Pediatrics Resuscitation

Done by :Al Yaqdhan Al Atbi, MD

EM resident R 1

Systemic approach to critically ill child Cardiac arrest Septic shock Respiratory failure SIDS

Outline

Cardiac arrest

Cardiac Arrest : cessation of blood circulation

resulting from absent of mechanical activity Not responsive , not breathing , no pulse . Prognosis :

In-hospital V.S out-hospital Shockable V.s Non shockable

Cardiac arrest

SIDS < 6 months Trauma > 6months Reversible causes:

etiologies

T’s H’sTension pneumothorax Hypovolemia

Temponade HypoxiaToxnis Hydrogen

Thrombosis pulmonary HypoglycemiaThrombosis coronary Hypo/hyperkalemia

hypothermia

Signs:

Unresponsiveness No breathing or only gasping no pulse

Rhythms: Shockable : Plusless VT , and VF Non shockable : PEA and Asystole

Recogntion of Cardiac arrest

Compression Rate ?

Single 30:2 ; two rescuers 15:2 Advance airway: 1breath every 6-8sec

Type of compression? Circumferential Vs chest compression

Depth? At least 1/3 of the AP diameter (5cm)

BLS review

Trauma:

“Improper resuscitation (fluids )is a major cause of preventable pediatric trauma death” Dykes et al 1989

Possible causes of arrest in trauma ?? Which sequance you will follow??

ABCDE or CAB

Pediatric cardiac arrest : special circumstances

Drowning :

Consider cervical spine injury Hypothermia :

Difficult to know when to terminate resuscitation Core temp should be > 30C CPR can be extended for > 2 hours if

hypothermic

Pediatric cardiac arrest : special circumstances

Neonates, infants, and children are primarily

dependent on HR for maintenance of CO.

Bradycardia and hypo perfusion signs critically ill child

HR < 60/min with hypoperfusion proper oxygenation and ventilation CPR

Bradycardia in pediatrics

Septic Shock in pediatric patients

Sepsis is the leading cause of death in peads High mortality rate 10%

Septic shock is : Simultaneous presence of SIRS Documented or suspected infection Cardiovascular failure (Low BP or need introps

despite resuscitation with 40ml/kg of crystalloids)

Hypotension formula (systolic BP below) :70mmHg + { child age in years*2} mmHg

Adjunct Inx:CBC, Lactate, ABG, coagulation , glucose , U&E, Ca

US

Respiratory failure

Respiratory failure is more common in peads than

cardiac arrest

Effective Rx of Respiratory failure prevents cardiac arrest.

Physiology: Lung surface area Respirator mechanism Accessory muscles Airways Cellular oxygenation

Airway:

Open airway (head tilt-chin left, jaw thrust) Clear airway (suction , remove foreign body) Consider OPA or NPA

Breathing : Monitor SpO2 O2 supplement Consider ventilation with bag-mask device Prepare for ETT

Circulation: Monitor HR, BP , rhythme IV access

Initial Management of respiratory distress or

failure

leading cause of death in infants. 8% of deaths in children < 1yr Rare in children <1months and >1 year of age. Common risk factor : PRON SLEEPING Inx:

Bloods and urine Autopsy and postpartum genetic testing: channalopathy

Psychosocial consideration: Direct , clear terms Greev

Sudden Infantile death syndrome

Excellent CPR is the foundation for successful resuscitation from

cardiac arrest.

Bradycardia with hypoperfusion (prearrest state) and chest compressions may improve survival.

Rapid administration of isotonic fluids is the initial step in resuscitation for all forms of pediatric shock.

The diagnosis of septic shock in children is primarily clinical

Respiratory failure in children is more common than cardiac arrest and is the most important pathophysiologic cause of cardiac arrest

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