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CPR IN CHILDHOOD
Ötvös Tamás m.d.
2013
Summary of changes since 2005
Lay rescuers have to start the CPR if the patient doesn’t breath well for 10sec
Healthcare providers can add looking for pulse (carotid, brachial, femoral)
CV-ratio:Lay rescuers 30:2Professionals 15:2 (30:2)
Summary of changes since 2005
Compression technique:For infants:
○ 2 finger for single rescuer○ 2 thumb encircling for at least 2 rescuers
For older children:○ 1 or 2 hand technique
Depth: 1/3 of the AP chest diameterCompression rate: 100-120/min
Summary of changes since 2005
DefibrillationModified or unmodified AED can be used
over the age 1 yearManual defibrillators: 4Joule/kgAntero-lateral or antero-posterior position
Airway:Cuffed tubes are safe (except newborns)Cricoid pressure (safe?)Capnometry is recommended
Paediatric Basic Life Support
Ensure the safety Check the responsiveness
Gently stimulate and ask:”are you all right?”Answering&moving: leave in position, check
his condition and get help, re-assess Shout for help Open the airways
Head tilt chin liftJaw thrust
Paediatric Basic Life Support
Keep the airway open, check the breathing for 10 secIf breathing, recovery position, get help&re-
assessAbsent of breathing
○ Remove any obvious airway obstruction○ Give 5 initial rescue breaths
Paediatric Basic Life Support
Asses circulation(no more than 10 sec)Look for signs of life (movement, coughing,
breathing)Check the pulse (professionals)
○ >1 year-carotid or femoral○ <1 year-brachial or femoral
Paediatric Basic Life Support
If there are no signs of life:Start chest compressionsCombine with rescue breathing
Chest compressions:100-120/minThe lower half of the sternum1/3 deep of the AP chest diameter>1 year: 1 or 2 hands technique<1 year: 2fingers(alone) or encircling way
Paediatric Basic Life Support
Continue CPR until:The child shows sign of lifeFurther qualified help arrivesYou become exhausted
Paediatric Basic Life Support
When to call Help?If there are 2 rescuers, one call helpIf there is 1 rescuer, after 1 min CPRIn the case of a child with a witnessed,
sudden collapse & the rescuer is alone (arrhytmia!!!)
Paediatric Advanced Life Support
During CPR Ensure high quality CPR: rate, depth, recoil Plan actions before interrupting CPR Give oxygen Vascular access (intravenous, intraosseous) Give adrenalin 3-5min Consider advanced airway&capnography Continuous chest compressions when
intubated Correct reversible causes
Paediatric Advanced Life Support
Reversible causes(4H/4T) Hypoxia Hypovolaemia Hypo-/hyperkalaemia/metabolic Hypothermia Tension PTX Toxins Tamponade-cardiac Thromboembolism
Drugs during CPR
Fluids
Isotonic crystalloids 20ml/kg
Drugs during CPR
Adrenalin
0.01mg/kg Every 3-5 min
Drugs during CPR
Amiodarone
VF or pulseless VT After 3. shock give 5mg/kg After 5. shock give 5mg/kg Infusion pump (dose?)
Drugs during CPR
Calcium
Hypocalcaemia Calcium channel blockers overdose Hypermagnesaemia Hyperkalaemia
Drugs during CPR
Glucose
Only in hypoglycaemia
Drugs during CPR
Magnesium
Hypomagnesaemia Torsade de Pointes
Drugs during CPR
Sodium bicarnonate
Do not give it routinely Hyperkalaemia Tricyclic antidepressant drug overdose
Special circumstances
Channelopathy (?) Blunt or penetrating trauma
(thoracotomy) Single ventricle
Post arrest management
Myocardial dysfunction (vasoactive drugs)
Temperature control (therapeutic hypothermia 32-34 Celsius)
Glucose control
Resuscitation of babies at birth
Relatively few babies need any resuscitation
Majority require only assisted lung aeration
Minority need chest compressions
Classification to initial assessment
Vigorous breathing or crying/good tone/HR>100/min (no intervention)
Breathing inadequately/normal or reduced tone/HR<100/min (dry, mask ventilation, chest compressions possible)
Breathing inadequately/floppy/low heart rate(dry,mask ventilation, chest compressions,drugs)
Apgar score
Airway
Neutral head position Suction not recommended (only if
there’s meconium in the airways)
Breathing
Circulatory support
After the lungs are inflated HR<60/min-start chest compressions Compression/Ventilation=3:1
Drugs
Adrenaline
Adequate ventilation and chest compression but HR<60/min
10-30ug/kg i.v. Tracheal route (not reccomended): 50-
100ug/kg
Bicarbonate
??? 1-2mmol/kg Not recommended
Fluids
10ml/kg bolus
When to stop CPR?
If there’s no detectable heart rate, after 10-15 min
Specific questions
Normal temperature Meconium (use suction) Air or 100% O2 (in term infants start
ventilation with air) Time of cord clamping (1min, if CPR is
not necessary) LMA can be used