Dr. May Amr Muhammad

AHA Senior Instructor (BLS, FA, ACLS, PALS, PEARS programs).

Resuscitation Science

• Resuscitation is the process of correcting physiological disorders in an acutely unwell patient (either arrested or an acute life threatening condition).

• Although basic life support skills are essential for all healthcare providers, the action taken prior to the arrest is essential for either arrest prevention or for better outcomes.

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1. CHILD.2. INFANT.

Who is ……….?

Unique Pediatric Features.

• According to the AHA 2010 CPR Guidelines only 4%- 13% of the children who have out-of-hospital arrest survive to hospital discharge. Although the outcome for the in-hospital cardiac arrest rise to about 27% it is still very disappointing.

• The Good news is that with early prevention (the first link in the Chain of survival) the hope is more especially with the recognition of the most common cause for the respiratory distress and the Shock.

Resuscitation Science

Initial Impression

Not Conscious, No spontaneous

Breathing

Cardiac Arrest (No pulse)

Respiratory Arrest (with

pulse)

Not Conscious with spontaneous

Breathing

Acute life threatening

Conscious with spontaneous

Breathing

Critically-ill Patient

Pediatric Pre-arrest conditionsRespiratory Upper Airway Obstruction

Lower Airway Obstruction

Lung Tissue Disease

Disorder Control of Breathing

Pediatric Pre-arrest conditions

Shock Hypovolemic

Obstructive

Distributive

Cardiogenic

Pediatric Pre-arrest conditions

Cardiac Tachycardia

Bradycardia

Acute Life threatening Conditions

• In the all age groups especially the pediatric age group the medical conditions that affects the conscious level with subsequent affection of the airway are categorized as acute life threatening conditions.

• This affection could rise from either central disorder of breathing or severe bradycardia.

Pediatric Chain of Survival

Systematic Approach• Open• Clear• Maintainable

Airway A• Respiratory Rate and Pattern.• Respiratory Effort• Chest Movement and Expansion.• Abnormal Lung and Airway Sounds.• Oxygen Saturation by Pulse Oximeter (≥94%)

Breathing B

• Heart Rate• Pulse (Central and Peripheral)• Capillary Refill Time• Skin Color and Temperature.• Blood Pressure.

Circulation C

• AVPU• Pupils Size and Reaction to light.• Random Blood Sugar.

Disability D• Skin Appearance• Temperature. Exposure E

Systematic Approach• Why this approach?Following the Systematic gives both the healthcare provider an evidence based system and the patient the maximum opportunity for the success.For the patient it guarantee the beginning with the most acute life threatening condition that kills first.

WHAT KILLS FIRST, TREATED FIRST.

Airway• Airway Anatomy Differences:

Airway• Opening the Airway:

Airway• Opening the Airway:

Airway• Clearing the Airway:

Airway• Maintaining Airway Patency:

Airway• Maintaining Airway Patency (Adjuvants):

Airway• Maintaining Airway Patency (Adjuvants):

Airway• Maintaining Airway Patency (Advanced):1- Supraglotic Devices:

Airway• Maintaining Airway Patency (Advanced):1- Infraglotic Devices:

Breathing• Oxygen Delivery Systems:1- Low-Flow systems:

Breathing• Oxygen Delivery Systems:2- High-Flow systems:

Breathing• Assisted Ventilations (Bag-Valve Mask Device):

3-5 breath every sec

Breathing• Assisted Ventilations (Bag-Valve Mask Device):

Breathing• Monitoring:

≥94 – 99%

Breathing• N.B: Waveform Capnography:

Pediatric Pre-arrest conditionsRespiratory Upper Airway Obstruction

Lower Airway Obstruction

Lung Tissue Disease

Disorder Control of Breathing

Respiratory Problems:

• Upper Airway Obstruction:1. Stridor, Barking cough, Snoring.• Lower Airway Obstruction:1-Wheezes, Prolonged Expiration.• Lung Tissue Disease:1- Grunting, crackles.• Disorder Control of Breathing1- Irregular respiratory pattern, inadequate respiration.

Respiratory Problems:

• Upper Airway Obstruction:Management:• Lower Airway Obstruction:Management:• Lung Tissue Disease:Management:• Disorder Control of BreathingManagement:

Circulation• Heart Rate:

Circulation• Heart Rate:

Circulation• Heart Rhythm

50 mm/sec

Circulation• Circulation Access 1- Intra-venous Cannulation:

Twice only

Circulation• Circulation Access:2-Intra-ossous Cannulation

Pediatric Pre-arrest conditions

Shock Hypovolemic

Obstructive

Distributive

Cardiogenic

Circulatory Problems:

• Hypovolemic1-weak peripheral pulse, delayed capillary refill.• Distributive1- (May be) Strong peripheral pulse, brisk capillary refill.

Pediatric Pre-arrest conditions

Cardiac Tachycardia

Bradycardia

Cardiac Problems (Bradycardia)

DisabilityThe child is awake giving appropriate response.(according to age). Alert

The child response only when called by name or on loudness. Voice

The child response only to painful stimuli as rubbing the chest bone with finger knuckles. Pain

The child doesn’t respond to any stimulus. Unresponsive

ExposurePossible Problem Appearance Types of Purple

Skin

Low platelet count. Tiny dots Petichiea

Severe infection or septic shock.

Larger Spots Purpura

Pediatric Chain of Survival

BLS Algorithm

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C•Chest Compressions

A•Airway

B•Breathing

BLS Guidelines (Since 2010)

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• 2- Emphasis on High Quality CPR:I. START within 10 sec. of arrest recognition.II. PUSH HARD: Compression rate AT LEAST 100 -

120 min.III. PUSH FAST: Compression depth AT LEAST 5

and not more than 6 cm in children and 4 cm in infants or 1/3 of the AP chest diameter).

IV. ALLOW COMPLETE CHEST RECOIL.V. Minimize interruptions.VI. Give effective breaths.VII. Avoid excessive ventilations.VIII.Early use of the feedback devices.

BLS in Guidelines (since2010)

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3- The routine use of cricoid pressure is no more recommended.4- No Look, Listen, and Feel .5- De- emphasis on the pulse check (from 5-10 sec only and if any doubt start chest compressions).6-Use of AED for infants:

Manual is preferred than Automated.If not available use the pediatric dose attenuator.If not available use the Adult AED.

7- Team Approach to CPR.

BLS in Guidelines (since 2010)

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1.Check Response Child PEDIATRIC

BLS

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BLS 2.Activate EMS and ask for AED.

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Child Infant

BLS 3. Scan for Breathing and Check PULSE simultaneously.

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Hand & Body Position. Don’t Forget.I. START within 10 sec. of arrest

recognition.II. PUSH HARD: Compression rate

of 100 -120/ min.III. PUSH FAST: Compression

depth of 5-6 cm in adults, (5 -6 cm in children and 4-5 cm in infants or 1/3 of the AP chest diameter).

IV. ALLOW COMPLETE CHEST RECOIL.

V. Minimize interruptions.

BLS4. Start Chest Compressions (Child).

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CHILD INFANT

BLS 4. Start Chest Compressions (CLILD & INFANT).

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I. Open Airway (Head Tilt – Chin Lift / Jaw Thrust).

II. Give Breath (Mouth to Barrier/ Mouth to mouth).

III. Use of airway Adjuvant.IV. Use of Advanced Airways.

BLS5. Give Breath.

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Power Button.

BLS6. Use AED.

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ADULT PEDIARTIC

BLS6. Use AED (Lead Position).

Questions

Take Home

Thank you