ETAT+ 2023 Infant and Child Resuscitation in Health Facilities.pdf

Infant and Child Resuscitation in Health Facilities Outline Introduction Approach to resuscitation of a collapsed child Airway Breathing Circulation Establishing intraosseous access Post-resuscitation care Introduction  Essential components for successful res...

Infant and Child Resuscitation in Health Facilities Outline Introduction Approach to resuscitation of a collapsed child Airway Breathing Circulation Establishing intraosseous access Post-resuscitation care Introduction  Essential components for successful resuscitation Use of guidelines Proper training of Implementation of that are evidence resuscitation the pediatric chain based providers. of survival Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care October 20, 2020 Vol 142, Issue 16_suppl_2  Pediatric chain of survival (in hospital cardiac arrest) Early Activation of High – Advanced Post cardiac Recovery recognition emergency Quality CPR resuscitation arrest care and response prevention Recovery has been added as the 6th link – children should survive resuscitation with as few long-term sequelae as possible Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care October 20, 2020 Vol 142, Issue 16_suppl_2  Preparation for resuscitation Team Equipment Area Training Checklist Room or Coordination Accessibility section for Activation Maintenance resuscitation Recognizing patients with severe illnesses that may result in cardiac arrest early is to be prepared Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care October 20, 2020 Vol 142, Issue 16_suppl_2  Causes of cardiac arrest Pneumonia In children most arrests are due to non Hypovolemic shock cardiac causes Septic shock Severe anemia Congenital heart diseases Cardiopulmonary Arrest In Children; Roy M. Vega; Hersimran Kaur; Peter F. Edemekong Reversible causes of cardiac arrest Tension pneumothorax Toxins 5Ts Tamponade(cardiac) Thrombosis(pulmonary) Thrombosis(coronary) Hypoxia Hypovolemia 6Hs Hypoglycemia Hypo/hyperkalemia Hypothermia Hydrogen ions excess(acidosis) Approach to a collapsed child A structured approach to a collapsed child Safety, Stimulate, Shout, Setting Airway Breathing Circulation  Safe, Stimulate, Shout, Setting (4S) 1. Safe 2. Stimulate PPEs Verbal not in any danger e.g. sharps tactile to check for response safety of the patient 4. Setting 3. Shout Move the patient to an area If no response to stimulation appropriate for resuscitation shout for help -flat Use of the hospitals system to -firm activate emergency team -well lit  Airway Look into the mouth, Is the airway  Clear and safe?  Obstructed:  Secretions (suction)  Vomitus (suction)  foreign body? (remove)  At risk? (insert an airway if AVPU at U) Position the airway If there is an airway problem – ACT!  Airway- positioning Use the head-tilt, chin-lift maneuver In trauma, use jaw thrust Position to a sniffing position Image from kidzAid Australia; kidzaid.com.au Pediatric anesthesia digital handbook Oropharyngeal airway Maintain an open airway in an unconscious patient ( AVPU at U) Indication From the upper mid incisor to the angle of the jaw Sizing Open the mouth With the tip facing down push the oropharyngeal airway into the mouth Insertion following the curvature of the tongue Breathing and Circulation  Breathing Open / Clear the AIRWAY: Look / Listen / Feel for BREATHING Child is breathing Check adequacy of breathing and need for oxygen. Proceed to rescue breaths with bag and mask  Choosing the right mask 1 2 3 4 5 6 7 8 WHO Technical specifications of Neonatal Resuscitation Devices 2016 Parts of a BVM device Image from https://airwayjedi.com/2017/03/26/manual-ventilation-self-inflating-vs-free-flow-bag, Resuscitation B – Giving Rescue Breaths Open / Clear the AIRWAY: Look / Listen / Feel for BREATHING Child IS NOT breathing Or only gasping 5 rescue breaths with Bag and Mask device 1 second inspiration, 1 second expiration Watch and make sure the chest rises Attach oxygen to The chest must rise well at least twice. BVM device as soon as possible Image from: Pinterest – Bagging a patient, the use of an Ambu bag  Resuscitation C – Check for signs of life 5 Inflation breaths with Bag and Mask device Check for Signs of Life and the Large Pulse (5-10secs) Heart Rate about 60 bpm or more No Signs of Life and Absent pulse or Heart Rate, < 60 bpm Continue with B & M Ventilation for Chest compressions (using oxygen): 15 compressions to every two B & M breaths Infant- rate of 30 breaths/min. Aim for 6 – 7 cycles of 15:2 per minute Older child- rate of 25 breaths/min If one rescuer – 2 breaths: 30 compressions Chest Must rise with each ventilation Re-assess after 1-2 minutes! Use your help to check circulation Ministry of Health 2016 ETAT+ paediatric protocols  Giving Effective CPR Lower ½ of sternum, one finger breadth above xiphisternum Compress the chest by 1/3rd its depth & allow for chest recoil Aim at a rate of 100-120 chest compressions/min Give 15 chest compressions: 2breaths for I minute High-quality CPR generates blood flow to vital organs and increases the likelihood of return of spontaneous circulation 2020 Paediatric American Heart Association guidelines High-quality CPR components Adequate chest compression depth Minimizing interruptions in CPR Allowing full chest recoil between compressions Avoiding excessive ventilation Optimal chest compression rate 2020 Paediatric American Heart Association guidelines  Chest Compressions: Infant Vs Older Child Infant Older Child 2-finger technique (1 rescuer) One–hand technique 2-thumb hand encircling technique (2 rescuers) Two–hands technique  Drugs in Resuscitation Recommended Consider IO/IV-line insertion when a 3rd helper arrives. Get samples for random blood sugar Consider IO/IV Adrenaline (0.1ml/kg 1:10,000) as rapid push plus a flush of 2-5mls normal saline Max dose 1mg. Repeat every 3-5 minutes until ROSC is achieved Manage hypoglycemia with IO/IV 10%dextrose NB! Better outcomes when initial dose of epinephrine is administered within 5 mins from the start of CPR) 2020 Paediatric American Heart Association guidelines Paediatric ALS. AHA journals: Originally published22 Aug 2000Circulation. 2000;102:I-253–I-290  Drugs in Resuscitation How to mix adrenaline Recommend drawing up the whole 1mL in 1:1000 adrenaline concentration vial. Dilute with 9mL of normal saline in a syringe. So 0.1mL/kg dosage (10mcg/kg ie 0.01mg/kg) is always administered. NB: Maximum single dose of 1mg can be administered NB! CPR considered futile beyond 15 mins of active high quality CPR or when >2 doses of adrenaline are needed Nursing clinical guidelines by The Royal Children’s Hospital, Melbourne. approved by the Nursing Clinical Effectiveness Committee. Reviewed February 2020. Paediatric cardiopulmonary resuscitation: Advances in science, Techniques & outcomes by Topjian et al, PMC 2009.  Ministry of Health 2016 ETAT+ paediatric protocols IO insertion Post resuscitation care  Post cardiac arrest syndrome Components Brain injury Myocardial Anticipate dysfunction Identify Treat Systemic ischemia and reperfusion response Persistence of metabolic dysfunction resulting from cardiac arrest  Post arrest care Targeted temperature Avoid fever. management Don’t provide extra warmth Blood pressure Use IV fluids and/or vasoactive management and drugs to prevent hypotension. hypoglycemia - Fluid - Ringer’s lactate prevention How much?, dextrose?, when to start? Oxygenation and Target SpO2 94-99% after return of ventilation spontaneous circulation management Use NRM at 10-15L/min; titrate Sp02 Decide on admission care Questions?  Summary 4S’s- Safe, Stimulate, Shout, Setting A- Clear and position the airway B- Correct size of the mask, chest MUST rise! C- High quality CPR! Post-resuscitation care is key to achieve better survival outcomes