pediatric basic & advanced cardiopulmonary life support
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Introduction
Also see:
Management
- initiate cardiopulmonary resuscitation (CPR) if there are no signs of life & a pulse is not palpated within 10 seconds
- provide conventional CPR (chest compressions with rescue breathing)
- compress at least one third of the anterior-posterior dimension of the chest
- newborns with poor muscle tone & breathing & meconium in the amniotic fluid should receive CPR under a radiant warmer for faster oxygen delivery[2]
- consider using cuffed tracheal tubes in infants & young children
- cuff pressure should not exceed 25 cm H2O
- appropriate sized tubes by age are as follows:
- 3 mm for age 1 year
- 3.5 mm for age 1-2 years
- age in years/4 + 3.5 mm for age >2 years
- modify or discontinue cricoid pressure if it impedes preintubation ventilation or intubation
- monitor capnography to confirm endotracheal tube position, recognizing that end-tidal CO2 in infants & children might be below detectable limits for colorimetric devices (85% sensitivity & 100% specificity).
- consider use of an esophageal detector device in children weighing >20 kg.
- use capnography monitoring to assess effectiveness of chest compressions
- avoid excessive ventilation, which can decrease cerebral perfusion pressure, rates of return of spontaneous circulation (ROSC), & survival rates
- after ROSC, titrate oxygen concentration to limit the risk for toxic oxygen byproducts
- for pediatric septic shock, include therapy directed at normalizing central venous oxygen saturation to 70%
- do not routinely use bicarbonate or calcium for pediatric cardiac arrest: both agents are associated with decreased survival
More general terms
References
- ↑ Kleinman ME et al. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010 Nov; 126:e1261 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20956433
- ↑ 2.0 2.1 Physician's First Watch, Oct 20, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. (in 15 parts, see Table of Contents) Circulation November 3, 2015, Volume 132, Issue 18 suppl 2 http://circ.ahajournals.org/content/132/18_suppl_2.toc - ↑ Atkins DL, de Caen AR, Berger S, et al. 2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality. Circulation. 2017 Nov 6 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29114009 <Internet> http://circ.ahajournals.org/content/early/2017/11/06/CIR.0000000000000540.long