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European Resuscitation Council. Summary Causes of cardiorespiratory arrest BLS sequence in...
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Transcript of European Resuscitation Council. Summary Causes of cardiorespiratory arrest BLS sequence in...
European Resuscitation CouncilEuropean Resuscitation Council
Summary
Causes of cardiorespiratory arrestBLS sequence in paediatricsAED in childrenForeign body airway obstruction relieve
BLS
Recognition of a person in cardiac or respiratory arrest
Delivery of oxygen to vital organs by CPRWithout the use of adjuncts
Paediatric cardiorespiratory arrest
Secondary to hypoxia, acidosis, inappropriate perfusion
Terminal Rhythm: Bradycardia, Pulseless Electrical Activity → Asystole
Out-of-hospital arrest is « hypoxic and hypercapnic with respiratory arrest preceding asystolic cardiac arrest»
Comparison with adult arrest
Ventricular Fibrillation in children is more rare than in adult 6-9% to 15-24% (SIDS excl) of cardiac arrest
Secondary to metabolic anomaly : 4H/4THypothermia TamponadeHypoxia Toxics - drugsHyper/hypokalaemia Thrombo-embolismHypovolaemia Tension-
pneumothorax
Activation of the EMS system
In child less than 8 years
All: Drowning, Trauma, Poisonning
Single rescuer summons help (EMS)
after one minute of BLS
“call fast”
Activation of the EMS system
In child older than 8 years All: Witnessed sudden collapse,
Known cardiopathySingle rescuer summons help (EMS) immediately to provide rapid access
to AED
“call first”
SSafetyafety
Ensure rescuer’s safety firstThen ensure victim’s safety (even
trauma)Use barrier devices (infectious diseases)Look for clues of what has caused the
emergency
SStimulatetimulate
Establish responsiveness Never shake a child
Tactile stimulation• Maintaining C-spine (stabilise forehead)• Shake arm or tug hair
Verbal stimulation• Child’s name• “Wake up”• “Are you alright”
SShout for assistancehout for assistance
Single rescuer: shouts for help while remaining with the child and starts CPR
Multiple rescuers: one rescuer provides BLS while one rescuer activates EMS system
Airway
Head tilt-chin lift
To open the airway, lift the tongue that occludes the AW by
Neutral position More head extension
Airway
Jaw thrust
To open the airway, lift the tongue that occludes the AW by
Checking the airway
Look into the mouth Ensure no foreign body is presentRemove with ONE gentle finger sweepAvoid blind finger sweep
(further impaction, soft tissue damage)
Breathing
Check breathing: Look, Listen, FeelFor up to10 seconds
If the childIf the child
Is breathing spontane-
ously and effectively
Maintain AWSummon helpPlace in recovery
position
Has no detectable,
spontaneous, effective
breathingDeliver rescue breaths
Rescue Breaths
Deliver up to 5 breaths to ensure 2 effective
Slow breath : 1 to 1.5 second each Minimise gastric distension Optimise oxygen delivered
Deep rescuer’s breath between each rescue breath Optimise amount of oxygen Minimise amount of expired CO2
Rescue Breaths
Mouth-to-mouth and nose technique
Rescue Breaths
Mouth-to-mouth technique
CCirculationirculationAssess for signs of circulation
For up to 10 secondsPulse
Brachial or femoral pulse in infant
Carotid pulse in childSigns of life
Cough Movement Normal breathing (no gasp)
If signs of circulation areIf signs of circulation are
Absent or pulse is very
slow + poor perfusionDeliver external chest
compression Depress 1/3 to ½ of A/P Ø
thorax Rate : 100/min (actual 60-80
min) Ratio : 5 compressions for
1 rescue breath
Found
Reassess breathingGive rescue breaths
(20 cpm)Reassess
CCirculationirculation
ECC in Infant
Two-fingers technique Two-thumbs technique
CCirculationirculation
ECC in Child < 8 years
CCirculationirculation
ECC in Child > 8 years
Ratio 15:2
RReassess
ECC produces a palpable central pulseReassess briefly after one minute and
summon helpContinue CPR non-stop
Activate EMS System
Take the child with you to continue CPRInformations
Detailed location, phone number Type of accident, number and age of
victims Severity and urgency (ALS) Confirm reception of message
Duration of CPR
ROSC and spontaneous respirationQualified team arrivesRescuer exhausted
Automated External Defibrillator (AED)
Evaluates the victim’s ECGDetermines if a “shockable”
rhythm is presentCharges the “appropriate” doseWhen activated by operator,
delivers a shockProvides synthesised voice
prompts to assist the operator
AED in children?Class Indeterminate recommendation in children < 8 years
Recommended (Class IIb) for children older than 8 years in the pre-hospital setting (ILCOR 2000) Most arrests in young children are of respiratory origin In this class of age arrests rhythms are mainly
asystole and PEA VF may occur in up to 25% of cardiac arrest when
SIDS are excluded Prompt defibrillation is the definitive treatment for VF
and pulseless VT CPR remains the most important step of Paeds-BLS
Recommendation (Circulation 2003; July)
ILCOR consensus statement for AED in children May be used for children 1-8 years of age with no
signs of circulation Should deliver a child dose Arrhythmia detection algorithm with high specificity
for paediatric shockable rhythms (i.e not recommend shock delivery for non-shockable rhythms)
Insufficient evidence to support recommendation for or against the use of AEDs in children < 1 year of age
For single rescuer, 1 minute of CPR before any other action (i.e. activating EMS or AED attachment)
Defibrillation is recommended for documented VF/pulseless VT. (Class I)
FBAO in conscious victim
Assess breathing adequacy
If conscious level
deteriorated
5 Abdominal Thrusts
5 BackBlows
Assess Airway
CHILD
Unconscious FBAO
Algorithm
5 BackBlows
5 Chest Thrusts
Assess Airway
INFANT
FBAO in unresponsive child
Unable to achieve chest
movements on 5 attempts of
breaths
Unconscious Victim
5 Back Blows
5 Chest Thrusts
Check mouth
Open Airway
Attempt 5 Rescue Breaths
5 Back Blows
5 Chest thrusts
Open Airway
Check mouth
Attempt 5 Rescue Breaths
5 Abdominal
Thrusts
Recovery positionTo avoid the back-fall of the tongue in the
pharynx and hence obstruction of AWTo avoid risk of aspiration of vomit,
secretions…
Recovery position
Principles As near a true lateral position as possible Patent airway maintained Child easily observed and monitored Child stable cannot roll over Free drainage of vomit/secretion No pressure on chest (impeding breathing) Can be turn easily on their back for BLS
?
ConclusionsWe discuss about…
•Results of BLS
•Sequence of Paeds-BLS
•Use of AED in children
•FBAO