Pediatric Cardiac Arrest Management

Course overview

Objectives Describe the 2020 PALS updates Explain pediatric ALS responses and how they differ from adults Describe the chain of survival and EMS role in cardiac arrest response Content Introduction Newborn A recently born infant usually considered the first few hours of life Neonate Considered the first 28 days of life Initial Care of the Neonate Physiologic Response to Birth Respiratory adaptations Cardiovascular adaptations Temperature regulation Routine care Support Dry Warm Position Airway Stimulation Assessment Consider age related variations for pediatric and geriatric patients for assessment and management of cardiac compromise Pediatric Cardiac problems typically associated with congenital heart conditions Cardiovascular compromise often caused by respiratory compromise General pathophysiology assessment and management Epidemiology Incidence Approximately six percent of deliveries require life support Incidence of complications increases as birth weight decreases Morbidity and mortality Neonatal mortality risk can be determined via graphs based on birth weight and gestational age Resuscitation is required for about eighty percent of the thirty thousand babies who weigh less than fifteen hundred grams at birth Risk factors Antepartum factors Multiple gestation Inadequate prenatal care Mothers age under sixteen or over thirty five History of perinatal morbidity or mortality Post term gestation Drugs or medications Toxemia hypertension diabetes Perinatal infections Known fetal malformations high risk obstetric patient Intrapartum factors Premature labor Meconium stained amniotic fluid Rupture of membranes greater than eighteen hours prior to delivery Use of narcotics within four hours of delivery Abnormal presentation Prolonged labor or precipitous delivery Prolapsed cord Bleeding Treatment strategies Preparation of resuscitation equipment Determine appropriate destination Assessment of the newborn Time of delivery Normal or abnormal vital signs Airway and ventilation Respiratory rate Respiratory effort Circulation Heart rate Color and cyanosis Normal Central versus peripheral Mucosal membranes End organ perfusion Capillary refill Compare strength of central pulses versus peripheral APGAR Appearance skin color Completely pink score two Body pink extremities blue score one Blue or pale score zero Pulse rate Above one hundred score two Below one hundred score one Absent score zero Grimace irritability Cries score two Grimaces score one No response score zero Activity muscle tone Active motion score two Some flexion of extremities score one Limp score zero Respiratory effort Strong cry score two Slow and irregular score one Absent score zero Treatment Prior to delivery prepare environment and equipment During delivery suction mouth and nose as head delivers After delivery Airway and ventilation Drying Head and face Body Warming Appropriate techniques Minimize heat loss via head Position Suction Technique Equipment Bulb suction Mouth first then nares Nasal suctioning is a stimulus to breathe Suction catheters Meconium aspirator Stimulation Flicking soles of feet Stroking back Blow by oxygen Never withhold oxygen Oxygen should be warmed Use when Newborn is cyanotic Heart rate greater than one hundred Adequate respiratory rate and effort Five liters per minute maximum Complications due to hypothermia Direct rather than tangential flow on face Bag valve mask Mask characteristics Appropriate size Minimize dead space Bag characteristics Pop off valve should be disabled Risk of pneumothorax with excessive pressures Initial breath may require high pressures Use when Apneic Inadequate respiratory rate or effort Heart rate less than one hundred Technique Rate Initial ventilations require higher pressure to expand lungs Circulation Vascular access Indications Administer fluids Administer medications Peripheral vein cannulation Intraosseous cannulation Chest compressions in addition to