Pediatric Resuscitation PDF

rhadzoo PEDIATRICS - No interventions needed. The victim is st...

rhadzoo PEDIATRICS - No interventions needed. The victim is stable and PEDIATRIC RESUSCITATION comfortable Dr. Lorelie C. Ramos, MD o Maintainable - The victim needs non-invasive interventions such as TOPIC OUTLINE proper positioning and airway clearing to make him I. SYTEMATIC APPROACH stable and comfortable i INITIAL ASSESSMENT o Unmaintainable ii SECONDARY ASSESSMENT - The victim needs advanced airway or intubation. The iii TERTIARY ASSESSMENT airway cannot be maintained despite proper II. CPR III. EMERGENCY DRUGS positioning and suctioning unless an advanced airway IV. APPENDIX is inserted.  4 Types of Pulmonary condition: I. SYSTEMATIC APPROACH o Upper airway obstruction  Main goal in the assessing the critically ill or injured child: o Lower airway obstruction o Cardiopulmonary arrest prevention o Lung parenchymal disease  In pediatrics, the most common cause of arrest: o Disorder control of breathing o Secondary to Pulmonary  A continuous process of evaluation, assessment, and management BREATHING sequence  4 parameters needed in evaluating the breathing of the victim:  Continue process until patient is stable enough to be transported to o Rate of breathing o Effort of breathing the next level of care o Air entry or breath sounds  If patient deteriorates, life-saving measures or interventions should o Oxygen saturation be done. CIRCULATION  Consist of:  5 parameters in evaluating the victim’s circulation: o Initial Assessment o Heart rate o Primary Assessment o Blood pressure o Secondary Assessment o Central and Peripheral pulse o Tertiary Assessment o Capillary refill time o Urine output  Presence of Shock is distinguished by severity: o Compensated Shock o Hypotensive Shock  Classify what particular shock the patient is suffering from. Such as: o Hypovolemic Shock o Distributive Shock o Obstructive Shock o Cardiogenic Shock DISABILITY  Check for: o Level of consciousness (AVPU) o Neurologic status of the patient o Blood Sugar EXPOSURE  Check for: o Fever (temperature of 37.8C) INITIAL ASSESSMENT o Rashes  Visual and Auditory tool o Bruises on the patient’s body  First few seconds of encounter with the patient SECONDARY ASSESSMENT  Appearance or the level of consciousness  Focus on the resuscitation-oriented history and pertinent physical  Breathing pattern including the rate, effort, and abnormal sounds. examination of the patient utilizing the mnemonic:  Color of the victim: pink, pale, mottled, or cyanotic o S – Signs and Symptoms  Physiologic condition of the patient is reassessed as: o A – Allergy o Respiratory Distress o M – Medications o Respiratory Failure o P – Past Medical History o Life-threatening condition with signs of life o L – Last Meal o Life-threatening condition without signs of life o E – Events prior to critical condition  A more detailed tool for assessing and evaluating the patient  After the secondary assessment, final diagnosis/impression is consist of: made, and final specific intervention is given/rendered to the o Airway patient. o Breathing TERTIARY ASSESSMENT o Circulation  Includes: o Disability o Laboratory o Exposure o Radiologic AIRWAY o Other Diagnostics  3 Types: o Clear II. CPR  Components of CPR: 1  rhadzoo o Chest Compressions  A lightweight, portable, computerized device than can identify an o Airway abnormal heart rhythm as shockable or non-shockable. o Breathing  Can deliver a shock that can stop the abnormal rhythm and allow ASSESS FOR BREATHING AND PULSE the heart’s normal rhythm to return (defibrillation).  Pulse  Earl defibrillation increases the chance of survival from cardiac o Infant: Brachial Pulse arrest that is caused by abnormal heart rhythm. - Place 2 or 3 fingers on the inside of the upper arm,  How to use and AED? midway between the infant’s elbow and shoulder. 1. Open the carrying case (if applicable). Power on the AED if - Press your fingers down and attempt to feel the pulse for needed. at least 5 but no more than 10 seconds. 2. Attach the AED pads to the victim’s bare chest. Avoid placing o Child: Carotid or Femoral Pulse the pads over clothing, medication patches, or implanted - Place 2 or 3 fingers in the inner thigh, midway between devices. Choose adult pads for victims 8 years of age and the hip bone and the pubic bone and just below the older. This should be done while a second rescuer continues crease where the leg meets the torso CPR. - Feel for a pulse for at least 5 but no more than 10 3. “Clear” the victims and allow the AED to analyze the rhythm. seconds. 4. If the AED advises a shock, it will tell you to clear the victim HIGH-QUALITY CPR and then deliver a shock. a. Before delivering a shock, clear the victim. DO this  Start compressions within 10 seconds after recognizing cardiac by making sure that no one is touching the victim. arrest. b. Press the Shock button. The shock will produce a  Push hard, push fast: Compress at a rate of 100-120/min with a sudden contraction of the victim’s muscles. depth of: 5. If the AED prompts that no shock is advised or after any o At least 5cm for adults but no more than 6cm. shock is delivered, immediately resume CPR, starting with o At least one third of the depth of the chest, approximately 5 chest compressions. cm, for children. 6. After about 5 cycles or 2 minutes of CPR, the AED will o At least one third of the depth of the chest, approximately 4cm, prompt you to repeat steps 3 and 4. in infants.  Allow complete chest recoil after each compression (try to limit interruptions to 30 kg) or IM junior autoinjector 0.15 mg (for patient weighing 10 to30 kg) 0.01mg/kg (0.01ml/kg of the 1 mg/ml concentration) IM q 15 minutes PRN (max single dose 0.3 mg)  0.01mg/kg (0.1 mL/kg of the 0.1 mg/ml concentration) IV/IO q 3 to 5 minutes (max single dose 1 mg) If hypotensive  0.1 to 1 mcg/kg per minute IV/1O Infusion if hypotension persists despite fluids and IM injection Asthma  0.01mg/kg (0.01 ml/kg of 1 mg/ml concentration) subcutaneously q15 min (max 0.3 mg or 0.3 ml) Croup  0.25 to 0.5 ml racemic solution (2.25%) mixed in 3 ml NS via inhalation  3 mg (3 ml of the 1 mg/ml concentration) epinephrine mixed with 3 ml NS (which yields 0.25 ml racemic epinephrine solution) via inhalation Norepinephrine Hypotensive (usually distributive) shock (ie, low SVR and fluid refractory)  0.05 to 0.5 mcg/kg per minute IV/1O infusion (Upper limit dosing range can be highly variable and should be based on clinical scenarios); titrate to desired effect Vasopressin Catecholamine-resistant hypotension  0.0002 to 0.002 unit/kg per minute (0.2 to 2 milliunits/kg per minute) continuous infusion Milrinone Myocardial dysfunction and increased SVR/PVR  Loading dose: 50 mcg/kg IV/1O over 10 to 60 minutes followed by 0.25 to 0.75 mcg/kg per minute IV/IO infusion Sodium Metabolic acidosis (severe), hyperkalemia bicarbonate  1 mEq/kg IV/IO slow bolus Sodium channel blocker overdose (eg. Tricyclic antidepressant)  1 to 2 mEq/kg IV/1O bolus until serum pH is >7.45 (7.50 to 7.55 for severe poisoning) 3 rhadzoo 4 rhadzoo 5 rhadzoo 6