be required to improve
oxygenation and restore effective heart rate in the
apneic, bradycardic infant.
27. cont
Initial breaths should be delivered slowly, over 1.0
to 1.5 seconds, with a force sufficient to make the
chest clearly rise.
Care and attention to abdominal distention
caused by insufflation of gas into the stomach
should be recognized and avoided.
28. cont
Consideration of the optimal method for delivering
breaths to infants supports the current
recommendation of mouth to mouth-and-nose
ventilation for infants up to 1 year old.
However, mouth-to-nose ventilation may be
adequate in this population.
29. cont
Consensus continues to support the emphasis on
the provision of more ventilation (breaths per
minute) for infants and children and more
compressions per minute for adult victims.
Current recommended ventilation rates are
based on normal ventilatory rates for age, the
need for coordination with chest compression,
and the perceived practical ability of the rescuer
to provide them .
Ideal ventilation frequency during CPR is
unknown.
30. Circulation
There is a lack of specific pediatric data on the
accuracy and time course for determining
pulselessness of victims who are apneic and
unresponsive.
Several reports have documented the inability of
lay rescuers and healthcare providers to reliably
locate or count the pulse of the victim.
The utility of the pulse check during pediatric
CPR has been questioned.
31. cont
Furthermore, the pulse check is difficult to teach
to laypersons.
It seems reasonable for healthcare providers to
search for a pulse because it may be palpated by
trained personnel, does not require sophisticated
equipment, and there is no better alternative.
However, resuscitative interventions should not
be delayed beyond 10 seconds if a pulse is not
confidently detected.
32.
33.
34. Chest Compression
When to Start
There is consensus that all pulseless patients and
patients with heart rates too low to adequately
perfuse vital organs warrant chest compressions.
Because cardiac output in infancy and childhood
is largely heart-rate dependent, profound
bradycardia is usually considered an indication
for cardiac compressions.
35. cont
Location of Compression
There is consensus for compression over the lower
half of the sternum, taking care to avoid compression
of the xiphoid.
Depth
Consensus supports recommendation of relative
rather than absolute depth of compression (eg,
compress approximately one third of the depth of the
chest rather than compress 4 to 5 cm).
Effectiveness of compression should be assessed by
the healthcare provider.
36. cont
Methods of assessment include palpation of
pulses, evaluation of end-tidal carbon dioxide,
and analysis of arterial pressure waveform (if
intra-arterial monitoring is in place).
Although it is recognized that pulses palpated
during chest compression may reflect venous
rather than arterial blood flow during CPR,36
pulse detection during CPR for healthcare
providers remains the most universally practical
“quick assessment” of chest compression
efficacy.
37. cont
Rate
Consensus supports a rate of approximately 100
compressions per minute. With interposed
ventilations, this will result in the actual delivery of
<100 compressions to the patient in a 1-minute
period.
38. Compression-to-Ventilation Ratio
Ideal compression-ventilation ratios for infants
and children are unknown. A single, universal
compression-ventilation ratio for all ages and both
BLS ( basics life support) and ALS interventions
would be desirable from an educational
standpoint.
There currently is consensus among resuscitation
councils for a compression-ventilation ratio of 3:1
for newborns and 5:1 for infants and children.
The justification for this difference from adult
guidelines includes the fact that respiratory
problems are the most common etiology of
pediatric arrest and therefore ventilation should
be
39. cont
emphasized, and physiological respiratory rates
of infants and children are faster than those of
adults.
Although the actual number of delivered
interventions is dependent on the amount of time
the rescuer spends opening the airway and the
effect of frequent airway repositioning on rescuer
fatigue, there is insufficient evidence to justify
changing the current recommendations for
educational convenience at this time.
40. cont
External chest compression must always be
accompanied by rescue breathing in children.
At the end of every compression cycle a rescue
breath should be given.
Interposition of compressions and ventilations is
recommended to avoid simultaneous
compression/ventilation.
41. Activation of the EMS System
Ideally the sequence of resuscitation is
determined by the etiology of the arrest.
In pediatric arrest, dysrhythmias requiring
defibrillation are relatively uncommon, and some
data suggest that early bystander CPR is
associated with improved survival.
42. cont
However, it is impractical to teach the lay public
different resuscitation sequences based on arrest
etiology.
The consensus recommendation is “phone fast”
rather than “phone first” for young victims of
cardiac arrest, but the appropriate age cut-off for
this recommendation remains to be determined.
Local EMS response intervals and the availability
of dispatcher-guided CPR may override these
considerations.
43. Recovery Position
There is consensus that an ideal recovery
position considers the following: etiology of the
arrest and stability of the C-spine, risk for
aspiration, attention to pressure points, ability to
monitor adequacy of ventilation and perfusion,
maintenance of a patent airway, and access to
the patient for interventions.
44. Relief of Foreign-Body Airway
Obstruction
There are three suggested maneuvers to remove
impacted foreign bodies: 1 back blows, chest
thrusts, and abdominal thrusts.
The sequences differ slightly among
resuscitation councils, but published data do not
convincingly support one technique sequence
over another.
45. cont
There is consensus that the lack of protection of
the upper abdominal organs by the rib cage
renders infants and newborns at risk for
iatrogenic trauma from abdominal thrusts;
therefore, abdominal thrusts are not
recommended in infants and newborns.
An additional practical consideration is that back
blows should be delivered with the victim
positioned head down, which may be physically
difficult in older children.
Suctioning is recommended for newborns rather
than back blows or abdominal thrusts, which are
potentially harmful to this age group.
46.
47.
48.
49. cont
IMMEDIATE MANAGEMENT – BASIC LIFE
SUPPORT – CARDIOPULMONARY
RESUSCITATION (CPR)
Airway
Clear the airway using the most appropriate
measures:
• Suction, in the case of vomitus, secretions or
blood.
• Manual clearance. Under direct vision insert
your fingers into the pharynx and remove food,
dentures or foreign bodies. Avoid “blind” finger
sweeps.
50.
51.
52. breathing
Breathing
Mouth-to-mouth respiration. Do this if there is no
apparatus available to ventilate the patient, e.g. if the
cardiac arrest occurs outside the hospital.
Clear the airway as explained above. Extend the head
and lift the jaw up. Kneel beside the patient's head.
Take a deep breath. Pinch the patient's nose with
your free hand. Apply your lips to the patient's mouth
to provide a seal. Blow into the patient's chest. Note
the rise and fall of the chest. Do this 12-15 times per
minute. Allow approximately 1-2 seconds for
inspiration and 3 seconds for expiration. In infants,
mouth to nose breathing works well. Give only gentle
puffs to avoid lung rupture.
53.
54. disadv
Disadvantages:
It is not a very pleasant procedure to carry
out.
The patient is ventilated with expired gases
which contain only 16% oxygen.
The rescuer tends to get "dizzy" after a few
minutes because of low carbon dioxide. Mouth-
to-mouth resuscitation cannot be carried out for
long.
55.
56. ventillation
Ventilation using a bag, valve and mask. A non-
rebreathing valve, self– inflating bag and mask may
be used. This enables the patient to be ventilated
more effectively.
• Clear the airway completely, as described
previously.
• Make sure the chest moves every time the bag is
squeezed.
• An air-tight seal between the face and the mask
is necessary to inflate the lungs. A self- inflating bag
fills during expiration regardless of the seal and a
one-way valve allows ventilation of the patient with
100% oxygen. A flow rate of 10L/min is necessary to
remove carbon dioxide.
(Endotracheal intubation is not an emergency
measure. Ventilation can be quite effective using a
mask and bag provided the rules are followed.
57.
58.
59. Vascular Access
Vascular access for the arrested victim is needed for
the delivery of resuscitative fluids and medications.
However, establishment of adequate ventilation with
BLS support of circulation is the first priority.
The intravenous or intra osseous route for the delivery
of medications is the preferred route, but the
endotracheal route can be used in circumstances
when vascular access is delayed.
It is likely that drug delivery following endotracheal
epinephrine administration may be lower than that
delivered by the intravascular approach.
Drug doses may need to be
60. cont
increased accordingly, with attention to drug
concentration, volume of vehicle, and delivery
technique.
There is consensus that the tibial intra osseous
route is useful for vascular access, particularly for
victims up to the age of 6 years.
In the newly born, the umbilical vein is easy to
find and frequently used for urgent vascular
access.
61. Complications From CPR
Reported complications from appropriately applied
resuscitative techniques are rare in infants and
children. The prevalence of significant adverse effects
(rib fractures, pneumothorax, pneumoperitoneum,
hemorrhage, retinal hemorrhages, from properly
performed CPR appears to be much lower in children
than in adults.
In the most recent study,59 despite prolonged CPR by
rescuers with variable resuscitation training skill
levels, medically significant complications were
documented in only 3% of patients.
Therefore, there is consensus that chest
compressions should be provided for children if the
pulse is absent or critically slow or if the rescuer is
uncertain if a pulse is present.
62. cont
Efforts to resuscitate
patients after cardiac arrest have preoccupied
scientists and clinicians for decades.1,2 However,
the majority
of patients are never successfully
resuscitated.1,3–5 Based
on the published reports, the overall survival rates
after
cardiac arrest are grim, ranging from 1% to <20%
for outof-hospital nontraumatic cardiac arrest and
<40% for inhospital cardiac arrest.1,6 Of these,
10% to 50% have poor
63. cont
6 Of these, 10% to 50% have poor
neurological function.1,7 Surprisingly, the
physiologic
principles that underlie the life-saving process of
cardiopulmonary resuscitation (CPR) remain only
partially
understood and are often controversial.1,8 Some
would
argue that current approaches to cardiac arrest
are fatally
flawed, and that is why the overall survival rates
have
hovered around 7% for out-of-hospital cardiac
64.
65.
66.
67. cont
Advantages
• ECM can be performed by anyone
• No equipment is required
• No risk of infection
• Ventilation is not interfered with.
Dangers
• Fractured ribs
• Pneumothorax
• Injury to liver
Internal Cardiac Massage (ICM)
This approach is rarely necessary but may be indicated:
• When cardiac arrest occurs intra operatively, the chest or abdomen is
already opened and the surgeon is present.
• In trauma arrests, e.g. penetrating chest wounds, severe chest crush
injuries, haemothorax.
• If ECM is ineffective because of underlying pathology, e.g. pericardial
tamponade, severe scoliosis
68. cont
Mouth to mouth respiration and external cardiac
massage
(oval drawn on the sternum shows where pressure
should be applied)
Cardiac massage
External cardiac massage (ECM) The heart is
compressed between the sternum and the vertebral
column.
Technique
The patient must lie on a rigid surface. The operator
should stand or kneel beside the patient so that his
shoulders are directly in line with his hands when
69.
70.
71.
72.
73.
74.
75.
76.
77.
78. cont
FACTORS PRECIPITATING CARDIAC ARREST
Hypoxia: inadequate inspired oxygen.
Hypercarbia: hypoventilation from any cause,
respiratory obstruction, severe lung disease, etc.
Myocardial infarction
Pulmonary embolism
Haemorrhage leading to hypovolaemia.
79. drugs
Drugs
• Anaesthetic drugs may lead to cardiac arrest by
causing:
Myocardial depression
Hypotension, due to peripheral venous pooling
Hypoxia or hypercarbia (which may be caused by
central respiratory depressants or neuromuscular blocking
agents)
Vagotonic action
Sympathetic stimulation.
• Non-anaesthetic drugs
Large doses of digitalis or procainamide
Anaphylaxis to IV contrast used in X-ray studies.
Vagal reflex mechanism: stimulation of organs e.g.
dilatation of rectum, cervix, uterus, etc. in an awake or
lightly anaesthetised patient.
80. cont
Electric shock
Electrolyte imbalance, especially potassium (K+)
imbalance.
Tension pneumothorax, cardiac tamponade
Drowning
Hypothermia
Air embolism