beth cetanyan, rn aha rf aka the guru · providing care to the pediatric arrest or peri-arrest...

Beth Cetanyan, RN AHA RF

Aka – The GURU

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*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.

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*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

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*In-Hospital 10 %

*Out of Hospital 10 - 34 %

*Isolated Respiratory Arrest 95%

*Dr. Diane Atkins Research

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* 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

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SIDS

Trauma

Submersion

Poisoning

Sepsis

AW obstruction

Severe Asthma

Pneumonia

Metabolic Disorders

Arrhythmias

ShockResp. Failure

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Respiratory

Shock

Cardiac

10%10%

80%

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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!

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*•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

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•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

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1,3,5,7,9

10,15,20,25,30

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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)

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Age Group 1-person

Compression to

Ventilation ratio

2-person

Compression to

Ventilation Ratio

Neonate (0-30

Days

3:1 3:1

Pediatric 30:2 15:2

Adult 30:2 15:2

Compressions at 100-120/minute

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*Deliver 1 breath every 6 seconds during

continuous chest compressions.

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*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

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*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.

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*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.

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*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.

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*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…