fa: pediatric
TRANSCRIPT
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Basic Paediatric Life Support
Guidelines 2005
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Peter J. Safar1924 – 2003
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The European Resuscitation Council (ERC):Paediatric Life Support (PLS) 1994, 1998, 2000
International Liaison Committee on Resuscitation (ILCOR)
+American Heart Association:
‘Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care’
Paediatric Life Support Working Party of the European Resuscitation Council 2004 / 2005
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www.erc.edu
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ERC Guidelines 2005
Better resuscitate as adult than doing nothing
Strong focus on simplification
Chest compressions / air ventilation alone may improve outcome
Many children receive no resuscitation at all because rescuers fear doing harm
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Resuscitation of the child is different from adults.
A lot of common in technique, but another starting point in children:
Children – secondary cardiac arrest (non-cardiac origin)
(hypoxia respiratory failure cardiac arrest)
Adults – primary cardiac arrest (cardiac origin) (sudden, early defibrillation)
Primary cardiac arrest in children 15 %
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Recognition of condition, which can lead to cardiac arrest and properly performed BLS.
Outcome of CPR in children: 3 – 17 % survival, survivors: severe neurological disability (80 %)
Factors, which could affect outcome of BLS:
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119 patients 18 years with cardiac arrest, 45 % 1 year, 64 % 3 years of age, causes of cardiac arrest:
Sudden infant death syndrome 32 %
Epidemiology:
Drowning 22 %Another respiratory diseases 9 %Congenital heart diseases 4 %Neurological diseases 4 %Oncological diseases 3 %Cardiological diseases 3 %Drug overdosage 3 %Smoke inhalation 2 %Anaphylaxis 2 %Endocrinological diseases 2 %
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Definitions (CPR point of view):
Infant: < 1 year of age
Child: 1 year – puberty
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Paediatric Basic Life Support Algorithm
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1. Ensure the safety of rescuer and child
2. Check the child’s responsiveness: child with suspectedcervical spinal injuries should not be shaken
stimulate + ask
If the child responds by answering or moving
If the child does not respond
• Leave the child in the position in which you find him• Reassess him regularly
• Shout for help• Open the child’s airway (tilt head and lift chin) (Esmarch manoeuvre)
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Esmarch manoeuvre
tilt head back
lift chin
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1. Ensure the safety of rescuer and child
2. Responsiveness stimulate + ask
3. Breathing
Open airways
• Look – chest movements• Listen – breath sounds at child´s nose and mouth• Feel – air movement on your cheek
10 s for decision that breathing is absent
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3. Breathing
If the child is breathing recovery position (lateral position, without obstruction of airways, free drainage of fluid)
• 5 slow breaths
Yes
No
If the child is not breathing
• 1 – 1.5 s each• movement of chest
1. Ensure the safety of rescuer and child2. Responsiveness stimulate + ask
Open airways
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3. Breathing
No chest movements
• open the airways (Esmarch manoeuvre)
Yes
No
• foreign body obstruction sequence
• 5 slow breaths
• open the mouth, remove obstruction
1. Ensure the safety of rescuer and child2. Responsiveness stimulate + ask
Open airways
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4. Circulation
• pulse
Yes
No
• movement, coughing, breathing
child: a.carotisinfant: a.brachialis
within 10 s
1. Ensure the safety of rescuer and child2. Responsiveness stimulate + ask
Open airways
3. Breathing
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4. Circulation
• continue breathing
Yes
No is present
slow pulse (under 60/min) is absent
not sure • chest compressions• breathing + chest compressions
1. Ensure the safety of rescuer and child2. Responsiveness stimulate + ask
Open airways
3. Breathing
2
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4. Circulation
• lower third of sternum
Yes
No Infant
• rate 100 / min
• compression of sternum with 2 fingers to 1/3 of depth of infant´s chest
• 1 rescuer: after 30 compressions 2 breaths (ratio 30:2)
1. Ensure the safety of rescuer and child2. Responsiveness stimulate + ask
Open airways
3. Breathing
• 2 rescuers – ratio 15:2
2
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4. Circulation
• lower third of sternum
Yes
No Child
• rate 100 / min
• compression of sternum with arms straight to 1/3 of depth of child´s chest
• 1 rescuer – ratio 30:2
1. Ensure the safety of rescuer and child2. Responsiveness stimulate + ask
Open airways
3. Breathing
2
• 2 rescuers – ratio 15:2
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• the child shows signs of life (spontaneous breathing, pulse, movement)
Continue resuscitation until
• qualified help arrives
• rescuer become exhausted
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1 rescuer one should start with CPR, another calls
When to call for assistance
1 rescuer perform CPR for 1 min before calling for assistance
Only exeption:child with known heart disease
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Foreign-body airway obstruction
Sudden onset of coughing, stridor or gagging
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Foreign-body airway obstruction
Infant • hold the child in a prone position, head lower than chest• 5 blows between shoulder blades
• 5 chest thrusts to the sternum
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Foreign-body airway obstruction
• hold the child in a prone position, head lower than chest• 5 blows between shoulder blades
Child
• 5 abdominal thrusts (Heimlich manoeuvre)
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Foreign-body airway obstruction
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www.erc.edu
Basic Paediatric Life Support
Guidelines 2005