حدیث امام على عليه السلام

2. حدیث امام على عليه السلام • رُبِّ عالِمٍ قَد قَتَلَهُ جَهلُهُ ، وَ عِلمُهُ مَعَهُ لا ینفَعُهُ؛ • چه بسیارند دانشمندانی که جهلشان آنها را کشته در حالی که علمشان با آنهاست، اما به حالشان سودی نمی دهد.

3. Pediatric Resuscitation Adel Ahadi ,MD

4. Assessment • 30 second rapid cardiopulmonary assessment is structured around ABCDE’s. • Airway • Breathing • Circulation • Disability • Exposure

5. Heimlich for Infants 5 back blow 5 Chest thrusts

6. Clearing the Mouth

7. Heimlich for children> 1year

8. Airway • Airway must be clear and patent for successful ventilation. • Position • Suction • Administration of oxygen • Bag-mask ventilation

9. Airway Management Head Tilt-Chin Lift Jaw Thrust Avoid extreme hyperextension

10. Breathing • Breathing is assessed to determine the child’s ability to oxygenate. • Assessment: • Respiratory rate • Respiratory effort • Breath sounds • Skin color

11. Breathing Look-Listen-Feel

13. Bag-Mask Ventilation • Clear, plastic mask with inflatable rim provides atraumatic seal • Proper area for mask application-bridge of nose extend to chin • Maintain airway pressures <20 cm H2O • Place fingers on mandible to avoid compressing pharyngeal space • Hand on ventilating bag at all times to monitor effectiveness of spontaneous breaths • Continous postitive pressure when needed to maintain airway patency

16. Circulation • In infants  1 finger breadth below intermammary line • 2 fingers or thumbs encircling • At least 100/minute • 1/3 to 1/2 of chest Brachial or femoral pulse is used to check for pulse

17. Circulation • In older children  the lower third of the sternum • Maintain continuous head tilt with hand on forehead • One hand • 100/minute • 1/3 to 1/2 of chest Carotid pulse is used to check for pulse

18. Intubation • Indications • Failure to oxygenate • Failure to ventilate • Failure to protect the airway • Anticipation of worsening clinical course

19. Tracheal Tube- size and depth? Children > 1 year: ETT size: (Age+16)/4 ETT depth (lip): ETT size x 3

20. Laryngoscope Blades Better in younger children with a floppy epiglottis Straight

21. Laryngoscope Blades Better in older children who have a stiff epiglottis Curved

23. Confirmation of ETT Placement • Seeing tube go through cords • Clinical Confirmation • Water vapor seen inside tube • O2 Saturation • Chest rise • Equal breath sounds • No sounds over epigastrium • CO2 Detection / Esophageal Detector Devices • Chest X-ray NO single technique is 100% reliable

24. Acute Deterioration after Intubation D.O.P.E: Displacement Obstruction Pneumothorax Equipment failure

25. Inadequate Improvement after Intubation? • Inadequate Tidal Volume • Excessive Leak Around The Tube • Leak or Disconnection in Ventilator System • Inadequate PEEP • Inadequate O2 Flow from Gas Source • Air Trapping and Impaired Cardiac Output

26. Routes for Drugs in CPR • Intravascular • Intraosseous • Endotracheal (LANE) • LIDOCAINE • ATROPINE • NALOXONE • EPINEPHRINE • Note: flush each medication with 3-5 ml of NS

27. IV Solutions • Crystalloid solution • Normal saline 20ml/kg bolus over 20 minutes • Lactated ringers

28. Vascular Access – New Guidelines • New guidelines: in children who are six years or younger after 90 seconds or 3 attempts at peripheral intravenous access – Intraosseous vascular access in the proximal tibia or distal femur should be initiated.

30. Glucose • 10% to 25% strength • Action: increases glucose in hypoglycemia • Dosing: 0.5 – 1 g/kg

31. Pediatric Resuscitation Fluids & Medications • Epinephrine(a&badrenergic stimulator) • Actions: vasoconstriction, increases contractility, heart rate, relaxes smooth muscle • Uses: cardiac arrest, symptomatic bradycardia, hypotension • Dose: 0.01mg/kg (0.1ml/kg of 1:10,000 solution) • May repeat every 3-5min • Continuous 0.1-1mg/kg/min

32. Amiodarone • Used in atrial and ventricular antiarrhythmic • Action: slows AV nodal and ventricular conduction, increase the QT interval and may cause vasodilation. • Dosing: IV/IO: 5 mg / kg bolus

33. Adenosine • Drug of choice of symptomatic SVT • Action: blocks AV node conduction for a few seconds to interrupt AV node re-entry • Dosing • First dose: 0.1 mg/kg max 6 mg • Second dose: 0.2 mg/kg max 12 mg

34. Pediatric Resuscitation Fluids & Medications • Sodium Bicarbonate • Uses: severe metabolic acidosis with effective ventilation, hyperkalemia, hypermagnesemia, tricyclic poisoning • Dose: 1mEq/kg (1ml/kg of 8.4%) IV • may repeat every 10min • Side effects: metabolic alkalosis, impaired O2 release, pseudo-hypokalemia, hypocalcemia, decreased VF threshold, Na+/water overload

35. Pediatric Resuscitation Fluids & Medications • Calcium Chloride • Uses: hypocalcemia, hyperkalemia, hypermagnesemia, Ca+ channel blocker overdose • Dose: 20mg/kg of CaCl 10% • Administer over 10-20 seconds • Flush before and after administration • May cause bradycardia

36. Pediatric Resuscitation Fluids & Medications • Dopamine (dopamine & b adrenergic stimulator) • Uses: inadequate cardiac output, hypotension, enhanced splanchnic blood flow & urine output • Dose: 2 to 20mg/kg/min • May cause tachycardia, arrhythmias, and hypertension

37. Pediatric Resuscitation Fluids & Medications • Naloxone • Narcotic antagonist • Reverses effects of respiratory depression, sedation, hypotension, hypoperfusion • Dose: 0.1mg/kg; 2mg for children over 5yo or 20kg • May abruptly reverse narcotic depression • Nausea, tachycardia, hypertension, tremulousness, seizures, arrhythmias, asystole, pulmonary edema

38. Pediatric Arrest • Most often respiratory • Lone-rescuer • 5 cycles CPR, then activate EMS • Two-rescuer CPR • 15 :2

39. PALS Tachycardia Algorithm

40. Pediatric ALS • No vasopressin or atropine • Pediatric AED attenuator if available • IO access if no IV

41. PALS Bradycardia Algorithm

42. THE END