Post on 14-Jul-2020
transcript
3/4/2019
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Pediatric Arrests: What can we do to save
a life?
Strive to ReviveMarch 8th, 2019
Landon A. Jones, MDMedical Director, Assistant Professor
Makenna David Pediatric Emergency Center
University of KentuckyDepartment of Emergency Medicine &
Pediatrics
Disclosures
I have no relevant financial relationships to disclose.
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Disclosures
I have no relevant financial relationships to disclose.
I DON’T believe in “see one, do one, teach one” method. I
learn best from “watch one, botch one.”
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My Hope . . . Learn from Me
The Reality . . . . .
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Pediatric codes are SUPER scary.
And for whatever reason . . .
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18 years, 0
days
18 years, 0
days
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17 years,
364 days
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17 years,
364 days
How do we begin to address this scary
situation?
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Simplify it.
Simplify it.
Prehospital
Arrest
1Arresting
Airway
2
Arresting Access
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4 year old boy found unresponsive by family.
CPR started within 3 minutes by a bystander.
Simplify it.
Prehospital
Arrest
1Arresting
Airway
2
Arresting Access
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As an EMS provider, you arrive at the scene to
find this . . .
You’re awesome and start high quality CPR
immediately.
Decision Time: ET Intubation? (Yes or
No)
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Potential factors Influencing n ET Intubation vs BVM
Story
Resources
Access
Safety
Distance
Comfort
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It is NOT a failure bringing
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It is NOT a failure bringing in a NON-intubated,
adequately oxygenated pediatric arrest patient by
BVM.
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Similar Results
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It is NOT a failure bringing in a NON-intubated,
adequately oxygenated pediatric arrest patient by
BVM.
It is NOT a failure bringing
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It is NOT a failure bringing in a NON-intubated,
adequately oxygenated pediatric arrest patient by
BVM.It is NOT a failure bringing in a NON-intubated,
adequately oxygenated pediatric arrest patient by
BVM.
Simplify it.
Prehospital
Arrest
1Arresting
Airway
2
Arresting Access
3
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Arresting Airway
What size ET tube do I need?
You make the decision to intubate.
Picking an ET Tube
16 + Age (in yrs)
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Picking an ET Tube
Age (in yrs)4
4+
116 + Age (in
Picking an ET Tube
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Maybe you had to BVM the child for a while before
you intubated.
And you (without looking) know that the kid’s tummy
would look like this on XR.
What do you
see?
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Lots of Bowel Gas
from Bagging
What size NG do you need?
Maybe you had to BVM the child for a while before
you intubated.
And you (without looking) know that the kid’s tummy
would look like this on XR.
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Pediatric Tubes
1x ET Tube Size
1x ET Tube Size
2x NG tube Size
Pediatric Tubes
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2x NG tube Size
3x ET Tube Depth
Pediatric Tubes
1x ET Tube Size
2x NG tube Size
3x ET Tube Depth
4x Biggest Chest Tube
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10F
15 cm
20F
Pediatric Tubes
1x ET Tube Size
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What I should have done with a belly full of air . . .
Decompress the Stomach with an NG
One of My Screw Ups
Decompress the Stomach with an NG
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Allows for Improved Diaphragmatic
Excursion
Decompress the Stomach with an NG
Decompress the Stomach with an NG
Allows for Improved Diaphragmatic
Excursion
Identifies the Esophagus
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. . . continuing with the Arresting Airway
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ijciis.org
Intubation Preparation
Intubation Preparation
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airwayjedi.com
Intubation Preparation
airwayjedi.com
Intubation Preparation
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What I should have done to facilitate a
successful intubation. . .
Placed a Shoulder Roll
Another of My Goof Ups
Pre - Intubation Positioning
Basically, this maneuver is a shoulder roll.
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Don’t forget a shoulder roll to make your life
easier when intubating a young child.
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Simplify it.
Prehospital
Arrest
1Arresting
Airway
2
Arresting Access
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Intravenous (IV)
Interosseous (IO)
What methods are available to administer resuscitation
meds/fluids?
Hypodermoclysis (Subcutaneous)
Arresting Access
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Every time I’ve
used this, I’ve
wished it had been
10 minutes
earlier.
Something I Could Have Done Better
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youtube.com
4 year old boy arresting. We’ve done everything we
can think of . .
. . . . . and he’s still arresting.
Our Case
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. . . I need help from my PICU colleague Dr.
Erin Powell.
It is NOT a failure bringing in a NON-intubated,
adequately oxygenated pediatric arrest patient by
BVM.
Take Home Points
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It is NOT a failure bringing in a NON-intubated,
adequately oxygenated pediatric arrest patient by
BVM.Simplify your arresting
airway with easy multiplication and a
shoulder roll.
Points
It is NOT a failure bringing in a NON-intubated,
adequately oxygenated pediatric arrest patient by
BVM.Simplify your arresting
airway with easy multiplication and a
shoulder roll.
Don’t be afraid to pull the trigger on the IO.
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Pediatric Arrests: What can we do to save
a life?
Strive to ReviveMarch 8th, 2019
Landon A. Jones, MDMedical Director, Assistant Professor
Makenna David Pediatric Emergency Center
University of KentuckyDepartment of Emergency Medicine &
Pediatrics
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