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Pediatric emergencies
- 1. PEDIATRIC EMERGENCIES Myrna D.C. San Pedro, MD, FPPS
- 4. Interactive Model of Injuries VICTIM (HOST) AGENT HUMAN ENVIRONMENT PHYSICAL ENVIRONMENT
- 7. Primary Factors in Pediatric Accidents Increased vulnerability and/or risk situation Psychosocial (endogenous) Predisposing Factors Environmental (exogenous) Predisposing Factors Accident Precipitating Factors Precipitating Factors
- 17. Safe Kids Philippines Study
- 18. Anticipating Cardiopulmonary Arrest Cardiopulmonary Failure Many Causes Respiratory Failure Cardiovascular Recovery Death Shock Neurological Impairment Neurological Recovery Path of various disease states leading to cardiopulmonary failure in infants and children
- 31. Basic Life Support Maneuvers PALS 2006-2007 MANEUVER ADULT > 8 Years CHILD 1-8 Years INFANT < 1 Year Activate EMS (lone rescuer) When victim FOUND unresponsive, activate EMS. If asphyxial arrest likely, activate AFTER 5 cycles 2 min CPR. When victim FOUND unresponsive, activate AFTER 5 cycles CPR. For SUDDEN, WITNESSED COLLAPSE, activate after verifying victim unresponsive. Airway Head tilt-chin lift maneuver. If trauma suspected, use jaw thrust maneuver. Breaths Initial 2 effective breaths at 1 sec per breath
- 32. MANEUVER ADULT > 8 Years CHILD 1-8 Years INFANT < 1 Year Rescue Breaths Without chest compression 10-12 breaths/min (about 1 breath every 5-6 seconds) 12-20 breaths/min (about 1 breath every 3-5 seconds) Rescue Breaths for CPR With advanced airway 8-10 breaths/min (about 1 breath every 6-8 seconds) Foreign-body airway obstruction Abdominal thrusts Back slaps and chest thrusts (5) Circulation Pulse check ( < 10 sec) Carotid (can use Femoral in the child) Brachial or Femoral
- 33. MANEUVER ADULT > 8 Years CHILD 1-8 Years INFANT < 1 Year Compression landmark Center of chest between nipples Just below the nipple line Compression method: Push hard and fast allowing complete recoil Heel of 1 hand on top of other hand 2 Hands: Heel of 1 hand on top of second hand 1 Hand: Heel of 1 hand only 1 rescuer: 2 fingers 2 rescuers: 2 thumbs with encircling hands Compression depth 1 ½-2 inches Approximately 1/3-1/2 the depth of the chest Compression rate Approximately 100/min Compression-ventilation ratio 1 or 2 rescuers 30:2 1 rescuer 30:2 2 rescuers 15:2
- 35. Airway
- 36. Rescue Breaths The correct volume for each breath is the volume that causes the chest to rise.
- 38. Pulse Check
- 42. DELIVERY SYSTEMS OXYGEN (%) FLOW RATE (L/min) Low Flow System Nasal cannula 22-60 2-4 Oxygen mask 35-60 6-10 High Flow System Face tent < 40 10-15 Oxygen hood 80-90 10-15 Oxygen tent > 50 > 10 Partial rebreathing mask with reservoir 50-60 10-12 Nonrebreathing mask with reservoir 95 10-15 Venturi mask 25-60 (mask specific) variable
- 44. Airway Adjuncts
- 46. Cricothyrotomy
- 57. Fluid Resuscitation in Hemorrhagic Shock 20 ml/kg Isotonic crystalloid solution OR 10 ml/kg PRBC or 20 ml/kg FWB 20 ml/kg Isotonic crystalloid solution 20 ml/kg Isotonic crystalloid solution Reassess Reassess Reassess --- Urgent transfusion should be considered if child fails to respond to 2-3 boluses of crystalloid solution (about 40-60 ml/kg)
- 61. / Drugs
Hinweis der Redaktion
- CP arrest in infants and children is rarely a sudden event. Instead, it is often the end result of progressive deterioration in respiratory and circulatory function. No matter what the cause is, the end result in this deterioration is the development of cardiopulmonary failure and possible arrest. If pulseless cardiac arrest develops, there is very poor prognosis. If the clinician recognizes early the manifestations of respiratory failure or shock and quickly starts therapy then cardiopulmonary arrest can often be prevented.
- Skilled physical examination is needed to recognize cardiopulmonary deterioration in the infant or child. Laboratory tests are useful adjuncts in determining the severity of physiologic derangements but they are not crucial to the initial evaluation. Every clinician who works with children should be able to recognize potential pulmonary and circulatory failure and impending cardiopulmonary arrest based on a rapid CP assessment. The rapid CP assessment is designed to evaluate pulmonary and cardiovascular functions and their effects on end-organ perfusion and function.
- Since the conditions of these patients are often dynamic, repeated assessments are necessary to evaluate trends in their conditions or the responses to therapy.
- Hypovolemic shock is the leading form of shock in children worldwide.
- Since cardiac and cardiopulmonary arrest in children is most commonly associated with the development of hypoxemia rather than with ventricular arrhythmias, about 1 min of rescue support may restore oxygenation and effective ventilation or may prevent the child with respiratory arrest from developing cardiac arrest.
- If the infant or child is unresponsive, has no evidence of trauma and obviously breathing effectively, the rescuer should place the victim in the recovery position and activate EMS.
- Cardiac output = volume of blood ejected by the heart each minute. Stroke volume = volume of blood ejected by the ventricles with each contraction. Of the variables affecting and affected by cardiac output, only the heart rate and blood pressure can be easily measured. Stroke volume and systemic vascular resistance must be indirectly assessed by examining the quality of pulses and evaluating tissue perfusion. Blood pressure is the product of cardiac output (flow) and systemic vascular resistance. Normal BP can be maintained despite a fall in cardiac output only if compensatory vasoconstriction occurs. Hypotension is a late and often sudden sign of cardiovascular decompensation. Therefore, even mild hypotension must be treated quickly and vigorously because it signals decompensation and CP arrest may be imminent. An observed fall of 10 mm Hg in systolic BP should prompt careful serial evaluations for additional signs of shock.
- Epinephrine: for cardiac arrest, symptomatic bradycardia unresponsive to ventilation and oxygenation and hypotension not related to volume depletion; severe acidosis may depress its action, thus, should be corrected first with oxygenation, hyperventilation and restoration of systemic perfusion. Atropine: symptomatic bradycardia associated with poor perfusion, intubation and AV block; not indicated for asystole or cardiac arrest. Isoproterenol: for heart block unresponsive to atropine, for bradycardia with poor perfusion. Dopamine: for hypotension or poor peripheral perfusion with adequate intravascular volume and stable rhythm; for cardiogenic, distributive (DSS) and hypovolemic shock conditions. Dobutamine: for hypoperfusion with high systemic vascular resistance; most effective in severe congestive failure or cardiogenic shock.
- This is due to larger head of a child than adult, more likely to “lead” in the fall. Cervical spine injury may be anatomic or functional. SCIWORA cannot be ruled out by radiographic examination and must be assumed to be present in all children with multiple injuries especially those apneic; accounts for large number of prehospital deaths previously thought to be due to head trauma.
- In hemorrhagic shock: 3 for 1 rule, 3ml blood loss to 1 ml fluid.