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.