* Beth Cetanyan, RN AHA RF Aka The GURU
*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. *
* *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
* *In-Hospital 10 % *Out of Hospital 10-34 % *Isolated Respiratory Arrest 95% *Dr. Diane Atkins Research
* 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
* SIDS Trauma Submersion Poisoning Sepsis AW obstruction Severe Asthma Pneumonia Metabolic Disorders Arrhythmias
Resp. Failure Shock
10% 10% Respiratory Shock 80% Cardiac *
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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! *
* * 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
* 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
* 1,3,5,7,9 10,15,20,25,30
* 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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*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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*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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*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) *
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 100-120/minute
*Deliver 1 breath every 6 seconds during continuous chest compressions. *
* *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
*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. *
*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. *
*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. *
* *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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*Life is Why