Pediatric resusucitation

Send This

Download

Comment

Favourite

more

Rating :

Rate It:

Embed :

Ron Buchanan on Nov 14, 2012 Says :

Why can I not download this presentation?

Post a comment

Post Comment on Twitter Post Comment on SlideWorld

Comments:

Subscribe to follow-up comments

2 Favorites

buchananr, favourited this 1 Years ago.

n.chahkandi, favourited this 1 Years ago.

First Prev [1] Next Last

Notes

Hide Notes

Slide 1 :

Pediatric Resuscitation

Slide 2 :

Pediatric Cardiac Arrest Usually secondary to respiratory failure or arrest

Slide 3 :

Most Important Intervention Adequate oxygenation, ventilation

Slide 4 :

Basic Life Support Airway Head-tilt/chin-lift method Big tongue; Forward jaw displacement critical Avoid extreme hyperextension With possible neck injury, jaw thrust

Slide 5 :

Basic Life Support Breathing Look-Listen-Feel Limit to volume causing chest rise Children usually underventilated! Use BVM only if proficient Pedi BVM’s should not have pop-off valves

Slide 6 :

Basic Life Support Breathing Do NOT use demand valve on children Ventilate infants, children every 3 seconds

Slide 7 :

Basic Life Support Circulation Infants: brachial Children: carotid

Slide 8 :

Basic Life Support Circulation Infant chest compressions 2 fingers 1 finger width below nipple line 1/2 - 1 inches At least 100/minute

Slide 9 :

Basic Life Support Circulation Child chest compressions One hand Lower half of sternum 1 - 1.5 inches 100/minute

Slide 10 :

Basic Life Support Circulation Child CPR Maintain continuous head tilt with hand on forehead Perform chin lift with other hand while ventilating

Slide 11 :

Best Sign of Effective Ventilation Chest Rise

Slide 12 :

Best Sign of Effective Circulation Pulse with Each Compression

Slide 13 :

Oxygen Therapy Initiate ASAP Do not delay BLS to obtain oxygen

Slide 14 :

Oxygen Therapy Use highest possible FiO2 No risk in short term100% O2 Humidify if possible Avoids plugging airways, adjuncts

Slide 15 :

Endotracheal Intubation Need to intubate is not same as need to ventilate!

Slide 16 :

Endotracheal Intubation Proper tube size Same size as child’s little finger Child > 1 year: [(Age + 16 ) / 4]

Slide 17 :

Endotracheal Intubation Children < 8 years old Small tracheal diameter Narrow cricoid ring Uncuffed tubes Infants, small children Narrow, soft epiglottis Straight blade

Slide 18 :

Endotracheal Intubation Attempts not >30 seconds Bradycardia: oxygenate, ventilate

Slide 19 :

Endotracheal Intubation Avoid hyperextension Use “sniffing position” Lift up; do not pry back

Slide 20 :

Endotracheal Intubation Confirm placement by: Seeing tube go through cords Chest rise Equal breath sounds No sounds over epigastrium CO2 in exhaled air

Slide 21 :

Endotracheal Intubation Mark tube at corner of mouth Avoid excessive head movement Frequently reassess breath sounds Ventilate to cause gentle chest rise

Slide 22 :

Endotracheal Drugs Epinephrine, atropine, lidocaine

Slide 23 :

Endotracheal Intubation Drug administration Do not delay while attempting IV access Dilute with normal saline Stop compressions Inject through catheter passed beyond ETT Follow 10 rapid ventilations

Slide 24 :

Cricothyrotomy Surgical contraindicated in children <12 Narrowing of trachea at cricoid ring makes procedure hazardous Use needle technique only

Slide 25 :

Vascular Access Same reasons as adults Drugs Fluids

Slide 26 :

Scalp Veins No value in cardiac arrest Useful in infants < 1 year old for maintenance fluids, drug route

Slide 27 :

Scalp Veins Rubber band for tourniquet 21, 23 gauge butterfly Attach syringe, flush needle before inserting

Slide 28 :

Scalp Veins Point needle in direction of blood flow Leave syringe attached, inject 1cc saline after entering vein to check infiltration

Slide 29 :

Hand, Arm, Foot Veins 22 gauge catheter for smaller children Restrain extremity before attempting Incise overlying skin with 19 gauge needle Flush needle as with scalp vein technique

Slide 30 :

External Jugular Life-threatening situations only 22 gauge catheter Restrain by wrapping in sheet Extend head over end of table, rotate 900 If vein perforates, do not go to other side Risk of paratracheal hematoma, airway obstruction

Slide 31 :

Prevention of Fluid Overload Avoid using bags over 250cc Use mini-drip sets, Volutrols Fluid resuscitation: 20cc/kg boluses

Slide 32 :

Intraosseous Cannulation Placement of cannula into long bone intramedullary canal (marrow space)

Slide 33 :

Intraosseous Cannulation Indication Vascular access required Peripheral site cannot be obtained In two attempts, or After 90 seconds

Slide 34 :

Intraosseous Cannulation Devices 16 gauge hypodermic needle Spinal needle with stylet Bone marrow needle (preferred)

Slide 35 :

Intraosseous Cannulation Site Anterior tibia 1 - 3 cm below knee Medial to tibial tuberosity

Slide 36 :

Intraosseous Cannulation Contraindications Fractures Osteogenesis imperfecta Osteoporosis Failed attempt on same bone

Slide 37 :

Intraosseous Cannulation Needle in place if: Lack of resistance felt Needle stands without support Bone marrow aspirated Infusion flows freely

Slide 38 :

What can be put thru an IO? Anything that can be put through an IV!

Slide 39 :

Remember……. You don’t need a line to give drugs during a code. Epinephrine, atropine, lidocaine can go down tube

Slide 40 :

Defibrillation 90% of pediatric cardiac arrest is Asystole, or Bradycardic PEA Defibrillation seldom needed

Slide 41 :

Defibrillation Pediatric VF suggests Electrolyte imbalances Drug toxicity Electrical injury

Slide 42 :

Defibrillation Paddle diameter: Infants: 4.5 cm Children: 8.0 cm Largest paddles that contact entire chest wall without touching If pediatric paddles unavailable, use adult paddles with A-P placement

Slide 43 :

Defibrillation Energy Settings Initial: 2 J/kg Repeat: 4 J/kg

Slide 44 :

Cardioversion Cardiovert only if signs of decreased perfusion Energy settings: Initial: 0.5 - 1.0 J/kg Repeat: 2.0 J/kg

Slide 45 :

Cardioversion Narrow-complex tachycardia, rate < 200 Usually sinus tachycardia Look for treatable underlying cause Do not cardiovert

Slide 46 :

Cardioversion Narrow-complex tachycardia, rate > 230 Usually supraventricular tachycardia Frequently associated with congenital conduction abnormalities

Slide 47 :

Cardioversion Narrow-complex tachycardia, rate > 230 If hemodynamically stable, transport Adenosine may be considered

Slide 48 :

Cardioversion Narrow-complex tachycardia, rate > 230 If hemodynamically unstable, cardiovert If no conversion after two shocks, consider possibility rhythm is sinus tachycardia

Slide 49 :

Drug Therapy Epinephrine Asystole, bradycardia PEA Stimulates electrical/mechanical activity

Slide 50 :

Drug Therapy Epinephrine Dosage IV or IO: 0.01 mg/kg 1:10,000 ET: 0.1 mg/kg 1:1000

Slide 51 :

Drug Therapy Atropine 0.02 mg/kg IV or IO Double ET dose Minimum dose: 0.1 mg to avoid paradoxical bradycardia Maximum single dose: Child: 0.5 mg Adolescent: 1mg

Slide 52 :

Drug Therapy Most bradycardias respond to Oxygen Ventilation For bradycardia 2o to hypoxia/ischemia, preferred first drug is epinephrine

Pediatric Endodontic...

PEDIATRIC ENDODONTIC...

PEDIATRIC EMERGENCIE...

Risk Assessment for ...

Pediatric Office Eme...

The Pediatric Abdome...

Free Powerpoint Templates

	SlidesOnline 5 Years ago.



2989 Views, 2 favourite
PowerPoint Slide Presentation on endotracheal intubation
More By User Flag as inappropriate Select your reason for flagging this presentation as inappropriate. If needed, use the feedback form to let us know more details. Cancel