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* Drug intoxication (eg, [[tricyclic antidepressant]]<nowiki/>s, [[digoxin]], [[cocaine]]) | * Drug intoxication (eg, [[tricyclic antidepressant]]<nowiki/>s, [[digoxin]], [[cocaine]]) | ||
*[[Commotio cordis]] <ref>Ralston.M.E (2020).Pediatric basic life support for healthcare providers. In James F Wiley (Ed.), UpToDate. Retrieved from <nowiki>https://www.uptodate.com/home</nowiki></ref> | *[[Commotio cordis]] <ref>Ralston.M.E (2020).Pediatric basic life support for healthcare providers. In James F Wiley (Ed.), UpToDate. Retrieved from <nowiki>https://www.uptodate.com/home</nowiki></ref> | ||
==References== | ==References== | ||
Revision as of 09:24, 11 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Neepa Shah, M.D.
Synonyms and keywords:
Overview
Pediatric Basic Life Support is a life-saving skill comprising of high quality CPR (Cardiopulmonary Resuscitation) and Rescue Breadths with Artificial External Defibrillator (AED).
- Bystander CPR - Bystander resuscitation plays a key role in out of hospital CPR. A study by Maryam Y Naim et all found out communities, where bystander CPR is practiced, have better survival outcomes in children less than 18 years from out of hospital cardiac arrest(CA)[1]
- Two studies (Total children 781) concluded that about half of the Cardio-Respiratory arrests in children under 12 months occur outside the hospital.
- Good Prognostic Factor upon arrival at the emergency department-
- The short interval between arrest and arrival at the hospital.
- Less than 20 minutes of resuscitation in the emergency department.
- Less than 2 doses of epinephrine.[2]
Classification
- Pediatric Basic Life Support is classified according to age[3]
- Age - Less than 1 year - Infant Basic Life Support
- Age - 1 year to Puberty - Child Basic Life Support
- Age - After Puberty - Adult Basic Life Support
- BLS can be classified as
- BLS in Out of hospital cardiac arrest (OHCA)
- BLS inpatient cardiac arrest (IHCA)
Causes of Cardiac arrest(CA) in children
- Ventricular Fibrillation
- Pulseless Ventricular tachycardia
- Children with preexisting cardiac disorders
- Drug intoxication (eg, tricyclic antidepressants, digoxin, cocaine)
- Commotio cordis [4]
References
- ↑ Naim MY, Burke RV, McNally BF, Song L, Griffis HM, Berg RA; et al. (2017). "Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry". JAMA Pediatr. 171 (2): 133–141. doi:10.1001/jamapediatrics.2016.3643. PMID 27837587.
- ↑ Sahu S, Kishore K, Lata I (2010). "Better outcome after pediatric resuscitation is still a dilemma". J Emerg Trauma Shock. 3 (3): 243–50. doi:10.4103/0974-2700.66524. PMC 2938489. PMID 20930968.
- ↑ Atkins DL, de Caen AR, Berger S, Samson RA, Schexnayder SM, Joyner BL; et al. (2018). "2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 137 (1): e1–e6. doi:10.1161/CIR.0000000000000540. PMID 29114009.
- ↑ Ralston.M.E (2020).Pediatric basic life support for healthcare providers. In James F Wiley (Ed.), UpToDate. Retrieved from https://www.uptodate.com/home
References
Goals of Resuscitation
Approach to Suspected Patient of Cardiac or Respiratory Arrest
Algorithm
According to the AHA guidelines[1] [2]
- Look out for the safety of yourself as a bystander and the child/infant.
- Call for help if alone and if 2 rescuers are present send one person to call the EMS (Emergency medical service) and get the AED(Automated external defibrillator).
- Check for response ask "What is your name?" Can you hear me"
- Check if the child is breathing,
- If the child is breathing normally, don't do CPR.
- If the child is not breathing or is gasping for air start CPR
- Check for a pulse in an infant it is the Brachial pulse. For children above 1 year of age check the Femoral artery pulse or the Brachial pulse, not more than 10 seconds.
- The new AHA guidelines in 2010[1],2015 have changed the order from "ABC" Airway, Breathing/ventilation, and Chest compressions (or Circulation) to "CAB" Compression (Circulation) Airway and Breathing/Ventilation.
- High-quality chest compressions:
- For infants - Place 2 fingers below the intermammary line not compressing any rib or xiphoid process and start compressions 100/minute and up to 4 cm or 1.5-inch depth in infants and 5 cm or 2-inch depth in children above 1 year.
- Use two hands wrapped around the thorax for better grip depending on the size of the child to avoid exhaustion especially if its a lone rescuer.
- If 2 people are there give 15 chest compressions followed by 2 rescue breaths. Interchange the position every 2 minutes if 2 people are present to avoid exhaustion and ensure high-quality CPR.
- If there is a single person for CPR give 30 chest compressions followed by 2 rescue breaths.
- CPR with rescue breaths has more survival benefit in children vs CPR- Only Compressions.
- In children the majority of the cause for cardiac arrest is Asphyxia .
- If the lone rescuer is not trained in ventilation then Compression only CPR can be done.
- Ventilation
- If you are a lone rescuer, follow 30 x 2 cycle which is 30 compressions with 2 breaths. Observe for a chest rise as you are giving ventilation.
- Use the head tilt and chin lift method to open the airway for injured and non-injured children.
- If there is no chest rise after mouth to mouth ventilation adjust the neck.
- Infants- Follow mouth to mouth ventilation, pinch the nose to prevent air movement out of the nose.
- Mouth to nose ventilation can also be administered, close the mouth to prevent air being lost in the mouth.
- Children- Follow Mouth to Mouth ventilation with pinching the nose.
- In each of the rescue breaths make sure the chest rises and quickly resume immediately compressions in 30 x 2 cycle if you are a lone rescuer for improving the survival
Basic Life Support Guidelines (Revised American Heart Association 2010 Guidelines)
General Consideration
- ↑ 1.0 1.1 Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW; et al. (2010). "Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S862–75. doi:10.1161/CIRCULATIONAHA.110.971085. PMC 3717258. PMID 20956229.
- ↑ Marino BS, Tabbutt S, MacLaren G, Hazinski MF, Adatia I, Atkins DL; et al. (2018). "Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease: A Scientific Statement From the American Heart Association". Circulation. 137 (22): e691–e782. doi:10.1161/CIR.0000000000000524. PMID 29685887.