Transcript PEDIATRIC ADVANCED LIFE SUPPORT

PEDIATRIC ADVANCED LIFE
SUPPORT
JOE JONES
NREMT-PARAMEDIC
PEDIATRIC CPR
Establish Unresponsiveness:
Open Airway
Breathing: Look, Listen, Feel: Absent – Begin Ventilations,
2 breaths.
Check pulse – Absent – Begin Compressions:
30 Compressions – 2 Ventilations, continue for 2 minutes or 5 cycles.
Call for AED child > 1 year old/Cardiac Monitor check rhythm treat
according to proper algorithm.
Do not interrupt CPR for any extended period of time continue to
compress and ventilate. Child age is considered to be from
1 – 8 y/o.
CPR CONTINUED
When this is a single rescuer attempt, compression ratio is
30 -2
When there are two rescuers then deliver compressions at
a rate of 15 – 2
This applies to infants and children.
Note: When patient is intubated one should deliver
ventilations 12 – 20 times/minute or one every 6 – 8
seconds.
CARDIAC ARREST SCENARIO
You arrive to find a 5 year old male in your trauma room who was brought
in by the mother stating he has not been acting right for the past 3 days.
She GIVES YOU A HX OF ASTHMA AND PREMATURE BIRTH. THE
CHILD IS NOTED TO BE WHAT APPEARS TO BE UNDER WEIGHT
FOR HIS AGE. Mother states she has not been able to get him in to see
M.D. due to the lack in her arms, there is no signs of trauma, you must act
quickly..
PEDIATRIC ADVANCED
LIFE SUPPORT
Pediatric rhythm
disturbances
Airway: open
Breathing: absent
Circulation: absent
What do we do now?
Begin CPR 30 compressions to 2 ventilations
Call for the monitor, doctor and all other appropriate personnel.
When Monitor/AED arrive at bed side, connect, check rhythm and
treat according to the PALS recommendations.
VENTRICULAR FIBRILLATION
PULSELESS VENTRICULAR TACHYCARDIA
Monitor Attached, CPR stopped, MONITOR REVEAL RHYTHM ABOVE
DEFIBRILLATE AT 2 JOULES PER KG. CONT. CPR 30 – 2
IV/IO IN PLACE BEGIN MEDICATIONS.
EPINEPHRINE .01 ML. KG 1-10,000
CPR is Continued for two minutes and:
DEFIBRILLATE: 4 JOULES PER KG. CONTINUE CPR
AMIODARONE 5 MG. KG.
LIDOCAINE 0.5 – 1 MG/KG
MOST SKILLED PERSON INTUBATE THE TRACHEA, CONFIRM PLACEMENT USING END
TITAL CO2, BBS, GOOD RISE-FALL CHEST, COMPLETE CPR, CONFIRM RHYTHM THEN:
COMPLETE CPR CYCLE AND DEFIBRILLATE 4 JOULES KG.
EPINEPHRINE .01MG KG REPEAT 3 – 5 MINUTES
CORDARONE 5 MG. KG. or LIDOCAINE repeated max 3 mg. kg.
Note: If Torsades is present, administer mag. Sulfate 25 – 50 mg. kg. epi .01 mg. kg. repeat
3 – 5 min.
ASYSTOLE/PEA
CPR UNTIL MONITOR IS AVAILABLE THEN CONFIRM RHYTHM ABOVE
CONTINUE CPR 30 – 2
INITIATE IV/IO AND ADMINISTER EPINEPHRINE .01 MG KG: (NOTE) USE
BROSELOW TAPE
INTUBATE/CONFIRM PLACEMENT
NOTE: ONCE CORRECT PLACEMENT OF THE TUBE IS VERIFIED, THEN
ONE DOES NOT NEED TO STOP COMPRESSIONS
EPINEPHRINE .01 MG/ KG
REPEAT 3-5 MIN. AT .01MG KG
ATROPINE ?????? WHY: ____ USE ONLY IF A CARDIAC EVENT IS
SUSPECTED
CONSIDER CAUSES TREAT APPROPRIATELY
EXAMPLE: HYPOXIA, ACIDOSIS, HYPOVOLEMIA, ELECTROLYTE
IMBALANCE.
UNSTABLE TACHYCARDIA
Remember a child is not considered to be in supraventricular
tachycardia until the rate is > 180 beats per minute, Infants
greater than 220. Rule out causes prior to beginning
cardiac treatment!!
Primary A-B-C’s Support that Airway
Administer Oxygen
Serious signs and symptoms present
Synchronize Cardiovert at .5 - 1 joule – kg.
Synchronize Cardiovert at 2 joules – kg.
Move to medications. (REFER TO STABLE TACHYCARDIA
FOR CORRECT MEDS AND DOSING).
Remember support the airway.
SVT STABLE
Primary A-B-C’s Administer oxygen
Vagal maneuvers – blow in closed straw, ice water to face
IV – IO in place
Adenosine .01 mg. – kg. not to exceed 6 mg. repeat
3 – 5 minutes
Adenosine. 02 mg. – kg not to exceed 12 mg.
Adenosine .02 mg. – kg. not to exceed 12 mg.
After Adenosine it will be M.D. choice; follow orders.
MAY CONSIDER BETA BLOCKER/CALCIUM CHANNEL
BLOCKERS OR CARDIOVERSION.
VENTRICULAR
TACHYCARDIA
STABLE
V – Tach
Primary A-B-C’s Administer oxygen
IV – IO in place
Amiodarone 5 mg. - kg. repeat in 5 – 10 minutes
Procainamide 15mg/kg IV over 30 – 60 minutes. Do not
administer Amiodarone and Procainamide together.
Lidocaine may be used when Amiodarone is not available
Remember do not rely on memory for drug doses, rely on
Broslow Tape
BRADYCARDIA
Primary A-B-C’s Administer oxygen.
Remember Bradycardia in children is usually caused by hypoxia, don’t
delay the administration of this DRUG
IV – IO in place
Epinephrine drug of choice. Use broslow tape for correct dose, never
rely on memory for correct dose of medications in peds.
Atropine???????? Primary cause is __________________? If the
provider believes the cause of the bradycardia is from a Vagal response
then Atropine would be the first drug of choice after oxygen.
Dose is .02 mg. – kg. never give less than .1mg. Be sure to administer
the medication rapid IVP.
SHOCK
The most common cause of shock in a child is hypovolemia. This
can come from several causes. Nausea/Vomiting, Bleeding, etc.
The treatment of choice is fluids. Shock is defined as Inadequate
Tissue Perfusion and is deadly if not corrected. It may be identified
as Compensated or Decompensated shock. The difference in these
two terms are Decompensated is when the blood pressure falls.
Remember in children when the blood pressure begins to fall it
happens quick so don’t wait for this symptom to occur.
TREATMENT OF SHOCK
CONTINUED
Primary A-B-C’s
Administer oxygen high flow
IV – IO
Prior to the IO one should make 3 peripheral attempts or 90 seconds
IO placed 2 cm. below tibial tuberosity medical side of the leg. It is
confirmed in correct place when fluids and medications flow freely
without signs of local tissue swelling.
Administer now 20 ml. – kg. then reassess patient.
This may be repeated times 4 for a total of 80 – ml-kg. in severe
cases.
Pediatric shock
Continued!!
Pump problems are treated according to rhythms.
Slow heart, speed up. Fast hearts, slow down. Do
not overload your patient. One may choose to use
a Vasopressor drug in this case.
Examples of these drugs are:
Dopamine – Dobutamine – Norepinephrine,
Epinephrine . Milrinone may be used in the case of
CHF for it’s classified as an inotropic medication.
Pediatric shock CONTINUED
Rely on the Broslow tape for correct doses never rely on
memory.
Hypovolemic shock, non-hemorrhagic shock should be treated
with fluids 20 ml./kg. reassess total up to 4 boluses.
Hemorrhagic shock initial with fluids then PRBC’s 10 ml./kg or
whole blood 20 ml/kg. To prevent adverse reactions one should
warm prior to administration of blood.
Septic shock fluids then consider ordering vasopressor along
with hydrocortisone. Normotensive patient: use dopamine
Hypotensive patient: warm shock vasodilated begin
norepinephrine.
Hypotensive patient: cold shock vasoconstricted use
epinephrine rather than norepinephrine.
RESPIRATORY SCENARIO
• You arrive in your trauma area and find a young mother holding
a 3 year-old child in her arms. The child is in, what appears to
be, extreme distress. She gives you a history of cold like
symptoms over the past 2 – 4 days and unable to get him any
better. She also advises you that the child has been
experiencing asthma since he was 18 months old.
• Physical Exam: Conscious, pale and crying with ventilations of
greater than 50 minute. There is noted wheezes to all lung
fields. What should you do for this patient?
RESPIRATORY TREATMENT
• AIRWAY, BREATHING, CIRULATION
• OXYGEN
• BETA AGONIST MEDICATION VIA NEBULIZER
• IV
• CHEST X-RAY
• CONSIDER STEROIDS
• ADMIT FOR DEFINITIVE TREATMENT