Download Resuscitation

Resuscitation
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The goal of resucitation is
to maintain adequate oxygenation and perfusion.
An sequence of events should be instituted
beginning with the ABC
Resuscitation (best survival)
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Children with a respiratory arrest .
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a short duration of CPR.
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and a pulse present at the time of apnea.
Signs and symptoms suggesting the
potential need for resuscitation
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CNS
lethargy ,irritability ,confusion
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Respiratory ;
apnea ,grunting ,nasal flaring ,tachypnea ,
poor air movement ,stridor ,wheesing
Signs and symptoms suggesting the potential
need for resuscitation (2)
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Cardiovascular;
Arrhythmia ,bradicardia, weak pulses ,poor
capillary refill , hypotention
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Skin and mucous;
Mottling , pallor , cyanosis , diaphresis , poor
turgor , dry mucouse membranes
Resuscitation
Responsiveness:
Gently shake if no injury
Speak loudly
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Call out for help
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Position the patient
Place supine
Keep neck immobilized
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Resuscitation
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1.
2.
3.
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Basic life support (BLS):
A irway
B reathing
C irculation
Advanced life support (ADL)
Airway Breathing Circulation Druge&fluid
ABC
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An sequence of events should be
instituted beginning with the ABC :

Opening Airway
Assessing Breathing
Assessing Circulation
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Respiratory support
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Head tilt/chin lift or jaw thrust if the
cervical spine is unstable .
Looking for the rise and fall of the chest.
Listening at the nose and mouth for
breathing.
This should be done in the less than 10
seconds
Rescue breathing in an infant
Head tilt- chin lift maneuver
Combined jaw thrust-spine stabilization maneuver
Rescue breathing in a child
Mask
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Smallest size face
mask
Large enough
Resuscitation Bag
Assess for mask leak
Monitor patient
response
Sellick’s maneuver
O2
Sellick’s maneuver
Compression of the cricoid
cartilage backward
compressing
the esophagus against the
Vertebral to prevent aspiration
Of gastric contents
Indication for endotracheal intubation
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Apnea , Airway obstruction unrelieved by airway
opening maneuvers.
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Increased work of breathing that may lead to fatigue.
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The need for PEEP
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Poor airway protective reflexes .
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Sedation or the need for paralysis
Intubation
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Laryngoscopy
Intubation
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reoxygenate with 100% O2
Gasteric tube
Check devices
Position the patient
ETT size (mm) =16+ age in yr
4
‫خداوند به هر پرندهاي دانهاي‬
‫ميدهد‪ ،‬ولي آن را داخل‬
‫النهاش نمياندازد‪.‬‬
Foreign body aspiration

1.
2.
3.
A conscious child suspected a foreign
body should be permitted to cough
spontaneously until:
coughing is not effective
Respiratory distress and stridor increase
the child becomes unconscious
Foreign body aspiration
Abdominal thrusts with victim
Standing or sitting( conscious)
Foreign body aspiration
Neonatal resuscitation
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High –risk situations should be anticipated
by:
 history of the pregnancy .
 labor and delivery.
 identification of signs of fetal distress .
Neonatal resuscitation
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5-10%require some degree of resuscitation
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Goals are:
1.
prevent the morbidity and mortality with
hypoxic-ischemic injury .
2.
Re-establish adequate spontaneous
respiration and cardiac output
Neonatal resuscitation
 IF Persistent cyanosis or failure to ventilate or
HR < 60

Depressed respiratory neuromuscular.
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Airway malformation.
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Lung problem (pneumothorax –diaphragmatic
hernia).
 Congenital heart disease.
Apgar evaluation of newborn
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Sign
0
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Heart rate
absent
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Respiratory effort
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Muscle tone
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Response to catheter no
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Color
absent
limp
blue,pale
1
2
<100
>100
irregular,slow
some flextion
Grimace
body pink
crying, good
active motion
cough,sneeze
completely pink
‫تنها راهي كه به شكست ميانجامد‪ ،‬تالش نكردن است‪.‬‬
Chest compressions in Infants(<1 y/o)
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One finger below intermammary line
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3th&4th fingers on sternum
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1/3 to1/2 depth of chest
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100 times per min.
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5 Compressions to 1 ventilation
Chest compressions in Infants(<1 y/o)
Cardiac compressions ( infant)
‫براي انسانهاي بزرگ‪ ،‬بنبستي وجود‬
‫ندارد زيرا آنها براين باورند كه‪:‬‬
‫يا راهي خواهند يافت‪ ،‬يا‬
‫راهي خواهند ساخت‪.‬‬
Assess for signs of circulation
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Check pulse(3-5 sec.)
Use brachial or femoral in infants
Use carotid in child>8 yr
Chest compressions:
neonate =120
1-8yr and>8 =100
Comprassion /ventilation:
neonate =3:1
1-8yr=5:1
>8yr=15:2
Poor response to ventilation in neonates AND children
may be due to
-
Loosely mask , Positioning of the tracheal tube , air in
stomach
 -airway obstruction , insufficient pressure , pleural
effusion.
 asystole , hypovolemia
 pneumothorax, diaphragmatic hernia
 prolong intrauterine asphexia
Medication in Neonatal resuscitation
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Medications rarely required .
 Medication should be administered :
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if HR is < than 60 /min after 30 sec of
ventilation and chest compressions .
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During asystole.
Intra osseous infusion
Intraosseous infusion
Chest compressions in child(1-8 y/o)
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One fingerbreadth above xyphoid-sternal
margin
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Heel of hand
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Depth:2.5-4 cm.
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100 Times per min.
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5 Comp. / 1 Vent.
Chest compressions
Chest compressions in a child
Chest compressions in child(>8 y/o)
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Two hands
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Depth : 3-5 cm.
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80-100 Times per min.
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One rescuer: 5 Comp. / 1 Vent.
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Two rescuer: 15 Comp. / 2 Vent.
Medication for cardiac arrest
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Epinephrine
0/01mg/kg iv/ io (1/10000=0/1cc/kg)
0/1mg/kg ET
(1/1000=0/1cc/kg)
Administer every3-5min
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Atropine
0/02mg/kg Min dose:0/1mg iv,io,ET
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Bicarbonate
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Calcium gluconate
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Glucose(10%-25%)
1mEq/kg infuse slowly if ventilation is
60-100mg/kg (0/6-1cc/kg) iv/io
2-4cc/kg
adequate
Brain death
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No spontaneous movement or interaction with enviroment
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No response to stimuli ( pain ,light ,sound , touch )
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Absence of brain stem reflexes
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Apnea .
All of the criteria should be present at least 6-24 hr after
coma and apnea .
Silence EEG ,no hypothermia and cardiovascular shock and
drug intoxication
Cardiovascular support
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1.
2.
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Chest compression must be given:
If there is no pulse
If the pulse is less than 60/min with poor
perfusion
Chest compressions are given without
interrupting ventilation
"If you love life, life will love you back." !