1. Paediatric Resuscitation
Dr S Chipiro

2. Session Objectives
–Identify at risk children requiring
resuscitation
–Familiarize with the General Approach
Resuscitation
–Demonstrate skills for paediatric
resuscitation
–Understand the importance of
teamwork and effective
communication during resuscitation
2

3. Definition
• Resuscitation is a series of
actions which are used to
assist or revivebabies from a
potential or apparent death .

4. Resuscitation General Approach
Anticipation
Assessment
Airway
Breathing
Circulation
Drugs

5. Anticipation
• STAY PREPARED FOR RESUSCITATION
• Recognise risk factors
• Communicate during patient transfer
• Sometimes the need for resuscitation can be
predicted, but often it cannot,

6. REQUIREMENTS
• ,
POLICY
FURNISHED
SPACE
SKILLED
PERSONNEL
EMERGENCY
TROLLEY

7. POLICY
• Displayed
• Familiarised with
• Criteria for resuscitation
• Duties of team members

8. FURNISHED SPACE
• Clean environment, Water, Soap, gloves
• Firm stable surface and good lighting
• Overheard radiant warmer, Room temperature at > 25
degrees C
• Oxygen supply ( humidified/heated/ blended if possible)
• Timer/clock
• Working Suction

9. SKILLED PERSONNEL
– A multidisciplinary team.
– Trained according to accepted standard of care
– Ongoing training and refresher course
– Available at point of care
– Teamwork
– Communication

10. EMERGENCY TROLLEY
• DEFIBRILLATOR
• Bag valve mask device-240-250ml + reservoir bag
• Face masks of different size
• Oropharyngeal
airways
• Portable Oxygen supply
• Stethoscope and a torch
• Pulse oximeter
• Suction devices and catheters
• timer/clock
• ET tubes, laryngeal mask, introducers, Suction devices
Laryngoscope with straight blade, extra batteries
• Drugs, IV fluids,

11. ,
• Check resuscitation trolley every shift and
after each resuscitation

12. Equipment

13. • ,

14. Equipment

15. Check and Assemble Ambubag

16. Assessment
• Rapid assessment and triaging of babies
• Safety, stimulate and shout
• Need for resuscitation must be identified immediately
• Safety is important especially in an external
environment because the rescuer should not become
the second victim.
• Stimulate - gently shake and ask e.g. Are you alright?
• Summon someone to call for help while you start
resuscitation.
• If alone call for help yourself
if no one comes within a minute of CPR.
• If in a hospital, help is usually a shout away

17. REMEMBER
• As you identify the problems in ABC you
rectify them

18. Airway
• Open the airway – head tilt/chin lift or jaw thrust
• Neutral position in infants and sniffing position
in children
• Check patency -LOOK, LISTEN and FEEL.
• Look for chest movement
• Listen for breath sounds with ear just above the
nose
• Feel the breath on your cheek above the mouth
• Use Oropharyngeal airways, ETT etc where
required

19. Open airway

20. BREATHING
• Assess effort of breathing
• Count the respirations
• Auscultate for breath sounds
• Listen for stridor / wheeze
• Assess skin colour
• Attach a saturation probe

21. Respiratory rate according to age at
rest
• ,

22. Breathing
• If patient’s airway is patent and patient
breathing-turn the child to his/her side and
put him/her in recovery position and
maintain the open airway.
• If breathing is still ineffective, start Positive
pressure ventilation

23. Positive pressure ventilation
Indications
• Apnoeic/gasping
• HR<100b/min
Decision to start PPV should be made within a
minute

24. ▪ Position the head in neutral
position -use towel under
shoulders; jaw thrust, chin lift
▪ Position the mask on the face
▪ Firm seal between the mask
and the face
▪ Squeeze bag to produce a
gentle chest rise
▪ Give 30-40 breaths per
minute.
▪ Increasing heart rate is a sign
of successful oxygenation
▪ Monitor SPO2 if possible
How to ventilate with bag and mask
Note ‘C’ or ‘E’ grip

25. Appropriate Face mask size

26. Use of oxygen
• Start ventilating with room air
• If O2 not available continue ventilating with
room air
• If no improvement in HR, colour connect to
oxygen
• If lone helper do not stop resuscitation to
look for oxygen
• Increase gradually to maintain targeted
saturations

27. Troubleshooting
• If no response to PPV
-check airway-position,seal
-obstruction>>>suction
-pneumothorax?
-check equipment

28. Circulation
 Aim to Improve cardiac output
Start chest compressions if
● No signs of life-no movement, not
coughing ,absent or abnormal breathing
● No pulses- use brachial in infants and
carotid or femoral in children
● Pulse less than 60b/minute

29. Chest Compressions
Technique
● Hand encircling technique-infants
● 2 finger technique- For lone rescuer
● Two hands or the one hand technique- Older
children.

30. Chest compressions
• Compress the lower half of the sternum to a
depth of at least one third of the chest diameter
• Chest wall should completely recoil before the
next compression.
• Ratio 15: 2 for all age groups
• Compressions should be continuous because
pausing unnecessarily will decrease coronary
perfusion pressure to zero and several
compressions will be required before adequate
coronary perfusion recurs.
• Rate of 100-120beats/minute for all ages

31. Hand Encircling Technique
• ,

32. Two finger technique
• ,

34. Advanced Resuscitation
• Endotracheal Intubation
• Drugs
• Glucometer

35. Endotracheal Intubation
Indications
• Ineffective or
prolonged bag and
mask ventilation
• Special circumstances
eg diaphragmatic
hernia
• The need for ongoing
mechanical ventilation

36. Tube size and level of insertion
Weight Tube size Level
(at the lip)
<1000g 2,5 6,5-7
1000-2000g 3,0 7-8
2000-3000g 3,5 8-9
3000-4000g 3,5-4 9-10,5
Weight (kg) + 6cm = depth (cm)

37. Drugs
• Adrenaline 1:10 000
-0.1ml/kg iv
-1ml/kg via trachea
• 10% Dextrose-
-2-4mls/kg iv
• Normal saline-if no response to resusc and evidence of
volume loss/shock
-10ml/kg over 30 mins up to 2 boluses, monitor response
• Naloxone-0.1mg/kg( 0.25mls/hr) im/iv

38. Post Resuscitation Care
• Continue monitoring of vital signs in all babies
• Admit/Refer
• Keep baby warm
• Continue support measures during transportation
• Counsel the parents
• Document
• Review

39. When to call of resuscitation
Consider stopping if:
• No spontaneous respirations/gasping after 20
mins of effective resuscitation
• No HR or HR <60b/min after 10 mins of
effective resuscitation

40. When not to resuscitate
Consider not starting when:
● Futile
-dead baby,lethal anomalies
● Poor prognosis
-BW<500g
-trisomy 13/18

41. Summary
• Resuscitation is a basic life saving skill that we should all
possess and keep perfecting.
• It is an art and science
• Anticipation and preparedness
• Teamwork
• Reviewing
• Keep parents informed
• Ongoing training-simulations/drills
• Don’t miss the demonstration

43. Acknowledgements
• ,
• Department of Paediatrics SMCH
• Department of Paediatrics Mpilo
Hospital
• MOHCC Family Health Department
• MOHCC Manicaland Province
• Paediatric Association of Zimbabwe
• American Academy of Paediatrics
• Helping Babies Breathe course
• Liverpool School of Tropical
Medicine: Life Saving Skills Course
• UNICEF Zimbabwe