Pediatric Basic & Advanced Life Support Gassem Gohal FAAP FRCPC Pediatric Dep. Head Jazan Faculty of Medicine
ObjecGves To be familiar with the systematic assessment of a seriously ill or injured child. To overveiw Basic,Advanced life support in Childern
Case 1 9 years old, boy presented to ER with shortness of breath leaning forward, agitated speech in short sentence, has sever retracgons, decrees air- entery with long expiratory wheeze,o2 sat 90% on RA
What different in pediatrics In most infants and small children respiratory arrest precedes cardiac arrest. Rarely sudden cardiac arrest caused by primary cardiac arrhythmias. Most oven asphyxial, resulgng from the progression of respiratory failure or shock or both
Assessment of respiratory Emergencies
Case 2 2 years old girl, had 3 days history of progressive diarrhea and vomigng, mother stated that her diapers are dry of urine she cries with less tears, on exam she is lethargic HR: 160 BP 80/60 dry mucous membrane, weak peripheral pulse
ABC or CAB? 2010 AHA for CPR recommend ABC or CAB sequence Chest compression Airway Breathing Ventilation WHY?
Pediatric BLS algorithm
Pediatric BLS algorithm
Inadequate Breathing With Pulse If pulse > 60 per minutes but there is inadequate breathing give rescue breathing at a rate of about 12 to 20 breathes per minute. Reassess pulse about every 2 minutes If child is breathing, put in recovery position
Unresponsive and not breathing If the child is unresponsive and not breathing (or only gasping) begin CPR. Start chest compression. (30 chest compressions) AVer one cycle 2 minutes check for pulses Call for help when able
Chest compression Rate of 100 compression per minute Push hard: sufficient force to depress at least one third the anterior- posterior diameter of the chest. 1 ½ inches in infants 2 inches in children Allow chest recoil aver each compression to allow the heart to refill with blood
Hand placement Infant: compress the sternum with 2 fingers placed just below the inter-mammary line Child: compress the lower half of the sternum at least one third of the AP diameter of the chest (2 inches) with one or two hands Note: do not compress over the xiphoid or ribs
Two-finger chest compression technique in infant (1 rescuer). Berg M et al. Circulation 2010;122:S862-S875 Copyright American Heart Association, Inc. All rights reserved.
Two thumb-encircling hands chest compression in infant (2 rescuers). Berg M et al. Circulation 2010;122:S862-S875 Copyright American Heart Association, Inc. All rights reserved.
chin lev head Glt
The EC clamp technique of bag-mask ventilations. Berg M et al. Circulation 2010;122:S862-S875 Copyright American Heart Association, Inc. All rights reserved.
Jaw trust (? Spinal injury)
Ventilation / Compression One rescuer: 30 compression to 2 ventilation After initial 30 compression, open airway using a head tilt-chin lift and give 2 breaths using mouth-to-mouth-and nose. Note: if you use mouth to mouth, pinch off the nose. Continue for approximately 2 minutes (about 5 cycles) before calling for ERS and AED.
Children Airway
IO
Rhythm Disturbances
Rhythm Disturbances
defibrillator
PALS Pulseless Arrest Algorithm. Kleinman M et al. Circulation 2010;122:S876-S908 Copyright American Heart Association, Inc. All rights reserved.
PALS Bradycardia Algorithm. Kleinman M et al. Circulation 2010;122:S876-S908 Copyright American Heart Association, Inc. All rights reserved.
PALS Tachycardia Algorithm. Kleinman M et al. Circulation 2010;122:S876-S908 Copyright American Heart Association, Inc. All rights reserved.
Team Roles
Team Dynamics Elements: 1. Closed- loop communicagon 2. Clear messages 3. Clear roles and responsibiliges 4. Knowing one s limitagons 5. Knowledge sharing 6. ConstrucGve intervengon 7. ReevaluaGon and summarizing 8. Mutual respect
Reference hlp://circ.ahajournals.org
Home work hlp://www.medschool.lsuhsc.edu/ emergency_medicine/docs/pals %20Cases.pdf Case based study describing PALS area where ABC way sgll adopgng Please study carefully ( EXAM included)