paediatric resuscitation..pptx

Paediatric resuscitation

1. Paediatric Resuscitation Dr S Chipiro

2. Session Objectives Identify at risk children requiring resuscitation Familiarize with the General Approach Resuscitation Demonstrate skills for paediatric resuscitation Understand the importance of teamwork and effective communication during resuscitation 2

3. Definition R esuscitation is a series of actions which are used to assist or revive babies from a potential or apparent death .

4. Resuscitation General Approach

5. Anticipation STAY PREPARED FOR RESUSCITATION Recognise risk factors Communicate during patient transfer Sometimes the need for resuscitation can be predicted, but often it cannot,

6. REQUIREMENTS ,

7. POLICY Displayed Familiarised with Criteria for resuscitation Duties of team members

8. FURNISHED SPACE Clean environment, Water, Soap, gloves Firm stable surface and good lighting Overheard radiant warmer, Room temperature at > 25 degrees C Oxygen supply ( humidified/heated/ blended if possible ) Timer/clock Working Suction

9. SKILLED PERSONNEL A multidisciplinary team. Trained according to accepted standard of care Ongoing training and refresher course Available at point of care Teamwork Communication

10. EMERGENCY TROLLEY DEFIBRILLATOR Bag valve mask device-240-250ml + reservoir bag Face masks of different size Oropharyngeal airways Portable Oxygen supply Stethoscope and a torch Pulse oximeter Suction devices and catheters timer/clock ET tubes , laryngeal mask, introducers, Suction devices Laryngoscope with straight blade, extra batteries Drugs, IV fluids,

11. , Check resuscitation trolley every shift and after each resuscitation

12. Equipment

13. ,

14. Equipment

15. Check and Assemble Ambubag

16. Assessment Rapid assessment and triaging of babies Safety, stimulate and shout Need for resuscitation must be identified immediately Safety is important especially in an external environment because the rescuer should not become the second victim. Stimulate - gently shake and ask e.g. Are you alright? Summon someone to call for help while you start resuscitation. If alone call for help yourself if no one comes within a minute of CPR. If in a hospital, help is usually a shout away

17. REMEMBER As you identify the problems in ABC you rectify them

18. Airway Open the airway – head tilt/chin lift or jaw thrust Neutral position in infants and sniffing position in children Check patency -LOOK, LISTEN and FEEL. Look for chest movement Listen for breath sounds with ear just above the nose Feel the breath on your cheek above the mouth Use Oropharyngeal airways, ETT etc where required

19. Open airway

20. B REATHING Assess effort of breathing Count the respirations Auscultate for breath sounds Listen for stridor / wheeze Assess skin colour Attach a saturation probe

21. Respiratory rate according to age at rest ,

22. Breathing If patient’s airway is patent and patient breathing-turn the child to his/her side and put him/her in recovery position and maintain the open airway. If breathing is still ineffective, start Positive pressure ventilation

23. Positive pressure ventilation Indications Apnoeic/gasping HR<100b/min Decision to start PPV should be made within a minute

24. Position the head in neutral position -use towel under shoulders; jaw thrust, chin lift Position the mask on the face Firm seal between the mask and the face Squeeze bag to produce a gentle chest rise Give 30-40 breaths per minute. Increasing heart rate is a sign of successful oxygenation Monitor SPO2 if possible How to ventilate with bag and mask Note ‘C’ or ‘E’ grip

25. Appropriate Face mask size

26. Use of oxygen Start ventilating with room air If O2 not available continue ventilating with room air If no improvement in HR, colour connect to oxygen If lone helper do not stop resuscitation to look for oxygen Increase gradually to maintain targeted saturations

27. Troubleshooting If no response to PPV -check airway- position,seal -obstruction>>>suction -pneumothorax? -check equipment

28. Circulation Aim to Improve cardiac output Start chest compressions if ● No signs of life-no movement, not coughing ,absent or abnormal breathing ● No pulses- use brachial in infants and carotid or femoral in children ● Pulse less than 60b/minute

29. Chest Compressions Technique Hand encircling technique-infants 2 finger technique- For lone rescuer Two hands or the one hand technique- Older children.

30. Chest compressions Compress the lower half of the sternum to a depth of at least one third of the chest diameter Chest wall should completely recoil before the next compression. Ratio 15: 2 for all age groups Compressions should be continuous because pausing unnecessarily will decrease coronary perfusion pressure to zero and several compressions will be required before adequate coronary perfusion recurs. Rate of 100-120beats/minute for all ages

31. Hand Encircling Technique ,

32. Two finger technique ,

33. Advanced Resuscitation Endotracheal Intubation Drugs Glucometer

34. Endotracheal Intubation Indications Ineffective or prolonged bag and mask ventilation Special circumstances eg diaphragmatic hernia The need for ongoing mechanical ventilation

35. Tube size and level of insertion Weight Tube size Level (at the lip) <1000g 2,5 6,5-7 1000-2000g 3,0 7-8 2000-3000g 3,5 8-9 3000-4000g 3,5-4 9-10,5 Weight (kg) + 6cm = depth (cm)

36. Drugs Adrenaline 1:10 000 -0.1ml/kg iv -1ml/kg via trachea 10% Dextrose- - 2-4mls/kg iv Normal saline -if no response to resusc and evidence of volume loss/shock - 10ml/kg over 30 mins up to 2 boluses, monitor response Naloxone -0.1mg/kg( 0.25mls/ hr ) im /iv

37. Post Resuscitation Care Continue monitoring of vital signs in all babies Admit /Refer Keep baby warm Continue support measures during transportation Counsel the parents Document Review

38. When to call of resuscitation Consider stopping if: No spontaneous respirations/gasping after 20 mins of effective resuscitation No HR or HR <60b/min after 10 mins of effective resuscitation

39. When not to resuscitate Consider not starting when: Futile -dead baby,lethal anomalies Poor prognosis -BW<500g -trisomy 13/18

40. Summary Resuscitation is a basic life saving skill that we should all possess and keep perfecting. It is an art and science Anticipation and preparedness Teamwork Reviewing Keep parents informed Ongoing training-simulations/drills Don’t miss the demonstration

41. Acknowledgements , Department of Paediatrics SMCH Department of Paediatrics Mpilo Hospital MOHCC Family Health Department MOHCC Manicaland Province Paediatric Association of Zimbabwe American Academy of Paediatrics Helping Babies Breathe course Liverpool School of Tropical Medicine: Life Saving Skills Course UNICEF Zimbabwe