Pediatric BLS: Difference between revisions

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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>
'''High - quality CPR'''
[[Cardiopulmonary resuscitation]] comprises of effective chest compression and [[ventilation]] by [[Rescue breathing|rescue breath]].
*According to the [[American Heart Association|AHA]] guidelines 2015,2017,2010, the following are the steps for [[CPR|high-quality CPR]].
**[[Rate]] - Rate of [[CPR]] is the frequency of the chest compressions in a minute the [[AHA]] guidelines recommend 100 compressions per minute.
**Depth- For high-quality [[CPR]], the depth of the compressions should be 4 cm for infants and 5 cm for children more than 1 year of age.
**Chest recoil- Allow the chest to recoil during chest compression which allows [[blood]] to flow back to the [[heart]] and hence the to the other vital organs.
**[[CPR]] with [[Rescue breathing|rescue breaths]]- The above guidelines suggest better [[Neurology|neurological complications]] in children more than 1 year of age who were given [[CPR]] with the [[Rescue breathing|rescue breaths]] as compared to children who received Compression- only CPR for [[Sudden cardiac death|cardiac arrest]]<ref name="pmid26472999">{{cite journal| author=Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL | display-authors=etal| title=Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2015 | volume= 132 | issue= 18 Suppl 2 | pages= S519-25 | pmid=26472999 | doi=10.1161/CIR.0000000000000265 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26472999  }} </ref><ref name="pmid29114009">{{cite journal| author=Atkins DL, de Caen AR, Berger S, Samson RA, Schexnayder SM, Joyner BL | display-authors=etal| title=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. | journal=Circulation | year= 2018 | volume= 137 | issue= 1 | pages= e1-e6 | pmid=29114009 | doi=10.1161/CIR.0000000000000540 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29114009  }} </ref><ref name="pmid20956229">{{cite journal| author=Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW | display-authors=etal| title=Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2010 | volume= 122 | issue= 18 Suppl 3 | pages= S862-75 | pmid=20956229 | doi=10.1161/CIRCULATIONAHA.110.971085 | pmc=3717258 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956229  }} </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

  • 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

References

  1. 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.
  2. 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.
  3. 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.
  4. 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


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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. 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.
  2. 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.