Difference between revisions of "Pediatric Basic Life Support(BLS) Special situations"

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{{CMG}}; {{AE}} {{Neepa Shah}}  
 
{{CMG}}; {{AE}} {{Neepa Shah}}  
 
==Overview==
 
==Overview==
Pediatric Basic Life Support is a life-saving skill comprising of high quality [[CPR (Cardiopulmonary Resuscitation)]] and Rescue Breadths with [[Artificial External Defibrillator (AED)]].  
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[[Pediatric]] [[Basic]] [[Life]] [[Support]] is a life-saving skill comprising of high quality [[CPR (Cardiopulmonary Resuscitation)]] and Rescue Breadths with [[Artificial External Defibrillator (AED)]].  
* Bystander CPR - Bystander resuscitation plays a key role in out of hospital CPR. A study by Maryam Y Naim et all <ref name="pmid27837587">{{cite journal| author=Naim MY, Burke RV, McNally BF, Song L, Griffis HM, Berg RA | display-authors=etal| title=Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry. | journal=JAMA Pediatr | year= 2017 | volume= 171 | issue= 2 | pages= 133-141 | pmid=27837587 | doi=10.1001/jamapediatrics.2016.3643 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27837587  }} </ref> found out communities, where bystander CPR is practiced, have better survival outcomes in children less than 18 years from out of hospital cardiac arrest(CA)
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* [[Bystander]] [[CPR]] - Bystander [[resuscitation]] plays a key role in out of hospital [[CPR]]. A study by Maryam Y Naim et all <ref name="pmid27837587">{{cite journal| author=Naim MY, Burke RV, McNally BF, Song L, Griffis HM, Berg RA | display-authors=etal| title=Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry. | journal=JAMA Pediatr | year= 2017 | volume= 171 | issue= 2 | pages= 133-141 | pmid=27837587 | doi=10.1001/jamapediatrics.2016.3643 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27837587  }} </ref> found out communities, where bystander [[CPR]] is practiced, have better [[survival]] outcomes in [[children]] less than 18 years from out of hospital [[cardiac]] [[arrest]] [CA]
  
* Two studies (Total children 781) concluded that about half of the Cardio-Respiratory arrests in children under 12 months occur outside the hospital.
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* Two studies (Total children 781) concluded that about half of the [[Cardio]] - [[Respiratory]] [[arrests]] in children under 12 months occur outside the hospital.
*Good Prognostic Factor upon arrival at the emergency department-
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*Good [[Prognostic]] Factor upon arrival at the emergency department-
 
**The short interval between arrest and arrival at the hospital.
 
**The short interval between arrest and arrival at the hospital.
 
**Less than 20 minutes of resuscitation in the emergency department.
 
**Less than 20 minutes of resuscitation in the emergency department.
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==Special situations==
 
==Special situations==
  
=== '''Resuscitation in special circumstances'''<ref name="pmid20956229">{{cite journal| author=Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW | display-authors=etal| title=Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2010 | volume= 122 | issue= 18 Suppl 3 | pages= S862-75 | pmid=20956229 | doi=10.1161/CIRCULATIONAHA.110.971085 | pmc=3717258 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956229  }} </ref>===
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=== '''Resuscitation in special circumstances'''<ref name="pmid20956229">{{cite journal| author=Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW | display-authors=etal| title=Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2010 | volume= 122 | issue= 18 Suppl 3 | pages= S862-75 | pmid=20956229 | doi=10.1161/CIRCULATIONAHA.110.971085 | pmc=3717258 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956229  }} </ref> ===
  
 
'''Child with a tracheostomy tube or stoma.'''
 
'''Child with a tracheostomy tube or stoma.'''
*The caregiver (Parents, nurse, or teacher) should be trained in how to use the tracheostomy tube.
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*The [[caregiver]] (Parents, nurse, or teacher) should be trained in how to use the [[tracheostomy]] tube.
*If there is a cardiac arrest in a child with a tracheostomy start immediately CPR with compressions followed by ventilation of 2 rescue breaths.
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*If there is a cardiac arrest in a child with a tracheostomy start immediately [[CPR]] with [[compressions]] followed by [[ventilation]] of 2 rescue breaths.
 
*Ventilation
 
*Ventilation
**Give rescue breaths from mouth to a tracheostomy tube, if the chest does not rise to suction the tube, if still there is no chest rise then can give mouth to stoma ventilation or bag-mask ventilation if available.
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**Give rescue breaths from mouth to a tracheostomy tube, if the chest does not rise to suction the tube, if still there is no chest rise then can give mouth to stoma ventilation or [[bag]] - [[mask]] [[ventilation]] if available.
 
'''Child with spinal trauma'''
 
'''Child with spinal trauma'''
 
*Steps to follow in a pediatric trauma case with cardiac arrest.
 
*Steps to follow in a pediatric trauma case with cardiac arrest.

Revision as of 12:35, 1 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Neepa Shah, M.B.B.S.[2]

Overview

Pediatric Basic Life Support is a life-saving skill comprising of high quality CPR (Cardiopulmonary Resuscitation) and Rescue Breadths with Artificial External Defibrillator (AED).

  • Two studies (Total children 781) concluded that about half of the Cardio - Respiratory arrests in children under 12 months occur outside the hospital.
  • Good Prognostic Factor upon arrival at the emergency department-
    • The short interval between arrest and arrival at the hospital.
    • Less than 20 minutes of resuscitation in the emergency department.
    • Less than 2 doses of epinephrine.[2]

References

  1. Naim MY, Burke RV, McNally BF, Song L, Griffis HM, Berg RA; et al. (2017). "Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry". JAMA Pediatr. 171 (2): 133–141. doi:10.1001/jamapediatrics.2016.3643. PMID 27837587.
  2. Sahu S, Kishore K, Lata I (2010). "Better outcome after pediatric resuscitation is still a dilemma". J Emerg Trauma Shock. 3 (3): 243–50. doi:10.4103/0974-2700.66524. PMC 2938489. PMID 20930968.


Special situations

Resuscitation in special circumstances[1]

Child with a tracheostomy tube or stoma.

  • The caregiver (Parents, nurse, or teacher) should be trained in how to use the tracheostomy tube.
  • If there is a cardiac arrest in a child with a tracheostomy start immediately CPR with compressions followed by ventilation of 2 rescue breaths.
  • Ventilation
    • Give rescue breaths from mouth to a tracheostomy tube, if the chest does not rise to suction the tube, if still there is no chest rise then can give mouth to stoma ventilation or bag - mask ventilation if available.

Child with spinal trauma

  • Steps to follow in a pediatric trauma case with cardiac arrest.
  • Look for airway obstruction.
  • If there is bleeding try to tie a tourniquet and apply external pressure.
  • If spinal trauma is suspected try to avoid cervical spine movement.
    • In spinal trauma ventilation should be done with caution apply jaw thrust and do not tilt head.
    • If the jaw thrust is not successful then one rescuer would minimize the motion of the cervical spine and the other rescuer should attempt to give rescue breadth by head still and chin lift method.
    • To achieve a neutral position for a child while in supine posture a study by Nypaver M et all[2] mentions that the back needs to be elevated in children less than 7 years.
    • In children less than 7 years its found that they have a disproportionately large head compared to their full bodies and when in a supine position the neck gets flexed.
      • To prevent cervical motion changes should be made to the backboard.
      • Changes like Raise the chest by putting a double mattress pad or use a recess for the occiput to lower the head. [3]

Child drowning[1]

  • The rescuer should try to get the drowning child as soon as possible out of the water and start CPR after checking pulse and ventilation.
  • If the rescuer has training in In water resuscitation start ventilation in water

Below is the IWR (In Water Resuscitation) guidelines[4]

  • Check if the child is breathing or conscious in the water.
    • If the child is breathing quickly swim back and get the child out of the water.
    • If the child is not breathing then give rescue breaths if spinal trauma is suspected then try to immobilize the spine while opening the airway and try to reach the shore as soon as possible.
    • If the distance to reach the shore is more than 5 minutes, try to give one more rescue breath 12-16 breaths/minute.

References

  1. 1.0 1.1 Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW; et al. (2010). "Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S862–75. doi:10.1161/CIRCULATIONAHA.110.971085. PMC 3717258. PMID 20956229.
  2. Nypaver M, Treloar D (1994). "Neutral cervical spine positioning in children". Ann Emerg Med. 23 (2): 208–11. doi:10.1016/s0196-0644(94)70032-x. PMID 8304600.
  3. Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA (1989). "Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous". J Bone Joint Surg Am. 71 (1): 15–22. PMID 2912996.
  4. Szpilman D, Soares M (2004). "In-water resuscitation--is it worthwhile?". Resuscitation. 63 (1): 25–31. doi:10.1016/j.resuscitation.2004.03.017. PMID 15451583.

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