2010-2011 ACP Recertification Pre-Course: Pediatric Manual Defibrillation
Pediatric Defibrillation - Overview Objectives Overview of Pediatric Defibrillation Etiology and Pathophysiology of Pediatric Defibrillation ECG Review
Objectives Review & Scenarios: Given pre-course reading and Webinars, small group discussion of various case studies, a manikin, and medical equipment, the paramedic will be able to: Explain the etiology and pathophysiology of cardiac arrest in pediatric patients, Identify the four cardiac arrest rhythms V-fib, V-tach, PEA, and asystole, Summarize the pharmacokinetics and pharmacodynamics of Lidocaine & Epinephrine, Describe and demonstrate the proper application of the Cardiac Arrest General Protocol (Non-traumatic) Adult and Pediatric on pediatric patients, using either adult settings, attenuator cables, or manual defibrillation (as appropriate to each service), As evaluated by the facilitator during case presentations, skill stations, oral scenarios, and a written evaluation.
Pediatric Defibrillation Overview Frequency of Pediatric VSA Happens more than you think! Initial rhythm 20% in VF We can treat! Success is possible Time to shock Appropriate energy delivered
Pediatric Defibrillation Etiology Non-Cardiac Trauma Pre-Existing Disease Pulmonary Most Commonly Boys < 4 years < 1 year
Pediatric Defib: ECG Interpretation Cardiac Arrest Rhythms VF Pulseless VT PEA Asystole
Pediatric Defib: ECG Interpretation Ventricular Fibrillation Fast, Irregular, Wide SHOCK!
Pediatric Defib: ECG Interpretation Pulseless Ventricular Tachycardia Fast, Regular, Wide SHOCK!
Pediatric Defib: ECG Interpretation PEA PULSE CHECK! Possible causes??
Pediatric Defib: ECG Interpretation Asystole No electrical activity PULSE CHECK!
Pediatric Defib: ECG Interpretation Shockable Rhythms? Non-Shockable Rhythms?
Rhythm? Shockable OR Non-Shockable?
Rhythm? Shockable OR Non-Shockable?
Rhythm? Shockable OR Non-Shockable?
Rhythm? Shockable OR Non-Shockable?
Rhythm? Shockable OR Non-Shockable?
Rhythm? Shockable OR Non-Shockable?
Rhythm? Shockable OR Non-Shockable?
Rhythm? Shockable OR Non-Shockable?
Rhythm? Shockable OR Non-Shockable?
Rhythm? Shockable OR Non-Shockable?
Pharmacology Patient > 30 days and < 12 years and < 40 kg Epinephrine Alpha and Beta receptor agonist Ionotropy & Chronotropy Vasoconstriction Lidocaine Interferes with ventricular automaticity Decreases duration of action potential
Pediatric Manual Defib Key Points! Transport patients <16 years after 1 Non- Shockable Interpretation Witnessed arrest Analyze Immediately!
Pediatric Manual Defib Questions? Contact SWORBHP 519-667-6718 ParamedicEducation@lhsc.on.ca
References DL Atkins, LL Hartley and DK York, Accurate Recognition and Effective Treatment of Ventricular Fibrillation by Automated External Defibrillators in Adolescents, Pediatrics 1998;101;393-397 HP Gutgesell, WA Tacker, LA Geddes et al., Energey Dose for Ventricular Defibrillation of Children, Pediatrics 1976;58;898-901 C Mogayzel, L Quan, JR Graves et al., Out-of-Hospital Ventricular Fibrillation in Children and Adolescents: Causes and Outcomes, Annals of Emergency Medicine April 1995;25;4;484-491
References RA Sampson, RA Berg, R Bingham et al., Use of Automated External Defibrillators for Children: An Update: An advisory Statement From the Pediatric Advanced Life Support Task Force, International Liaison Committee on Resuscitation, Circulation 2003;107;3250-3255 PE Sirbaugh, PE Pepe, JE Shook et al., A Prospective, Population-Based Study of the Demographics, Epidemiology, Management, and Outcome of Out-of-Hospital Pediatric Cardiopulmonary Arrest, Annals of Emergency Medicine February 1999;33;2;174-184 KD Young, JS Seidel, Pediatric Cardiopulmonary Resuscitation: A Collective Review, Annals of Emergency Medicine February 1999;33;2;195-205