1. Ötvös Tamás m.d.
2013

2. Summary of changes since
2005
Lay rescuers have to start the CPR if the
patient doesn’t breath well for 10sec
 Healthcare providers can add looking for
pulse (carotid, brachial, femoral)
 CV-ratio:

 Lay rescuers 30:2
 Professionals 15:2 (30:2)

3. Summary of changes since
2005

Compression technique:
 For infants:
○ 2 finger for single rescuer
○ 2 thumb encircling for at least 2 rescuers
 For older children:
○ 1 or 2 hand technique
 Depth: 1/3 of the AP chest diameter
 Compression rate: 100-120/min

4. Summary of changes since
2005

Defibrillation
 Modified or unmodified AED can be used
over the age 1 year
 Manual defibrillators: 4Joule/kg
 Antero-lateral or antero-posterior position

Airway:
 Cuffed tubes are safe (except newborns)
 Cricoid pressure (safe?)
 Capnometry is recommended

6. Paediatric Basic Life
Support
Ensure the safety
 Check the responsiveness

 Gently stimulate and ask:”are you all right?”
 Answering&moving: leave in position, check
his condition and get help, re-assess
Shout for help
 Open the airways

 Head tilt chin lift
 Jaw thrust

7. Paediatric Basic Life
Support

Keep the airway open, check the
breathing for 10 sec
 If breathing, recovery position, get help&re-
assess
 Absent of breathing
○ Remove any obvious airway obstruction
○ Give 5 initial rescue breaths

10. Paediatric Basic Life
Support

Asses circulation
 (no more than 10 sec)
 Look for signs of life (movement, coughing,
breathing)
 Check the pulse (professionals)
○ >1 year-carotid or femoral
○ <1 year-brachial or femoral

11. Paediatric Basic Life
Support

If there are no signs of life:
 Start chest compressions
 Combine with rescue breathing

Chest compressions:
 100-120/min
 The lower half of the sternum
 1/3 deep of the AP chest diameter
 >1 year: 1 or 2 hands technique
 <1 year: 2fingers(alone) or encircling way

15. Paediatric Basic Life
Support

Continue CPR until:
 The child shows sign of life
 Further qualified help arrives
 You become exhausted

16. Paediatric Basic Life
Support

When to call Help?
 If there are 2 rescuers, one call help
 If there is 1 rescuer, after 1 min CPR
 In the case of a child with a witnessed,
sudden collapse & the rescuer is alone
(arrhytmia!!!)

18. Paediatric Advanced Life
Support








During CPR
Ensure high quality CPR: rate, depth, recoil
Plan actions before interrupting CPR
Give oxygen
Vascular access (intravenous, intraosseous)
Give adrenalin 3-5min
Consider advanced airway&capnography
Continuous chest compressions when
intubated
Correct reversible causes

19. Paediatric Advanced Life
Support








Reversible causes(4H/4T)
Hypoxia
Hypovolaemia
Hypo-/hyperkalaemia/metabolic
Hypothermia
Tension PTX
Toxins
Tamponade-cardiac
Thromboembolism

22. Drugs during CPR
Fluids
Isotonic crystalloids
 20ml/kg


23. Drugs during CPR
Adrenalin
0.01mg/kg
 Every 3-5 min


24. Drugs during CPR
Amiodarone
VF or pulseless VT
 After 3. shock give 5mg/kg
 After 5. shock give 5mg/kg
 Infusion pump (dose?)


25. Drugs during CPR
Calcium
Hypocalcaemia
 Calcium channel blockers overdose
 Hypermagnesaemia
 Hyperkalaemia


26. Drugs during CPR
Glucose

Only in hypoglycaemia

27. Drugs during CPR
Magnesium
Hypomagnesaemia
 Torsade de Pointes


28. Drugs during CPR
Sodium bicarnonate
Do not give it routinely
 Hyperkalaemia
 Tricyclic antidepressant drug overdose


29. Special circumstances
Channelopathy (?)
 Blunt or penetrating trauma
(thoracotomy)
 Single ventricle


30. Post arrest management
Myocardial dysfunction (vasoactive
drugs)
 Temperature control (therapeutic
hypothermia 32-34 Celsius)
 Glucose control


31. Resuscitation of babies at
birth
Relatively few babies need any
resuscitation
 Majority require only assisted lung
aeration
 Minority need chest compressions


33. Classification to initial
assessment
Vigorous breathing or crying/good
tone/HR>100/min (no intervention)
 Breathing inadequately/normal or
reduced tone/HR<100/min (dry, mask
ventilation, chest compressions
possible)
 Breathing inadequately/floppy/low heart
rate(dry,mask ventilation, chest
compressions,drugs)


34. Apgar score

35. Airway
Neutral head position
 Suction not recommended (only if
there’s meconium in the airways)


36. Breathing

37. Circulatory support
After the lungs are inflated
 HR<60/min-start chest compressions
 Compression/Ventilation=3:1


38. Drugs

39. Adrenaline
Adequate ventilation and chest
compression but HR<60/min
 10-30ug/kg i.v.
 Tracheal route (not reccomended): 50100ug/kg


40. Bicarbonate
???
 1-2mmol/kg
 Not recommended


41. Fluids

10ml/kg bolus

42. When to stop CPR?
If there’s no detectable heart rate, after 1015 min

43. Specific questions
Normal temperature
 Meconium (use suction)
 Air or 100% O2 (in term infants start
ventilation with air)
 Time of cord clamping (1min, if CPR is
not necessary)
 LMA can be used
