Automated External

Defibrillation

DAN Paediatric Module

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AED – PAEDIATRIC MODULE Objectives

• Causes of Paediatric Cardiac Arrest

• Frequency of the problem

• Reliability of the system

• AED use in children

• Paediatric Pads

• Pad Placement

• Paediatric Skills

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AED – PAEDIATRIC MODULE Causes of Paediatric Cardiac Arrest

• Some causes of cardiac arrest in children include:

• sudden infant death syndrome (SIDS)

• trauma

• motor vehicle accident

• electrocution

• drowning

• overdose / poisoning

• illness

• congenital heart disease

• choking or airway compromise

• a hard blow to the chest has also been known to cause cardiac arrest –

as when a child is playing sports

Automated External Defibrillation Paediatric Module

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AED – PAEDIATRIC MODULE Frequency of the problem

• Cardiac arrest is less common in children than adults, and its causes are more diverse

• There is very little information on what goes on in the first few minutes of a paediatric cardiac arrest

• In typical emergency care situations involving children, monitoring equipment is not attached until late in the response

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AED – PAEDIATRIC MODULE Frequency of the problem

Automated External Defibrillation Paediatric Module

• Typical respiratory arrest treatment protocols focus on airway management and rescue breathing

• If a child moves into cardiac arrest as a result of the respiratory arrest, the focus must turn to getting the heart started again

• Airway procedures are not enough

• AEDs represent the only opportunity rescuers have to establish a normal heart rhythm prior to the arrival of advanced cardiac life support

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AED – PAEDIATRIC MODULE Reliability of the System

• Researchers tested HeartStart’s Patient Analysis System on a database of 696 human paediatric rhythms for:

• Sensitivity (deciding to deliver a shock)

• Specificity (correctly deciding not to shock)

• The system recognized VF 96 percent of the time (sensitivity) and specificity was 100 percent – both well above the European Resuscitation Council (ERC) goals for AEDs

• The unit never chose to deliver a shock based on a rhythm that did not require one

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AED – PAEDIATRIC MODULE AED use in children

Energy dose in children

• The ideal energy dose for safe and effective defibrillation is unknown

• For children 1 to 8 years of age, it is reasonable to use a pediatric dose-attenuator system if one is available. If the rescuer provides CPR to a child in cardiac arrest and does not have an AED with a pediatric attenuator system, the rescuer should use a standard AED.

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AED – PAEDIATRIC MODULE Paediatric AED Pads

• Many manufacturers now supply purpose-made paediatric pads or programmes

• Most of them have an attenuator that automatically reduces the energy coming out of the defibrillator, delivering a lower energy shock

• For instance with a FR2+ Paediatric Pads from Philips the child receives a shock of 50 joules instead of the 150 joules delivered to adults

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AED – PAEDIATRIC MODULE Paediatric AED Pads

If Paediatric AED pads are not available, it is acceptable – although not ideal – to use adult AED pads on a child in cardiac arrest.

You cannot use Paediatric AED pads on an adult.

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AED – PAEDIATRIC MODULE Paediatric AED Pads

Optimal pad force

• To decrease transthoracic impedance during defibrillation, the pads should be applied firmly

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AED – PAEDIATRIC MODULE Paediatric AED Pads

• Paediatric pads come in various colours

• Removes confusion about which pads to use on a child

• Alleviates (or reduces) concerns from the least experienced and most stressed responder

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AED – PAEDIATRIC MODULE Paediatric Pad Placement

Automated External Defibrillation Paediatric Module

• When performed correctly both antero-posterior (A/P) and antero-lateral pad positions work equally well

• Most rescuers find it easier to use the A/P pad position when working with small children

• A/P is recommended because of the child’s small chest

Skill Development

Session

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SKILL DEVELOPMENT SESSION Paediatric CPR Review

• Ensure your safety and the safety of the child • Unresponsive?

• Shout for help • Open airway

• Breathing is not normal or absent? • 5 rescue breaths • Look for signs of life • Start CPR

• 30 compressions / 2 rescue breaths • Continue CPR until signs of life:

• starts to wake up, to move, opens eyes and to breath normally

When alone go and call for help after 1 minute CPR

Skill Development Session

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SKILL DEVELOPMENT SESSION Proper Pad Placement

• Place one pad vertically on the upper back, below the left scapula

• Place the second pad on the front of the child’s chest, to the left of the sternum

• Proper pad positioning and contact are very important

• Make sure pads are positioned correctly

Skill Development Session

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SKILL DEVELOPMENT SESSION Providing Care with an AED

• Attach the paediatric defibrillator pads to the child and the AED

• Allow the AED to analyse heart rhythm

• Don't touch the child

Skill Development Session

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SKILL DEVELOPMENT SESSION Providing Care with an AED

• If shock is required:

• Follow the AED unit’s prompts.

• Visually and physically clear the patient.

• State “I’m clear. You’re clear. All clear.”

• Administer shock.

• Resume CPR for 2 minutes. The AED will automatically reanalyse after this period

• Continue CPR and follow AED prompts until normal breathing resumes or EMS arrives

Skill Development Session

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AED – PAEDIATRIC MODULE Summary

• Program rationale

• Causes of Paediatric Cardiac Arrest

• Frequency of the problem

• Reliability of the system

• Paediatric Pads

• Pad Placement

• Skills

Automated External Defibrillation Paediatric Module