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Download 34. Pediatric BLS(순천향의대 장혜영)
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2010년 AHA 심폐소생술 가이드라인 설명회 Pediatric BLS 순천향대학교 서울병원 응급의학과 장혜영 Pediatric Chain of survival PBLS Prevention Early CPR Prompt access to EMS Rapid PALS Integrated post-CA care 대한심폐소생협회 ABC or CAB? in PBLS Incidence) Asphyxial CA ≫ VF CA ( in infants and children) Ventilations are extremely important in ped resuscitation. ABC makes a difference? CAB 대한심폐소생협회 C-A-B in pediatric resuscitation 2005 Guideline 2010 Guideline 심폐소생술 시행 순서는 심폐소생술 시행 순서는 A-B-C C-A-B 먼저 기도를 개방하고 인공호흡 을 2회 시행 후 흉부 압박 2회 인공호흡을 하기 전에 먼저 흉부압박 심폐소생술을 시행. 1인 구조자 30회, 2인 구조자 15회 의 흉부 압박으로 심폐소생술 시작 기도 개방 후 “호흡 상태 확인” 과정 생략 대한심폐소생협회 PBLS Sequence for Lay Rescuers Safety of Rescuer and Victim Assess Need for CPR Check for Response Check for Breathing Start Chest Compressions Open the Airway and Give Ventilations Coordinate Chest Compressions and Breathing Activate Emergency Response System 대한심폐소생협회 High quality CPR in PBLS Push fast : at least 100 compressions / min Push hard : at least 1/3 depth of AP diameter of the chest 1.5 inches (4cm) in infants 2 inches (5cm) in children Allow complete chest recoil Minimize interruptions of chest compressions Avoid excessive ventilation 대한심폐소생협회 Chest compression depth in children Pediatrics. 2009;124:e69-74 : 280 consecutive CT reconstruction, < 8 yrs 대한심폐소생협회 Chest compression depth in children Pediatrics. 2009;124:e69-74 # Residual internal depth < 10 mm ; potential to injure the intrathoracic structures and may actually not be achievable 대한심폐소생협회 Chest compression depth in children Pediatrics. 2009;124:e69-74 - 1/2 compression : residual space < 10 mm: 94%, 너무 깊다 - 1/3: compression: 0.5% 대한심폐소생협회 Chest compression depth in children 2005 가이드라인 2010 가이드라인 흉부 전후 직경의 흉부 전후 직경의 1/3~1/2 깊이로 최소 1/3 깊이로 흉부 압박 흉부 압박 이 깊이는 영아에서 4cm, 소아에서 5cm에 해당 대한심폐소생협회 Pediatric BLS Algorithm 대한심폐소생협회 대한심폐소생협회 Chest compression for infants 1 rescuer : Two finger tech 2 rescuers : Two thumb-encircling tech 대한심폐소생협회 Two thumb-encircling technique No data show benefit from a circumferential squeeze Higher CPP than the 2-finger technique If you cannot physically encircle the victim’s chest, compress the chest with 2 fingers. 대한심폐소생협회 Defibrillation in pediatric BLS For infants a manual defibrillator is preferred when a shockable rhythm is identified by a trained healthcare provider (Class IIb, LOE C). If a manual defibrillator is not available, an AED equipped with a pediatric attenuator is preferred for infants. If neither is available, an AED without a dose attenuator may be used (Class IIb, LOE C). AEDs that deliver relatively high energy doses have been successfully used in infants with minimal myocardial damage and good neurological outcomes. 대한심폐소생협회 AED use in infants 2005 가이드라인 2010 가이드라인 1세 미만 영아의 경우 영아에서 수동 제세동기 사용을 권 제세동기 사용 적합/부적합을 장하지만, 불가능할 경우 아동용 충격 권고하기에는 량 감쇄 시스템을 부착한 AED 사용이 데이터가 충분하지 않다. 권장된다. 둘 중 어느 것도 사용할 수 없는 경우, 충격량 감쇄기가 없는 AED를 사용할 수 있다. - 영아에서 AED 사용이 안전하고 효과적 이었다는 증례보고가 있다. (사용의 안전성 을 지지하는 근거는 아직 제한적이다) 대한심폐소생협회 Hands-Only CPR in PBLS Optimal CPR in infants and children includes both compressions and ventilations, but compressions alone are preferable to no CPR (Class 1 LOE B). 대한심폐소생협회 Hands-Only CPR in PBLS Lancet. 2010; 17: 1347-54 - 5,170 children, < 17 yrs - 3,675 (71%) non-cardiac causes, 1,551 (30%) cardiac arrests 대한심폐소생협회 Lancet. 2010; 17: 1347-54 대한심폐소생협회 Avoid excessive ventilation Excessive ventilation is harmful because it Increases intrathoracic pressure and impedes venous return and therefore decreases cardiac output, cerebral blood flow, and coronary perfusion. Causes air trapping and barotrauma in patients with small airway obstruction. Increases the risk of regurgitation and aspiration in patients without an advanced airway. 대한심폐소생협회 Other CPR Techniques and Adjuncts Insufficient data in infants and children to recommend for or against the use of the following: Mechanical devices to compress the chest Active compression-decompression CPR Interposed abdominal compression CPR (IAC-CPR) The impedance threshold device pressure sensor accelerometer (feedback) devices. 대한심폐소생협회 Foreign-Body Airway Obstruction No change 5 back blows + 5 chest compressions for infants Abdominal thrusts for children 대한심폐소생협회 Special Resuscitation Situations 대한심폐소생협회 대한심폐소생협회 BLS for injured child (X) (O) (O) Neutral Position 대한심폐소생협회 Thank you.
