1 / 24

P ediatric A dvanced L ife S upport

P ediatric A dvanced L ife S upport. By R2 張家穎. 高級小兒救命術. 預防措施 早期 CPR 早期求救. 小兒生命之鏈. Basic Life Support. Pediatric assessment triangle A ppearance, B reathing, C irculation A irway B reathing C irculation D : disability, differential diagnosis E xposure. Appearance BC. T one

rafi
Download Presentation

P ediatric A dvanced L ife S upport

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pediatric Advanced Life Support By R2 張家穎

  2. 高級小兒救命術 預防措施早期CPR早期求救 小兒生命之鏈

  3. Basic Life Support • Pediatric assessment triangle Appearance, Breathing, Circulation • Airway Breathing Circulation D: disability, differential diagnosis Exposure.

  4. AppearanceBC • Tone • Interactiveness • Consolability • Look/Gaze • Speech/Cry TICLS

  5. ABreathingC • Nasal flaring. • 胸凹 • 點頭式呼吸 • Use of accessory muscles.

  6. ABCirculation • Pink • Pale • Mottling skin. • Cyanosis. • Capillary refill time: normal <2 sec. • DBP: 70+ age *2

  7. Ｃapillary refill time: Normal : <2 sec.

  8. 2nd assessment ABCDE

  9. AirwayBCDE • 建立呼吸道 • Nasal airway. Oral airway. • Endotracheal tube: size: 4+ age/4. 比較小朋友的小指頭 depth: 12+ age/2. or endo size *3. B.W.(Kg)+6 • LMA

  10. ABreathingCDE • Adequate ventilation. • Indications for endotracheal tube insertion: Fail to keep patent airway. Respiratory failure Severe shock GCS< 9 IICP

  11. ABCirculationDE~1 • Chest compression. (HR<60)

  12. ABCirculationDE~2 • HR: fast, slow, asystole • Fast: Stable Unstable narrow: drug: adenosin: 0.10.20.2 mg/Kg shock: synchronized shock: 0.51 J/Kg. wide: synchronized shock: 0.51 J/Kg. • Slow: HR<60, 常因缺氧, 低血壓或是酸血症所引起. 先弄好ventilation/oxygenation Chest compression Bosmin use: 0.1 mg/Kg via endo. 0.01 mg/Kg via IV. • Pulse(-): VT/VF: unsynchronized shock: 244J/Kg. PEA: 4H4T CCB is contraindicated!!! 電 電 電 藥 電 藥 電　 xylocaine: 1mg/kg. amiodarone 5mg/kg.

  13. ABCirculationDE~3 • Fluid bolus: 10~20 ml/Kg NS or LR • Transfusion: after 3 times of fluid challenge. 10~15 ml/Kg. • Inotropics use: Dopamine Dobutrex Primacor Levephed

  14. ABCDisabilityE • AVPU: Alert Voice Pain Unresponsive • Protect brain- Keep vital signs stable first. Avoid hypotension. hyperglycemia. hyperthermia. • 連續發作超過三十分鐘,而沒有恢復意識,即稱為癲間重積狀態, mortality達10~15%.

  15. ABCDExposure

  16. ＤＯＰＥ • D: Displacement • O: Obstruction. • P: pneumothorax. • E: equipment failure.

  17. Vascular acess.

  18. Newborn management • Oral suction. • 擦乾擺位. • PAT observation. • O2 supply and stimulation(摩擦背部,按摩腳底). • Positive pressure ventilation. • Chest compression. 3:1=90:30. • Endotracheal tube insertion. • On Umbilical vein and giving medication. If meconium presents?

  19. Trauma • Usually multiple organ trauma. FAST- subxiphoid, subcostal, suprapubic • Pneumothorax, hemothorax, pulmonary contussion.

  20. Permissive hypotension. • Blood product transfusion: PRBC: 10~15 ml/kg. PLT: 10~15 ml/kg. if plt<50,000. FFP: 10~15 ml/kg, if INR>1.5*. Cryo: 10~15 ml/kg, if fibrinogen <0.8 g/l • Adequate urine output: Infant: 2ml/kg/hr. child: 1.5 ml/kg/hr. adolescent: 0.5 ml/kg/hr.

  21. ~The End~ Thanks for your attension.

More Related