Beth Cetanyan, RN AHA RF Aka The GURU

Transcription

1 * Beth Cetanyan, RN AHA RF Aka The GURU

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3 *Discuss common causes of Pediatric CA *Review current PALS Guidelines *Through case presentations and discussion, become more comfortable and confident in providing care to the Pediatric Arrest or Peri-Arrest Patient. *

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5 * *Survival to discharge from out-of-hospital pediatric *cardiac arrest (PCA) survival has not changed in 20 years *remains at 6% *3% for infants *9% for children and adolescents

6 * *In-Hospital 10 % *Out of Hospital % *Isolated Respiratory Arrest 95% *Dr. Diane Atkins Research

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8 * 2010 ILCOR Pediatric Taskforce * Chest compressions should be started immediately while second rescuer prepares to start ventilations *Effectiveness of PALS is dependent on high-quality CPR *Laypersons: 75% effective *Healthcare providers: 50-60% effective *What s wrong with this picture? * Tap and Out *The Rock Island Fire Department story * * Kleinman et al Circulation 2011

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10 * SIDS Trauma Submersion Poisoning Sepsis AW obstruction Severe Asthma Pneumonia Metabolic Disorders Arrhythmias

11 Resp. Failure Shock

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13 10% 10% Respiratory Shock 80% Cardiac *

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18 Healthcare providers accurately determine presence or absence of a pulse in infants and children about 80% of the time * Average time to detect a pulse is 15 seconds Palpation of a pulse (or its absence) is not reliable as the sole determinant of cardiac arrest! If the victim is unresponsive, not breathing normally Start CPR! *

19 * * Family presence during resuscitation is beneficial to those who choose to be present * Family members should be offered the opportunity to witness resuscitative efforts in the hospital * Family presence during a resuscitation in the prehospital setting is of less clear benefit

20 * Prehospital arrests Management of unexpected arrest in athletes Supraglottic airways Minute ventilation during CPR Safe defibrillation doses in children Why isn t family presence positive in prehospital How best to train to this curriculum

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22 * 1,3,5,7,9 10,15,20,25,30

23 * One study demonstrated a medication dosing error rate of 34% among 5,547 pediatric patients treated in the field. Another study at a university-affiliated pediatric hospital found 252 tenfold medication errors were identified throughout a five-year period.

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28 *9 y/o boy *Collapsed during hoops *14 minute EMS response *NO Bystander CPR!! *30 minute CA * Multiple epi and Dfibs *ROSC *LV ejection fraction 50% *Cooled to 36-37C *Poor Neuro prognosis *

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31 *Call for nearby help *Assess breathing and pulse simultaneously *Less than 10 seconds *Activate Emergency Response System or call for back up

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33 *At least 1/3 anteroposterior diameter of the chest. * Infants puberty *Usually equals 1.5 inches! *After puberty, depth is at least 2 inches (no greater than 2.4 inches) *

34 Age Group Neonate (0-30 Days 1-person Compression to Ventilation ratio 2-person Compression to Ventilation Ratio 3:1 3:1 Pediatric 30:2 15:2 Adult 30:2 15:2 * Compressions at /minute

35 *Deliver 1 breath every 6 seconds during continuous chest compressions. *

36 * *Initial bolus 20 ml/kg *Emphasize IV fluid for Septic Shock *Emphasizes individualized treatment plans for each patient, based on frequent clinical assessment before, during, and after fluid therapy

37 *No evidence to support the routine use of atropine as a premedication to prevent bradycardia in emergency peds ETT *Still may be considered in situations where there is an increased risk of bradycardia. *

38 *Amiodarone or Lidocaine is equally acceptable for VF / VT in pediatric patients. *Lidocaine was associated with higher ROSC rates and 24 hour survival. *Neither Lido or Amiodarone was associated with improved survival to discharge. *

39 *For Children who are comatose in the first several days after CA, temperature should be monitored closely and fever treated aggressively. *For comatose kids with ROSC, maintain 5 days of normothermia or 2 days of initial continuous hypothermia (32 34C) followed by 3 days of normothermia. *

40 * *2 y/o boy *Found at bottom of the pool *Mother rescued and began CPR *6 minute EMS response! *EMS with CPR for 1-2 more minutes after arrival ROSC! *Coughing / moving arms / legs *Ph 6.95 PCO2 35mmHg *4 weeks post CA NO Neurological deficits!

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48 *Life is Why