Lekha ThomasPaediatric FBAO Treatment Ineffective cough Effective cough Encourage cough Continue to...

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Lekha Thomas

Transcript of Lekha ThomasPaediatric FBAO Treatment Ineffective cough Effective cough Encourage cough Continue to...

Page 1: Lekha ThomasPaediatric FBAO Treatment Ineffective cough Effective cough Encourage cough Continue to check for deterioration to ineffective cough or relief of obstruction babies under

Lekha Thomas

Page 2: Lekha ThomasPaediatric FBAO Treatment Ineffective cough Effective cough Encourage cough Continue to check for deterioration to ineffective cough or relief of obstruction babies under

Adult basic life support including choking

Paediatric basic life support and FBAO

Anaphylaxis

AED

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The majority of cases of sudden cardiac arrest occur in adults out of hospital, and are of cardiac origin.

One third of all people developing MI die before reaching hospital and most of them die within an hour of the onset of symptoms- the presenting rhythm in most of these deaths is VF and with each minutes delay in defibrillation chance of successful outcome fall by 7-10%

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Presenter
Presentation Notes
The term chain of survival is used to describe the important links that should be in place for improved outcome after cardiac arrest. Early recognition of critically ill patient( chest pain or sob)- and getting help may prevent cardiac arrest or if the patient has arrested to call 999. Early CPR will slow down the deterioration of brain and heart. Brain afftected after 4 mts of cardiac arrest and brain death in about 7 minutes. Early debrillation - aim to attempt defibrilllation within 5 mts of collapse. Advanced life support once the help arrives. The chain is only as strong as the weakest link; all 4 links in this chain should be strong.
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Approach safely

Check response

Shout for help

Open airway

Check breathing

Call999

30 chest compressions

2 rescue breaths

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Approach safelyApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 999

30 chest compressions

2 rescue breaths

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Approach safely

Check responseApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 999

30 chest compressions

2 rescue breaths

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Shake shoulders gently

Ask “Are you all right?”

If he responds• Leave as you find him.

• Find out what is wrong.

• Reassess regularly.

Check response

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Shout for helpApproach safelyApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 999

30 chest compressions

2 rescue breaths

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Open airwayApproach safelyApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 999

30 chest compressions

2 rescue breaths

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Check breathingApproach safelyApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 999

30 chest compressions

2 rescue breaths

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Look, listen and feel for NORMAL breathing

Check breathing

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Occurs shortly after the heart stops in up to 40% of cardiac arrests

Described as barely, heavy, noisy or gasping breathing

Recognise as a sign of cardiac arrest

Abnormal breathing

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Approach safelyApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 999

30 chest compressions

2 rescue breaths

Call 999

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30 Chest compressionsApproach safelyApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 999

30 chest compressions

2 rescue breaths

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• Place the heel of one hand in the centre of the chest

• Place other hand on top • Interlock fingers or avoid putting

pressure on the side of the chest• Compress the chest

– Rate 100 – 120 min-1

– Depth 5 – 6 cm– Equal compression : relaxation

• When possible change CPR operator every 2 min

Chest compressions

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2 Rescue breathsApproach safelyApproach safely

Check response

Shout for help

Open airway

Check breathing

Call 999

30 chest compressions

2 rescue breaths

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Rescue breaths

Pinch the nose Take a normal breath Place lips over mouth Blow until the chest rises Take about 1 second Allow chest to fall Repeat

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Continue CPR

30 2

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Approach safely

Check response

Shout for help

Open airway

Check breathing

Call 999

30 chest compressions

2 rescue breaths

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Presenter
Presentation Notes
BHF advertisement for hands only CPR Hard- depth fast- rate.
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http://i.dailymail.co.uk/i/pix/2012/01/04/article-2081962-0F556DAC00000578-685_634x354.jpg
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Presenter
Presentation Notes
Mild obstruction - encourage him to cough and do nothing else. IF severe obstruction and conscious- Start with back blows( back blows and abdominal thrusts increase the intrathoracic pressure and expels FB from the airway.) Stand to the side and behind the victim. With one hand support his chest and lean him forward so the FB when it is dislodged will fall forward and not further down the airway. WIth the heel of the other hand give sharp blow in between the shoulder blades. Aim is to relieve the obstruction with each blow and may not need all 5 back blows- check after each blow whether it is dislodged. If no response to the 5 back blows- try adbominal thrusts- Heimlich maneovre. Clench the fist and place between sternum and umbilicus. Grasp this hand with the other hand and pull sharply inwards and upwards. Repeat upto 5 times. Keep alternating back blows and abd thrusts If patient looses consciousness at any point BLS
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Presenter
Presentation Notes
This algorithm for health care professionals with a duty to respond.- lay people are taught to follow the same as adult algorithm. Ensure personal safety. Check for response- gently stimulate the child. If no response shout for help. Open the airway- head tilt /chinlift followed by look listen and feel for breathing for 10 seconds. If not breathing normally give 5 rescue breaths. maintain headtilt /chinlift Pinch the nose with the thumb and index finger of the hand on the forehead. blow into the mouth over 1-1.5 sec to see chest rising- move back and wait for chest to fall. in very small babies may have to breath into the nose and mouth making a good seal. Repeat 4 times. Assess signs of life- Look for any movement- was there any cough or gag response during rescue breaths. Pulse palpation is not reliable - can check for carotid pulse in child over 1 yr and brachial pulse for infant- femoral pulse for any child. If no signs of life- start chest compression- place the hand a finger breadth above xiphisternum. 2 finger in infant- one hand for small child and 2 hands for older child. depth - atleast one third of the depth of the chest- about 4 cm in the infant and 5 cm in a child. 100-120 /mt 15 :2 BLS for one minute before going to call for help if you are on your own.- if other people around get help early on
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Paediatric FBAO Treatment

Ineffective cough Effective cough

Encourage coughContinue to checkfor deteriorationto ineffectivecoughor relief ofobstruction

babies under 1 year

children over 1 year

If at any point the child becomes unconscious, commence CPR

5 back blows5 abdominal thrusts

Presenter
Presentation Notes
In infant give back blows- support infant in head down prone position deliver back blows with the heel of one hand in between the shoulder blades. checking if obstruction relieved after each blow. Give upto 5 back blows if obstruction not relieved give chest thrusts- turn infant to supine position but still keep head down- give chest thrust along the lower sternum about a finger breadth above xiphisternum- give upto 5 chest thrusts. Similar to chest compressions but sharper in nature and delivered at slower rate. ( these manoeuvres increase intrathoracic pressure and dislodge foreign body) In children over 1 yr- stand or kneel behind the child and lean the child forwards- give sharp blows to the back in between the shoulder blades. if obstruction not relieved after back blows -give abdominal thrusts stand or kneel behind the child. clench your fist and place it between the umbilicus and xiphisternum grasp this hand with other hand and pull sharply inwards and upwards repeat upto 5 times
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Defibrillators• MANUAL DEFIBRILLATORS• AUTOMATED EXTERNAL DEFIBRILLATORS (AED’s)• FULLY AUTOMATED AED• SEMI AUTOMATIC AED

Presenter
Presentation Notes
Manual defibs- where you have to analyse the rhythm and shock if needed- mainly in hospitals. All AED analyse the rhythm and determine the need for shock. Fully automatic AED administers the shock without the need for any intervention by the operator. Semi automatic AED- indicate the need for shock but is delivered by the operator.
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Debrillation Defibrillation is the passage of an

electrical current of sufficient magnitude across the myocardium to depolarise a critical mass of cardiac muscle simultaneously

Enables the natural pacemaker tissue to resume control.

Successful defibrillation is defined as absence of VF/VT at 5 secs after a shock delvery.

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Defibrillation

Defibrillation success changes with time -

Minutes Elapsed

1 2 3 4 5 6 7 8 9 10 11

80% chance of success

60% chance of success

20% chance of success

Virtually no chance of success

Presenter
Presentation Notes
Time line
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Automated External Defibrillators

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Factors Affecting Defibrillation

•Time between onset of VF/VT & defibrillation•Pad position

Presenter
Presentation Notes
one pad to the right of the sternum below the clavicle and the other pad in the mid axillary line -- has to be clear of any breast tissue. usually have a picture of right and left- if placed wrong way it shouldn;t be removed and replaced as it wastes time and may not adhere when reattached. needs to expose the victims chest- so needs to cut the clothing. if excessive hair which is preventing the pads from sticking can shave hair but donot delay defibrillation if razor is not available.- pads are quite sticky. In children safe to use adult AED from 8yrs onwards -- 1-8 yrs ideal to use one with paediatric pads but if not available to use adult defib. Adult defib not recememnded in under 1 yr.
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Environmental Factors

•Wet areas.

•Risk of explosion- petrol stations.

Presenter
Presentation Notes
As long as there is no direct contact between the victim and the operator it is safe to use the defib- make sure chest is dry.
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Safety FactorsRemove Oxygen from the vicinity of the pt

Check pt for……….•…Jewellery•…Pacemaker•…GTN/Hormone/Nicotine patches

Presenter
Presentation Notes
10- 15 cm away from the pacemaker- usually under the left clavicle. If pacemaker below the rt clavicle- use AP position of pads.
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Presenter
Presentation Notes
DEMONSTRATE AED shake and shout. assess breathing if not breathing normally call 999 and get AED start chest compressions. as soon as AED arrives attach the pads while contining the chest compressions. Switch it on and donot touch the patient while it is analysing the rhythm. if shock indicated- ensure safety check- STAND CLEAR and press shock button. restart CPR straightaway. if shock not indicated continue CPR. assess rhythm every 2 minutes -
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What is anaphylaxis?

Anaphylaxis is:– A severe, life-threatening, generalized or systemic hypersensitivity reaction

Anaphylaxis is characterised by:

– Rapidly developing, life threatening, Airway and/or Breathing and or Circulation problems

– Usually with skin and/or mucosal changes

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Signs and symptoms Airway swelling , hoarse voice, stridor Breathing problems- wheeze,

tachypnoea, cyanosis Circulation- tachycardia, hypotension,

pale ,clammy and reduced level of consciousness

Skin and mucosal changes- urticaria and angioedema

Abdominal pain , vomiting and diarrhoea

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Who gets anaphylaxis?

• Mainly children and young adults

• Commoner in females

• Incidence seems to be increasing

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`

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About 20 anaphylaxis related deaths reported each yr in the UK-

Risk of death is increased in those with pre-existing asthma, particularly if asthma is poorly controlled

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Differential diagnosis

Life-threatening conditions:

• Asthma - can present with similar symptoms and signs to anaphylaxis, particularly in children

• Septic shock - hypotension with petechial/purpuric rash

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Differential diagnosis

Non-life-threatening conditions:• Vasovagal episode

• Panic attack

• Breath-holding episode in a child

• Idiopathic (non-allergic) urticaria or angioedema

Seek help early if there are any doubts about the diagnosis

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Treatment of anaphylactic reactions

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Presenter
Presentation Notes
NEVER GIVE IV adrenaline in the community- can cause cardiac arrest.
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Auto-injectors … (e.g. Anapen, Epipen)

• For self-use by patients or carers

• Should be prescribed by allergyspecialist

• For those with severe reactions and difficult to avoid trigger

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Guidelines and posters available atwww.resus.org.uk


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