ResuscitationResuscitation

The goal of resucitation is The goal of resucitation is

to maintain adequate oxygenation and perfusion.to maintain adequate oxygenation and perfusion.

An sequence of events should be instituted An sequence of events should be instituted beginning with thebeginning with the ABC ABC

Resuscitation (best survivalResuscitation (best survival))

Children with a respiratory arrest .Children with a respiratory arrest .

a short duration of CPR.a short duration of CPR.

and a pulse present at the time of apnea. and a pulse present at the time of apnea.

Signs and symptoms suggesting the Signs and symptoms suggesting the potential need for resuscitationpotential need for resuscitation

CNSCNS lethargy ,irritability ,confusionlethargy ,irritability ,confusion

Respiratory ; Respiratory ; apnea ,grunting ,nasal flaring ,tachypnea , apnea ,grunting ,nasal flaring ,tachypnea , poor air movement ,stridor ,wheesing poor air movement ,stridor ,wheesing

Signs and symptoms suggesting the potential Signs and symptoms suggesting the potential need for resuscitation (2)need for resuscitation (2)

Cardiovascular;Cardiovascular; Arrhythmia ,bradicardia, weak pulses ,poor Arrhythmia ,bradicardia, weak pulses ,poor

capillary refill , hypotention capillary refill , hypotention

Skin and mucous;Skin and mucous; Mottling , pallor , cyanosis , diaphresis , poor Mottling , pallor , cyanosis , diaphresis , poor

turgor , dry mucouse membranesturgor , dry mucouse membranes

ResuscitationResuscitation

Responsiveness: Responsiveness:

Gently shake if no injuryGently shake if no injury

Speak loudlySpeak loudly

Call out for helpCall out for help

Position the patientPosition the patient

Place supinePlace supine

Keep neck immobilizedKeep neck immobilized

ResuscitationResuscitation

Basic life support (BLS):Basic life support (BLS):

1.1. A A irway irway

2.2. B B reathing reathing

3.3. C C irculationirculation

Advanced life support (ADL)Advanced life support (ADL) AAirway irway BBreathing reathing CCirculation irculation DDruge&fluidruge&fluid

ABCABC

An sequence of events should be An sequence of events should be instituted beginning with the ABC :instituted beginning with the ABC :

Opening Opening AAirwayirway Assessing Assessing BBreathingreathing Assessing Assessing CCirculationirculation

Respiratory supportRespiratory support

Head tilt/chin lift or jaw thrust if the cervical Head tilt/chin lift or jaw thrust if the cervical spine is unstable .spine is unstable .

Looking for the rise and fall of the chest.Looking for the rise and fall of the chest.

Listening at the nose and mouth for Listening at the nose and mouth for breathingbreathing..

This should be done in the less than 10 This should be done in the less than 10 secondsseconds

Rescue breathing in an infantRescue breathing in an infant

Head tilt- chin lift maneuverHead tilt- chin lift maneuver

Combined jaw thrust-spine stabilization maneuverCombined jaw thrust-spine stabilization maneuver

Rescue breathing in a childRescue breathing in a child

MaskMask

Smallest size face Smallest size face maskmask

Large enough Large enough Resuscitation BaResuscitation Bagg

Assess for mask leakAssess for mask leak Monitor patient Monitor patient

responseresponse Sellick’s maneuverSellick’s maneuver O2O2

Sellick’s maneuverSellick’s maneuver

Compression of the cricoidCompression of the cricoid

cartilage backwardcartilage backward

compressing compressing the esophagus against the the esophagus against the

Vertebral to prevent aspirationVertebral to prevent aspirationOf gastric contentsOf gastric contents

Indication for endotracheal intubationIndication for endotracheal intubation

Apnea , Airway obstruction unrelieved by airway opening Apnea , Airway obstruction unrelieved by airway opening maneuvers.maneuvers.

Increased work of breathing that may lead to fatigue.Increased work of breathing that may lead to fatigue.

The need for PEEP The need for PEEP

Poor airway protective reflexes .Poor airway protective reflexes .

Sedation or the need for paralysisSedation or the need for paralysis

IntubationIntubation

LaryngoscopyLaryngoscopy

IntubationIntubation

reoxygenate with 100% O2reoxygenate with 100% O2 Gasteric tubeGasteric tube Check devicesCheck devices Position the patient Position the patient

ETT size (mm) =16+ age in yrETT size (mm) =16+ age in yr

44

ر ه هد بخداوندهاي ‌اي دانه‌پرن

د، ولي آن ‌ميدهل النهاش ‌را داخ

.اندازد‌نمي

Foreign body aspirationForeign body aspiration

A conscious child suspected a foreign A conscious child suspected a foreign body should be permitted to cough body should be permitted to cough spontaneously until:spontaneously until:

1.1. coughing is not effectivecoughing is not effective

2.2. Respiratory distress and stridor increaseRespiratory distress and stridor increase

3.3. the child becomes unconsciousthe child becomes unconscious

Foreign body aspirationForeign body aspiration

Abdominal thrusts with victim

Standing or sitting( conscious)

Foreign body aspirationForeign body aspiration

Neonatal resuscitationNeonatal resuscitation

High –risk situations should be anticipated High –risk situations should be anticipated byby::

history of the pregnancy .history of the pregnancy .

labor and delivery.labor and delivery.

identification of signs of fetal distress .identification of signs of fetal distress .

Neonatal resuscitationNeonatal resuscitation

5-10%require some degree of resuscitation5-10%require some degree of resuscitation

Goals are:Goals are:

1.1. prevent the prevent the morbidity and mortalitymorbidity and mortality with with hypoxic-ischemic injury .hypoxic-ischemic injury .

2.2. Re-establish adequate spontaneous Re-establish adequate spontaneous respiration and cardiac output respiration and cardiac output

Neonatal resuscitationNeonatal resuscitation

IF Persistent cyanosis or failure to ventilate or IF Persistent cyanosis or failure to ventilate or HR < 60HR < 60

Depressed respiratory neuromuscular.Depressed respiratory neuromuscular.

Airway malformation.Airway malformation.

Lung problem (pneumothorax –diaphragmatic Lung problem (pneumothorax –diaphragmatic hernia).hernia).

Congenital heart disease.Congenital heart disease.

Apgar evaluation of newbornApgar evaluation of newborn

Sign 0 1 2Sign 0 1 2

Heart rateHeart rate absent <100 >100 absent <100 >100

Respiratory effortRespiratory effort absent irregular,slow crying, good absent irregular,slow crying, good

Muscle toneMuscle tone limp some flextion active motion limp some flextion active motion

Response to catheterResponse to catheter no Grimace cough,sneeze no Grimace cough,sneeze

ColorColor blue,pale body pink completely pink blue,pale body pink completely pink

.انجامد، تالش نكردن است تنها راهي كه به شكست مي

Chest compressions in Infants(<1 y/o)Chest compressions in Infants(<1 y/o)

One finger below intermammary lineOne finger below intermammary line

3th&43th&4thth fingers on sternum fingers on sternum

1/3 to1/2 depth of chest1/3 to1/2 depth of chest

100 times per min.100 times per min.

5 Compressions to 1 ventilation5 Compressions to 1 ventilation

Chest compressions in Infants(<1 y/o)Chest compressions in Infants(<1 y/o)

Cardiac compressions Cardiac compressions ( infant)( infant)

هاي ‌براي انسانبستي وجود ‌بزرگ، بن

ندارد زيرا آنها بر اين باورند كه:

يا راهي خواهند يافت، يا

راهي خواهند ساخت.

Assess for signs of circulationAssess for signs of circulation Check pulse(3-5 sec.)Check pulse(3-5 sec.) Use brachial or femoral in infantsUse brachial or femoral in infants Use carotid in child>8 yrUse carotid in child>8 yr

Chest compressions:Chest compressions: neonate =120 1-8yr and>8 =100 neonate =120 1-8yr and>8 =100

Comprassion /ventilation:Comprassion /ventilation: neonate =3:1 1-8yr=5:1 neonate =3:1 1-8yr=5:1 >8yr=15:2 >8yr=15:2

Poor‌response‌to‌ventilation‌‌in‌neonates‌AND‌childrenPoor‌response‌to‌ventilation‌‌in‌neonates‌AND‌children‌may‌be‌due‌to‌may‌be‌due‌to

- - Loosely mask , Positioning of the tracheal tube , air in Loosely mask , Positioning of the tracheal tube , air in stomach stomach

--airway obstruction , insufficient pressure , pleural airway obstruction , insufficient pressure , pleural effusion. effusion.

asystole , hypovolemia asystole , hypovolemia pneumothorax,pneumothorax, diaphragmatic herniadiaphragmatic hernia

prolong intrauterine asphexiaprolong intrauterine asphexia

Medication in Medication in Neonatal resuscitationNeonatal resuscitation

Medications rarely requiredMedications rarely required ..

Medication‌should‌be‌administered‌:Medication‌should‌be‌administered‌:

if if HR is < than 60 /min after 30 secHR is < than 60 /min after 30 sec of ventilation of ventilation and chest compressionsand chest compressions . .

During asystole.During asystole.

Intra osseous infusionIntra osseous infusion

Intraosseous infusionIntraosseous infusion

Chest compressions in child(1-8 y/oChest compressions in child(1-8 y/o)) One fingerbreadth above xyphoid-sternal One fingerbreadth above xyphoid-sternal

marginmargin

Heel of handHeel of hand

Depth:2.5-4 cm.Depth:2.5-4 cm.

100 Times per min.100 Times per min.

5 Comp. / 1 Vent.5 Comp. / 1 Vent.

Chest compressionsChest compressions

Chest compressions in a childChest compressions in a child

Chest compressions in child(>8 y/o)Chest compressions in child(>8 y/o)

Two handsTwo hands

Depth : 3-5 cm.Depth : 3-5 cm.

80-100 Times per min.80-100 Times per min.

One rescuer: 5 Comp. / 1 Vent.One rescuer: 5 Comp. / 1 Vent.

Two rescuer: 15 Comp. / 2 VentTwo rescuer: 15 Comp. / 2 Vent..

Medication for cardiac arrestMedication for cardiac arrest

Epinephrine Epinephrine 0/01mg/kg iv/ io (1/10000=0/1cc/kg) 0/01mg/kg iv/ io (1/10000=0/1cc/kg)

0/1mg/kg ET (1/1000=0/1cc/kg) 0/1mg/kg ET (1/1000=0/1cc/kg)

Administer every3-5minAdminister every3-5min

Atropine Atropine 0/02mg/kg Min dose:0/1mg iv,io,ET0/02mg/kg Min dose:0/1mg iv,io,ET

Bicarbonate Bicarbonate 1mEq/kg infuse slowly if ventilation is adequate1mEq/kg infuse slowly if ventilation is adequate

Calcium gluconate Calcium gluconate 60-100mg/kg (0/6-1cc/kg) iv/io60-100mg/kg (0/6-1cc/kg) iv/io

Glucose(10%-25%)Glucose(10%-25%) 2-4cc/kg 2-4cc/kg

Brain deathBrain death

No spontaneous movement or interaction with enviromentNo spontaneous movement or interaction with enviroment

No response to stimuli ( pain ,light ,sound , touch ) No response to stimuli ( pain ,light ,sound , touch )

Absence of brain stem reflexesAbsence of brain stem reflexes

Apnea .Apnea .

All of the criteria should be present at least 6-24 hr after All of the criteria should be present at least 6-24 hr after coma and apnea . coma and apnea .

Silence EEG ,no hypothermia and cardiovascular shock and Silence EEG ,no hypothermia and cardiovascular shock and drug intoxicationdrug intoxication

Cardiovascular supportCardiovascular support

Chest compression must be given:Chest compression must be given:

1.1. If there is no pulse If there is no pulse

2.2. If the pulse is less than 60/min with poor If the pulse is less than 60/min with poor perfusionperfusion

Chest compressions are given without Chest compressions are given without interrupting ventilationinterrupting ventilation

"If you love life, life will love you back.""If you love life, life will love you back." !!