CARDIOPULMONARY RESUSCITATION IN THE CRITICALLY ILL CHILD AND ADOLESCENT Flashcards
Cardiopulmonary resuscitation (CPR) is an emergency attempt to ___________________ by ___________________________ until ___________________ return
maintain or restore life
keeping vital organs (brain and heart) oxygenated
spontaneous respiration and circulation return
Cardiopulmonary arrest (CPA) is often the end result of progressive ___________ or __________________
respiratory
circulatory failure
CPAs can occur outside or inside hospital, and inside hospital is divided into those that occur in _____________ or on ______________ .
These distinctions are made because _________________________________ differs between them and this is reflected in the outcome of cardiopulmonary resuscitation efforts
intensive care
general wards.
access to immediate trained help
Causes of CPAs
The primary causes are very varied but, in children, cardiac arrest is often precipitated by ______________ , __________ failure, _______ or central nervous system infections.
In adolescents, _________ can lead to an arrest from poor positioning when unconscious, head or chest injuries, or massive blood loss.
respiratory failure
circulatory failure
sepsis ; polytrauma
Cardiopulmonary arrests are more common in ____________________ (LMIC), probably because children are very ill and arrive late at hospital.
Almost all CPR attempts in LMIC occur in hospital
low- and middle-income countries
PHYSIOLOGY OF CPR
The aim of CPR is to maintain adequate, oxygenated, blood flow to vital organs. Blood flow is maintained in standard CPR by manual, regular ______________________.
During this , ______________ is raised and the heart is squeezed between the _______ and the _________ .
Pressure rises in both sides of the heart and blood is pushed forward out of the non-beating heart towards the ___[___ , ___________ and other parts of the body. _____________ prevent backflow.
Between compressions, the chest wall _________ and the heart ________________.
If cardiac compressions are _________ or _________, or not _________ enough, the blood flow generated is poor and the outcome is poor
compressions of the chest.
intrathoracic pressure ; sternum
spine ; brain ; coronary arteries
Heart valves ; recoils
fills with blood ; too fast
too slow ; deep enough
A SYSTEMATIC APPROACH TO THE CRITICALLY ILL CHILD
Children are not young adults
Remember important differences between adult and kids
RR
BP-
0to28days ______ mmHg in term neonates;
1-12months ______mmHg in infants;
1 to 10 years ______ mm Hg + (____________)
>10 years _______ mm Hg in children
HR
60
70mm
70 mm Hg + (2 x age in years)
90 mm Hg
CPR in children starts with assessment
ABC (________________) = BAC (_________________)
It is a rapid, accurate and easily-learned model for the initial assessment of any child
It allows the clinician, using only visual clues, to rapidly assess the severity of the child’s illness or injury and urgency for treatment, regardless of the underlying diagnosis
Airway Breathing Circulation
Breathing Appearance Circulation
ABC of Resuscitation
Airway
__________________
Breathing
Give __________________ or give some __________________
Circulation
Assess for __________ , __________, obtain __________
Position and clear airway
positive pressure ventilation
rescue breaths
perfusion, shock
vascular access
Breathing
Check for signs of _________. Abnormal _________. Abnormal _________
_________, _________, Head _________
________________ is a more accurate immediate indicator of oxygenation and ventilation than conventional measures, such as counting RR or chest auscultation
distress ; airway sounds
positioning ; Retractions
Nasal flaring ; Head bobbing
Work of breathing
Work of breathing reflects the child’s physiologic _____________________ to cardiopulmonary stress
Assessing work of breathing entails careful _________ for _________ _________________ and observing for specific _________ information about _________. characteristics of work of breathing
compensatory response
listening ; abnormal airway sounds
visual information
breathing effort
Appearance
Is the child __________ ?
__________
__________
Consolability
__________/__________
__________/__________
responsive
Tone
Interactiveness
Look/Gaze
Speech/Cry
Combining assessment of appearance and work of breathing can establish __________
A child with normal appearance and increased work of breathing is in ______________
Abnormal appearance and increased work of breathing means ___________________
Abnormal appearance and abnormally decreased work of breathing is ____________________
severity
respiratory distress
early respiratory failure
late respiratory failure
Circulation
An important indicator of core perfusion is ___________________
When cardiac output is inadequate, the body shuts down circulation to non-essential anatomic areas such as the _______ in order to preserve blood supply to vital end organs (e.g. ______, _______ and ______
Therefore, circulation to skin reflects the overall status of circulation to the body’s important end organs.
circulation to skin
skin
brain, heart and kidney
_________ , _________ and _________ are key visual indicators of reduced circulation to skin
Pallor
mottling
cyanosis
Abnormal appearance and decreased circulation to skin means ________
shock
The commonest cause of cardiopulmonary arrest in pediatric is __________________________
Other common reversible causes include:
Hypoxia. 2) Hypovolemia/ Hypotension. 3) Hypothermia. 4) Hypoglycemia. 5) Acidosis (H+). 6) Hypokalemia (electrolyte disturbance). 1) Cardiac Tamponade. 2) Tension pneumothorax. 3) Thromboembolism (pulmonary, coronary). 4) Toxins (eg. digoxin, local anesthetics, TCA, insecticides)
Significant portion of kids respond to AW management alone.
Time spent ____________________ at the expense of adequate AW management is a common mistake.
Vascular access necessary in in-hospital CPR as you may need to give drugs such as Epinephrine
Drugs can be given through _________. General order of attempts should be: __________, ________ , or _______ and then ___________
respiratory. Airway obstruction
securing a vascular access
ETT.
antecubital, hand, or foot and then intraosseous
Indications of Intraosseous
_____________ required
Peripheral site cannot be obtained in _____ attempts or after ________________
Contraindications
__________
Failed attempt on _________
What can be put thru an IO? _________________________
Vascular access required
3 ; 90 seconds
Fractures ; same bone
Anything that can be put through an IV
Intraosseous sites
Children 0 to 6 years of age:
A. Medially to _____________
B. Above __________________
Children 6 to 12 years of age:
A. Medially to ______________
B. Above ______________
C. ________________
tibial tuberosity ; medial malleolus
tibial tuberosity ; medial malleolus
Femoral head
CHEST COMPRESSIONS
• Compress the heart against the spine ________cm
• Increase intrathoracic pressure
• Circulate blood to vital organs: heart, brain
• ____ compressions to ____ ventilation (____-____ compressions and ____ vents per min
4-5cm
30 ; 2
100-120 ; 8
Paediatric cardiac arrest algorithm
Start _______
Shockable rhythm? – _____ / ______
Shock with ________________
CPR for _______
Get _____________
Repeat cycle
IV Epinephrine every _________
Consider ________ airway
CPR
VF/ VT
AutomatedExternalDefibrillator (AED)
2 min
vascular access
3-5 min
advanced airway
DIFFERENCE BETWEEN ADULT CPR AND NEONATAL, CHILD CPR
common cause of CPR
Compression depth
Usually cardiac; usually respiratory failure
5 cm or 2 in.
1/3 depth of chest or about (5cm child or 4 cm infant
Drowning victims: start CPR sequence with ____________ before __________
2 initial breaths
chest compressions
PRECAUTIONS TO TAKE DURING CPR
Push _____, push ______ : ______ compressions/minute to a depth of ______
Allow for full ___________ after each compression
Minimize ___________ in chest compression
hard ; fast
100 ; 5 cm
chest recoil ; interruption
When to start and when to stop CPR
CPR should commence as soon as _________ or _________ is inadequate. It is better to initiate resuscitation before _____________________________.
CPR can be stopped when the _________ and __________ support circulation and breathing is __________ and regular; in other words, ROSC has occurred
respiration ; circulation
breathing and the heart actually stop.
heart rate ; volume
spontaneous
ROSC –???
Return of Spontaneous Circulation
