Goals of resuscitation
To improve the quality of care provided to seriously ill or injured children resulting in improved outcome
Basic Life Support
- check scene safety
- check responsiveness
- activate emergency response, ask for an AED
- check breathing and pulses simultaneously (5-10 secs)
- start CPR
Where to check for pulses in infant and child?
Infant: brachial
Child: carotid
Characteristics of high quality CPR
- push hard
- push fast
- allow complete chest recoil
- minimize interruptions
- avoid excessive ventilation
What is the chest compression depth in infants and children?
At least 1/3 AP diameter of chest in pediatric patients
Infants: 1.5 inches (4 cm)
Child: 2 inches (5 cm)
What is the chest compression depth in adolescents?
Follow adult recommendations
- at least 2 inches (5 cm) but no more than 2.4 inches (6 cm)
What is the chest compression rate?
- 100 to 120 compressions per minute
How to Allow complete chest recoil?
Avoid leaning on the chest between compressions to allow full chest wall recoil
How much interruption is permitted?
Limit to less that 10 seconds
Is the amount of time spent doing high quality chest compressions during CPR
Chest compression fraction (CCF)
How many breaths given if 1 rescuer or 2 rescuer?
1 rescuer: 30 compressions followed by 2 breaths
2 rescuer: 15 compressions followed by 2 breaths
- give each breath over 1 second
ECG rhythm interpretation
- heart rate
- rhythm interval: regular or irregular
- presence of P wave
- QRS complex: narrow or wide
Cable connections
White lead: right shoulder (RA)
Red lead: left lower ribs (LL)
Black lead: left shoulder (LA)
Sinus tachycardia
infants <200 bpm; children <180 bpm
Present P wave
Sinus bradycardia
<60 bpm
Regular rhythm
Present P wave
Narrow QRS
Supraventricular tachycardia
infants >200 bpm; children >80 bpm
ABSENT P wave
Drug of choice: Adenosine 0.1 m/kg
Ventricular tachycardia
100-250 bpm
ABSENT P wave
WIDE QRS complex
Ventricular Fibrillation
150-500 bpm
IRREGULAR CHAOTIC RATE
NO IDENTIFIABLE P WAVE
NO IDENTIFIABLE QRS COMPLEXES
can give Amiodarone
NEW UPDATE ON AHA GUIDELINES
- rescue breathing
1 breath every 2-3 seconds (20 to 30 breaths per minute)
Before: 1 breath every 3-5 seconds (12 to 20 breaths per minute)
NEW UPDATE ON AHA GUIDELINES
- ventilation rate during CPR with an advanced airway
1 breath every 2 to 3 seconds (20 to 30 breaths per minute)
Before: 1 breath every 6 seconds (10 breaths per minute)
NEW UPDATE ON AHA GUIDELINES
- cuffed endotracheal tubes
CHOOSE CUFFED ETTS over uncuffed ETTs for intubating infants and children
- pay attention to ETT size, position, and cuffe inflation pressure (usually <20 to 25 cm H20)
- decreased need for reintubation
- decrease risk for aspiration
- subglottic stenosis is rare
NEW UPDATE ON AHA GUIDELINES
- cricoid pressure during intubation
Insufficient evidence to recommend routine application to prevent aspiration during ET intubation in children
NEW UPDATE ON AHA GUIDELINES
- emphasis on early epinephrine administration
Administer the initial dose of epinephrine WITHIN 5 MINUTES FROM THE START OF CHEST COMPRESSIONS
NEW UPDATE ON AHA GUIDELINES
- invasive blood pressure monitoring to assess CPR quality
- maybe recommended for rescuers to use blood pressure to guide CPR quality
- favorable outcome: infants 25 mmHg, children 30 mmHg
