Paediatric Resusctation Guide Flashcards
Rather than shockable rhythms, children are more likely to have
pulseless electrical discharge (PEA)
or
asystole
what aetiologies for cardiorespiratory arrest are children more likely to have
more often a respiratory illness or airway obstruction leading to hypoxia and a respiratory arrest
also, hypovolaemia and shock from sepsis, blood loss in trauma, severe gastroenteritis or anaphylaxis
how is the child anatomy different
larger head, short neck, large tongue, larger epiglottis, smaller airways, more compliant chest
DRSABCDE
danger
responsiveness (AVPU)
send for help
airways
breathing
circulation
diability
environmental, exposure, and extended examination
airways BLS
open the mouth, look for obstruction and remove if possible
do not use the blind finger sweep as this can damage mucosa
open the airway by positioning the patient
- neutral for infants
- sniffing position for children
head tilt and chin lift / jaw thrust
how to open the airway if a neck injury is suspected
use jaw thrust to avoid worsening the injury
breathing BLS
assess if the patient is breathing
look for chest wall movement
if they are not breathing give two effective rescue breaths
expired air resuscitation: create a seal over the mouth and blow out for 1-2 seconds, watching for the chest wall rising
how much ventilation should be given before moving on to external cardiac compressions
at least 2
circulation BLS
assess for signs of life, and a pulse (either brachial or femoral) for no longer than 10 seconds.
do not assess carotid in infants, too difficult due to short necks.
if there are no signs of life commence external chest compressions - cardiopulmonary resuscitation CPR
ensure the patient is on a hard flat surface
finger/hand position = lower half of sternum
compress 1/3 of the chest wall 15 compressions:2 breaths
defibrillator BLS
assess for neurological function using AVPU
A = alert GCS 15
V = responds to voice GCS 12
P = responds to pain GCS < 9
U = unresponsive GCS 3
Environment, exposure and extended examination BLS
expose the patient to look for rashes, life-threatening injuries
Airways ALS
use a suction catheter if required
can use forceps to remove foreign bodies under direct vision
use an airway adjunct :
- oropharyngeal airway (guedel): use in unconscious patients. insert under direct vision
- nasopharyngeal airway: lubricate and insert into the nostril. dont use if there is suspicion of a base skull fracture.
breathing ALS
use a bag valve mask with a reservoir
bag sizes:
neonate - 250ml
infants - 500ml
children - 1500ml
apply high flow oxygen
circulation ALS
attach monitoring and assess rhythm
defibrillation pad position: one over apex in the mid-axillary line, just below the right sternum
in small infants, you can place one on the chest to the left of the sternum and one on the back below the left scapula
follow the APLS algorithm
insert at least one IV cannula (take bloods)
if this is unsuccessful, use intraosseous
give fluid bolus: 20ml/kg of 0.9 saline
APLS algorithm