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