Pediatric Resuscitation Techniques
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RMH Field Care Audit 08/15/12
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Pediatric Resuscitation Techniques
- 1. I Got You, Babe... Veronica Bonales, M.D. RMH PCMD HCEMCC - Paramedic Coordinator
- 2. AW 13 y.o. female playing soccer. Comes to the sidelines and complains of not feeling well then suddenly collapses. Bystander CPR is initiated. EMS arrives on scene, intubates and transfers the patient...
- 4. Pediatric Resuscitaion Numbers are bleak 27% of in-hospital cardiac arrests survive Survival to discharge only 6% Larger percentage of out-of-hospital cardiac arrests do not survive Some of the survivors are left seriously incapacitated
- 6. Baby Huey
- 7. Baby Ruth 9/49 created, appeared in “Casper” comic book then film 1950.
- 8. Pediatric Resuscitation Do pedis have heart attacks...? 5 - 15% Asphyxial arrest Progressive respiratory failure Shock
- 9. Pediatric Resuscitation Asphyxia Hypoxemia (low O2), hypercapnea (high CO2), acidosis (low pH) Leads to... Bradycardia, hypotension Leads to... Cardiac arrest
- 10. Pediatric Resuscitation Respiratory Issues Not ventilating Not oxygenating Or both...
- 11. Pediatric Resuscitaion Impending respiratory failure Increased respiratory rate Grunting, nasal flaring, retractions Poor respiratory effort Gasping, decreased breath sounds esp. with decreased mental status Cyanosis despite supplemental oxygen
- 12. Pediatric Resuscitaion Shock Inadequate blood flow and oxygen delivery to meet tissue metabolic demands...
- 13. Pediatric Resuscitaion Most common type of shock in children.... Hypovolemic
- 14. Pediatric Resuscitaion Shock Hypovolemic Cardiogenic Septic Anaphylactic Neurogenic
- 15. Pediatric Resuscitation Metabolic rates higher Require more energy and consume more oxygen Illness or stress accelerates
- 16. Pediatric Resuscitation Higher fluid requirement Newborn 70 - 80% water (adult 50 - 60%) Prone to dehydration (diarrhea, emesis, blood loss) Greater surface area to weight ratio 25% more total circulating blood volume per body weight
- 17. Pediatric Resuscitaion Compensated Shock Tachycardia Cool and pale distal extremities Delayed cap refill (>2 sec) Weak peripheral pulses Blood pressure....? Normal
- 18. Pediatric Resuscitation Greater capacity to increase heart rate Heart rate >160 bpm tachycardic Vessels “clamp down” Peripheral pulses will become thready and disappear before central pulses Skin color and cap refill important
- 19. Pediatric Resuscitaion Continuum Signs of end-organ damage Decreased mental status, decreased urine output, metabolic acidosis, tachypnea, poor central pulses, mottling
- 21. Pediatric Resuscitation With oxygen, pyruvate converts to acetyl CoA Without oxygen, pyruvate converts to lactate
- 22. Pediatric Resuscitaion Decompensated Shock Weak or absent peripheral pulses Weak central pulses Hypotension
- 23. Pediatric Resuscitaion Look at the patient not the number... Tachycardia - fever, pain, anxiety Bounding pulses in anaphylactic, septic and neurogenic shock
- 25. Baby Houseman
- 26. Baby Houseman Dirty Dancing 1987 Featured Jennifer Grey and Patrick Swayze Both hired because they had dance experience
- 28. “Nobody puts Baby in a corner...”
- 29. Pediatric Resuscitaion Upper Airway Diseases Croup/Asthma Epiglottitis (vaccination status) Foreign Body Aspiration Anaphylaxis Congenital Trauma Other Infections
- 34. Pediatric Resuscitaion Croup Most common upper airway problem Due to: Flu virus, RSV, Parainfluenza virus, Adenovirus Late fall/early winter
- 35. Pediatric Resuscitaion Usually affects infants and toddlers Cold symptoms 2 - 3 days Nasal congestion, hoarseness Tachypnea, low grade fever Worse at night Inflammation, edema of upper airways 58% stridor 94% barking or seal-like cough
- 36. Pediatric Resuscitaion Usually affects infants and toddlers Cold symptoms 2 - 3 days Nasal congestion, hoarseness Tachypnea, low grade fever Worse at night Inflammation, edema of upper airways 58% stridor 94% barking or seal-like cough
- 37. Pediatric Resuscitaion Asthma Most common chronic disease of childhood Admission rate for age <5 is higher than for all other age groups Mortality rising 1/2 of all deaths in pre-hospital setting Length of final attack < 2hr in 50% of deaths
- 38. Pediatric Resuscitaion Triggers lead to bronchial spasming, mucosal edema, increased secretions URI’s, exercise, cold air exposure, emotional stress, passive exposure to smoke, allergens
- 39. Pediatric Resuscitaion Symptoms: Tachypnea Tachycardia Retractions Wheezing or decreased breath sounds Normal or low O2 sats
- 40. Pediatric Resuscitaion Factors of Severe Attack Prior ICU admission or intubation >3 ED visits in a year >2 Hospital admissions in a year Use of >1 MDI canister in last month Use of rescue inhaler >Q4H Worsening symptoms despite aggressive home therapy
- 41. Pediatric Resuscitaion Signs of Severe Asthma Attack Altered appearance Exhaustion Inability to recline Interrupted speech Severe retractions Decreased air movement
- 42. Pediatric Resuscitaion ALOC Trauma, temperature AEIOUTIPS Infection Alcohol Psychogenic, poison Epilepsy, endocrine, Shock, space-occupying electrolytes lesion, SAH Insulin Opiates, overdose Uremia
- 43. Pediatric Resuscitaion Hypoglycemia Low glycogen stores in the liver Alcohol, accidental ingestion of anti-hyperglycemic agents, overmedication with insulin Inborn errors of metabolism
- 44. Pediatric Resuscitation Coma Hypoglycemia Hypothermia
- 45. Pediatric Resuscitation Coma Hypoglycemia Hypothermia
- 46. Pediatric Resuscitaion Ingestions Two peaks Toddlers - accidental Teens - intentional
- 47. One Pill Can Kill Theophylline Tricyclic antidepressants Clonidine (0.2mg, temporary reverse Narcan) Verapamil Propanolol Camphor Methyl salicylate (oil of wintergreen)
- 49. ...Baby One More Time
- 50. ...Baby One More Time Britney Spears’ debut album and hit in January 1999 Originally titled “Hit Me One More Time” and changed due to concerns about condoning domestic violence
- 52. Pediatric Resuscitaion First Always: Scene Safety
- 53. Pediatric Resuscitaion First Always: Scene Safety Does location provide clues? Where are you? Weapons, toys, objects Medications Witnesses
- 54. Pediatric Resuscitaion Look at the child... Listen to the parent...
- 55. Pediatric Resuscitation First Impression Pediatric Assessment Triangle Appearance Work of breathing Circulation to skin
- 56. Pediatric Resuscitation First Impression Pediatric Assessment Triangle Appearance Work of breathing Circulation to skin
- 58. Pediatric Resuscitation Appearance Tone Interactiveness Consolability Look/Gaze Speech/Cry
- 59. Pediatric Resuscitation Appearance Work of Breathing Tone Abnormal breath sounds Interactiveness Consolability Abnormal positioning Look/Gaze Retractions Speech/Cry Flaring
- 60. Pediatric Resuscitation Appearance Work of Breathing Tone Abnormal breath sounds Interactiveness Consolability Abnormal positioning Look/Gaze Retractions Speech/Cry Flaring • Circulation to Skin • Pallor, Mottling, Cyanosis
- 63. Pediatric Resuscitaion Disability AVPU Alert Voice Pain Unresponsive
- 64. Pediatric Resuscitation In the event of a code... Age + 16 divided by 4 = ETT size
- 65. Pediatric Resuscitation Broselow Tape Been in use over 12 years Height and weight based dosing Child must be laying flat
- 67. Pediatric Resuscitation • Vascular access • Peripheral IV • IO device in R leg • 20 ml/kg LR or NS • Rebolus until hemodynamically stable
- 70. AW Born with small Left Coronary Artery which was not located anatomically correct
- 72. Baby Ruth
- 73. Baby Ruth Invented in 1921, this famous bar had a rather “infamous” cameo in this 1980‘s golf movie...
- 75. Caddyshack
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