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การ ดูแลรักษาผุ้ป่วยฉุกแนในทารกและเด็ก PowerPoint PPT Presentation


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การ ดูแลรักษาผุ้ป่วยฉุกแนในทารกและเด็ก. นท . หญิง แสนดี สันตะกุล. Systematic Approach to the Seriously I ll or Injured C hild. ระบบหายใจ ปัญหานำ หัวใจหยัดกระทันหัน ระบบการไหลเวียนเลือด (หัวใจเต้นผิดจังหวะ). ภาวะหายใจลำบาก. การหายใจล้มเหลว. ภาวะ shock.

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2159517

.


Systematic approach to the seriously i ll or injured c hild

Systematic Approach to the Seriously Ill or Injured Child

()

shock

(arrest)


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1.

2.

3.

4.

5.


C b c

(C-B-C)


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,

yes

no

O2

yes

no

PR < 60 /min

yes

no

Primary survey

Secondary survey

Laboratory

CPR

C-A-B

cardiac

arrest


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,

1 3

2

> 60/min

10

< 60/min

,poor capillary refill

CPR

: 30 : 2

:15 : 2

AED /defibrillator

shock

2

CPR PALS


High quality cpr

High-Quality CPR

  • 5

  • : 1/3 1 (4) 2 (5) 1

  • : 100 /

  • : complete chest recoil

  • :

  • : excessive ventilation/ hyperventilation


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: 1 (4) 1 : 2 (5)


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SAMPLE : S=symptoms & signs, A=allergies, M=medications, P=past medical history

L=last meal, E=events


Primary assessment

Primary assessment


Airway

Airway ()


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  • ____1_______

    4

  • (C 3-4) subglottic area subglottic


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  • head-tilt-chin lift

    ( jaw thrust)


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  • 100 120 .

  • 100%

  • 15-20


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Complete obstruction

Partial obstruction

CPR

Heimlick /back blow and chest thrush


Heimlich maneuver

Heimlich maneuver


5 back blow 5 chest compression

5 back blow/ 5 chest compression


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  • nasopharyngeal airway, oropharyngeal airway


Oral airway

oral airway

  • Mouth gag coma

    oral airway


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  • Endotracheal tube/ face mask with positive airway pressure


Breathing

Breathing ()


Breathing1

Breathing ()

(Apnea) 20 20


Breathing2

Breathing ()


Breathing3

Breathing ()

Stridor

  • Upper airway obstruction

  • Foreign body, epiglottitis, croup, airway edema,


Breathing4

Breathing ()

Wheezing

  • Lower airway obstruction

  • Acute bronchiolitis, asthma

  • inspiratory wheezing foreign body,

    Gurgling


Breathing5

Breathing ()

Crepitation / crackles

  • Pneumonia, pulmonary edema


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  • respiratory failure

  • croup, acute epiglottitis,foreign body


Croup

Croup

  • larynx

  • Laryngotrachobronchitis

  • Parainfluenza, RSV, Influenza

  • 6 - 3


Epiglottitis

Epiglottitis

  • H. influenzae

  • 3 6

  • classic


Acute epiglottitis

acute epiglottitis

  • epiglottis glottis


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  • stridor

  • (barking cough)


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Croup score > 4 : admit

  • Racemic epinephrine

  • Dexamethasone IM/IV

Croupscore > 7

  • /tracheostomy


Circulation

Circulation ()

  • cuff

  • cuff 2/3


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Capillary refill time

: < 2

: > 2

(, , )


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  • cell/ tissue hypoxia---anaerobic metabolism---- lactic acid CO2

  • -----

  • Multi-organ failure----


Compensated shock

Compensated shock

  • BP systolic BP

    HR SVR

    - Tachycardia -

    capillary refill < 2 sec

    -


Hypotensive shock

Hypotensive shock

  • systolic BP < 5th percentile BP

  • , ,


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  • intraosseous

  • : , , , capillary refill,


Hypovolemic shock

Hypovolemic shock

  • 3

  • 1

  • 1


Hypovolemic shock1

Hypovolemic shock


Fluid therapy

(Fluid therapy)

  • Isotonic crystalloid solution : NSS, LR

  • Colloid solution : 5%albumin, FFP, Dextran

  • isotonic crystalloid 20 ml/kg 5-20 20 ml/kg


Intraosseuous

Intraosseuous

  • medial aspect proximal tibia

  • set bone marrow aspiration

  • DTX, Elyte, blood gas, lactate

  • IV flush normal saline ( 5-10 )

  • 24 ( resuscitation) central line


Anaphylactic shock

Anaphylactic shock

  • : angioedema

  • : Adrenaline (1:1,000) 0.01 ml/kg IM

    0.3 mg 10-15

  • isotonic crystalloid, adrenaline infusion, antihistamine, bronchodilator, +/- corticosteroid


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  • Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid


Initial evaluation and resuscitation

Initial evaluation and resuscitation

  • Goal :

  • laryngospasm /

  • basic life support

  • CPR : A-B-C


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  • Airway :

  • Breathing :

  • ET-tube

  • Circulation :

  • abdominal thrusts regurgitation and aspiration

  • cervical collar


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  • CPR

  • CPR

  • : , ,

  • CPR 32-34C


Therapeutic hypothermia

Therapeutic hypothermia

  • 24-48

  • : 32-34C 12-24


Respiratory distress

Respiratory distress


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  • Simple febrile convulsion

  • : 3 5

  • 24

  • 15


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  • -

    - Diazepam 0.5 mg/kg

    - Diazepam 0.3 mg/kg


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  • ()

  • ( )


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Suspected poisoning child

Suspected poisoning child

  • 2


Suspected poisoning child1

Suspected poisoning child

  • /


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  • (Decontamionation)

    - (Ipecac syrup)

    - (Gastric lavage)

    - (Activated charcoal)

    - (Catharsis)

  • , ,


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  • Ipecac syrup

  • 20-30

  • 6-12 10 ml

  • 1-12 15 ml

  • 12 30 ml

  • , 6 , ,


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  • ,

  • gag reflex,


Activated charcoal

Activated charcoal

  • 1 g/kg 30 g 60-100ml

  • 2

  • hepatoenteral recirculation activated charcoal 4-6 3-4


Cathartics

(Cathartics)

  • activated charcoal

  • 20 % Magnesium sulfate 25 mg/kg 3

  • Magnesium citrate 10-20 ml

  • 70% Sorbitol 3-4ml/kg ( 3 35% Sorbitol 1.5-2 mg/kg)


Child abuse

(Child abuse)


Child abuse1

(Child abuse)

  • /


Child abuse2

(Child abuse)


Child abuse3

(Child abuse)


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  • frenulum


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  • /


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Thank you

Thank you


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