Pediatric CardioPulmonary Resuscitation(cpr)

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WHAT IS CPR ????......... Cardio pulmonary resuscitation is a series of steps used to establish artificial ventilation and...1-Establish basic life support. 2-Oxygenate, ventilate, and start chest compression:  Provide positive-pressure ventilati...BLS for infant &children Infant are less than one year of age (except newborn) Childern are from one year to puberty 3-Attach a defibrillator or monitor:  Assess and monitor the cardiac rhythm.  If using a defibrillator, place one defibr...4-Assess rhythm and check for signs of life: Look for signs of life, which include responsiveness, coughing, spontaneous ...A. Non-shockable (asystole or PEA)  This is the more common finding in children.  Perform continuous CPR:  Continue to ... Give adrenaline: If vascular access has been established, give adrenaline 10 mcg kg-1 (0.1 mL kg-1 of 1 in 10,000 solut...Consider and correct reversible causes (4Hs and 4Ts):  Hypoxia  Hypovolaemia  Hypothermia  Hypo/hyperkalaemia, metabol...B. Shockable (VF/pVT)  This is less common in children but may occur as a secondary event and is likely when there has be...Cont…  Defibrillate the heart:  Charge the defibrillator while another rescuer continues chest compressions.  Once the ... Resume CPR: Without reassessing the rhythm or feeling for a pulse, resume CPR immediately, starting with chest compress... Continue CPR for 2 min, then pause briefly to check the monitor: If still VF/pVT, give a third shock (with same energy l... Resume CPR:  Without reassessing the rhythm or feeling for a pulse, resume CPR immediately, starting with chest compres...After each 2 min of uninterrupted CPR, pause briefly to assess the rhythm: If still VF/pVT: Continue CPR with the shock...If organised electrical activity is seen, check for signs of life and a pulse: If there is ROSC, continue post-resuscitat...Drugs used in CPR Adrenaline  Adrenaline induces vasoconstriction, increases coronary and cerebral perfusion pressure and enhances myocardi...Amiodarone  In the treatment of shockable rhythms, give an initial IV bolus dose of amiodarone 5 mg kg-1 after the third ...Calcium  routine administration of calcium during cardiac arrest has been associated with increased mortality  it should...Sodium bicarbonate  Administration of sodium bicarbonate generates carbon dioxide, which diffuses rapidly into the cells,...Fluids in CPR  Hypovolaemia is a potentially reversible cause of cardiac arrest.  If hypovolaemia is suspected, give IV ...Post-resuscitation care Oxygen  In neonates there is evidence that hyperoxaemia can be detrimental and room air is recomm...Carbon dioxide  In children who do not recover consciousness immediately following ROSC, controlled ventilation may help ...Intravascular fluids and inotropes  Following ROSC, the use of fluids and/or inotropes to avoid hypotension is recommende...Prognostic factors for outcomes of resuscitation  No single prognostic factor is sufficiently reliable to inform decision...Blood glucose control  Closely monitor plasma glucose concentrations in any ill or injured child including after cardiore...Refrences  https: //www.resus.org.uk/resuscitation-guidelines/paediatric-advanced-life- support/  Oxford Handbook of Ped...CPR In Pediatric (Pediatric Advanced Life Support) CPR In Pediatric (Pediatric Advanced Life Support) CPR In Pediatric (Pediatric Advanced Life Support)

 

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WHAT IS CPR ????......... Cardio pulmonary resuscitation is a series of steps used to establish artificial ventilation and...BLS for infant &children Infant are less than one year of age (except newborn) Childern are from one year to puberty WHEN YOU HAVE TO START CPR ????....... 1-No response 2-If the victim is not breathing normally such as gasping for breath ...American heart association new icon ‫؟‬ CHAIN OF SURVIVAL Adult CHAIN OF SURVIVAL Pediatrics STEPS OF CPR 1- Check the scene safety 2- Check for consciousness 3- check breathing &pulse together 4- call for help 6- s...CHECK RESPONSE • Gentle taping the foot of baby • And call him baby baby…… No response Activate emergency response • If the infant not respond Immediately call for help and get automated external defibrillator...pulse&Check breathing • Look for chest rise • Hear agonal breathing • Check pulse in brachial artery within 10 seconds • O...Signs of poor perfusion cool extremitie s Altered mental status Weak Pulse Skin : pale mottling then cyanosis Start compression One rescuer By two fingers at lower 1|2 of breast bone (sternum) 30 compression to 2 breaths Depth ab...Two rescuer Encircle the chest by both hands 15 compression to 2 breaths Switch every 2 minutes or 10 cycle Hand placement  Infant: compress the sternum with 2 fingers placed just below the inter- mammary line  Child: compress t...Compression depth Infant at least one third of A P diameter of chest or about4 cm Children at least one third of A P diame...High quality C P R Start chest compression within 10 second of recognition Push hard about 4 cm, push fast from 100-120 co...CPR FROM EGYPT TO GHANA COUNTRY Defibrillation • Defibrillators are either manual or automated (AED). • AED can be used for infants and children up to app...Paddle Size Two sizes of hand-held paddle “Adult” size : 8 to 10 cm for children > 10 kg ( approximately 1 year) “Infant” ...Paddle Position: Place over the right side of the upper chest and the apex of the heart (to the left of the nipple over t...Defibrillation sequence Switch ON the device Apply Paddles Clear the patient for analyzing the rhythm Charging if shock ne...DEFIBRRILATION Manual Defibrillation Dosing The recommended first energy dose for defibrillation is 2 J/kg. If second dose is required, i...If you heard “you will forgot” If you saw “you will remember” If you did “you will become perfect” SO you must practice CPR INFANT CPR WORKSHOP TOMMORROW friday 8:30 AM AUDITRUM HALL Take home message Infant not small adult C A B not A B C nothing delay compression HIGH QUALITY C P R is mandatory CPR is ...What is new in pediatric cprWhat is new in pediatric cprWhat is new in pediatric cprWhat is new in pediatric cprWhat is new in pediatric cprWhat is new in pediatric cpr

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Start CPR ImmediatelyStart CPR Immediately Brain damage starts in 4-6 minutes Brain damage is certain after 10 minutes Bet...Checking Vital SignsChecking Vital Signs A – Airway Open the airway Head tilt chin lift B – Check For Breathing Look, list...Mouth to Mouth Barrier DevicesMouth to Mouth Barrier Devices Shields Masks After giving breaths… Locate proper hand position for chest compressions C – Chest compression Checking for CPRChecking for CPR EffectivenessEffectiveness Does chest rise and fall with rescue breaths? Have a second re...1- Ensure chest compression of adequate rate 2- Chest compression of adequate depth 3-Allow full chest recoil in between c...Old BLS 2010 BLS 2015 (1 rescue)BLS 2015 (1 rescue) BLS 2015 (2 rescue)BLS 2015 (2 rescue) ITEM 2015 ( UPDATE( 2010 ( Old ) Explanation New algorithms Two algorithms for 1-Rescuer and Multiple-Rescuers Handheld ce...ITEM 2015 ( UPDATE( as 2010 ( Old) Explanation C-A-B Sequence Chest compression first CPR should begin with 30 compression...ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Chest Compression Depth depress the chest at least 1/3 the anteroposterior dia...ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Chest Compression Rate Use the recommended adult chest compression rate of 100...Procedure:  Reaffirming the C-A-B sequence as the preferred sequence for pediatric CPR  New algorithms for 1-rescuer and multiple-r...Pediatric Advanced life support PALS Pediatric Advanced life support PALS ITEM 2015 (UPDATE( Explanation Fluid Resuscitation Early, rapid IV administration of isotonic fluids for septic shock. (20...ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Atropine for ETT no evidence support routine use of atropine as a premedicatio...ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Invasive hemodynamic monitoring during CPR If invasive hemodynamic monitoring ...ITEM 2015 (UPDATE( 2010 ( Old ) Explanation antiarrhythmic medications for shock refractory VF or pulseless VT Amiodarone ...ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Vasopressors for Resuscitation It is reasonable to give epinephrine during car...ITEM 2015 (UPDATE( 2010 ( Old ) Explanation ECPR Compared With Standard Resuscitation ECPR may be considered for children ...ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Targeted Temperature Management For comatose children maintain either 5 days n...ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Intra-arrest and Post- arrest Prognostic Factors Multiple factors should be co...ITEM 2015 (UPDATE( Explanation Post–Cardiac Arrest Fluids and Inotropes fluids and inotropes/vasopressors should be used t...ITEM 2015 (UPDATE( 2010 ( Old ) Explanation Post–Cardiac Arrest Pao2 and Paco2 avoid Hypoxemia. titrate oxygen administrat... Restrictive fluid volumes in febrile illness.  Routine use of atropine as a premedication for emergency ETT in non-neon...Updates of 2015 PALS guidlinesUpdates of 2015 PALS guidlinesUpdates of 2015 PALS guidlinesUpdates of 2015 PALS guidlinesUpdates of 2015 PALS guidlinesUpdates of 2015 PALS guidlines

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