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EPLS

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  1. EPLS Paediatric Basic Life Support European Resuscitation Council

  2. Summary • Causes of cardiorespiratory arrest • BLS sequence in paediatrics • AED in children • Foreign body airway obstruction relieve

  3. BLS • Recognition of a person in cardiac or respiratory arrest • Delivery of oxygen to vital organs by CPR • Without the use of adjuncts

  4. Paediatric cardiorespiratory arrest • Secondary to hypoxia, acidosis, inappropriate perfusion • Terminal Rhythm: Bradycardia, Pulseless Electrical Activity → Asystole Out-of-hospital arrest is « hypoxic and hypercapnic with respiratory arrest preceding asystolic cardiac arrest»

  5. Comparison with adult arrest • Ventricular Fibrillation in children is more rare than in adult • 6-9% to 15-24% (SIDS excl) of cardiac arrest • Secondary to metabolic anomaly : 4H/4T • Hypothermia Tamponade • Hypoxia Toxics - drugs • Hyper/hypokalaemia Thrombo-embolism • Hypovolaemia Tension-pneumothorax

  6. Activation of the EMS system In child less than 8 years All: Drowning, Trauma, Poisonning Single rescuer summons help (EMS) after one minute of BLS “call fast”

  7. Activation of the EMS system In child older than 8 years All: Witnessed sudden collapse, Known cardiopathy Single rescuer summons help (EMS) immediately to provide rapid access to AED “call first”

  8. Safety • Ensure rescuer’s safety first • Then ensure victim’s safety (even trauma) • Use barrier devices (infectious diseases) • Look for clues of what has caused the emergency

  9. Stimulate Establish responsiveness Never shake a child • Tactile stimulation • Maintaining C-spine (stabilise forehead) • Shake arm or tug hair • Verbal stimulation • Child’s name • “Wake up” • “Are you alright”

  10. Shout for assistance • Single rescuer: shouts for help while remaining with the child and starts CPR • Multiple rescuers: one rescuer provides BLS while one rescuer activates EMS system

  11. Airway To open the airway, lift the tongue that occludes the AW by • Head tilt-chin lift Neutral position More head extension

  12. Airway To open the airway, lift the tongue that occludes the AW by • Jaw thrust

  13. Checking the airway • Look into the mouth • Ensure no foreign body is present • Remove with ONE gentle finger sweep • Avoid blind finger sweep (further impaction, soft tissue damage)

  14. Breathing Check breathing: Look, Listen, Feel For up to10 seconds

  15. Is breathing spontane- ously and effectively Maintain AW Summon help Place in recovery position Has no detectable, spontaneous, effective breathing Deliver rescue breaths If the child

  16. Rescue Breaths Deliver up to 5 breaths to ensure 2 effective • Slow breath : 1 to 1.5 second each • Minimise gastric distension • Optimise oxygen delivered • Deep rescuer’s breath between each rescue breath • Optimise amount of oxygen • Minimise amount of expired CO2

  17. Rescue Breaths • Mouth-to-mouth and nose technique

  18. Rescue Breaths • Mouth-to-mouth technique

  19. Circulation Assess for signs of circulation For up to 10 seconds • Pulse • Brachial or femoral pulse in infant • Carotid pulse in child • Signs of life • Cough • Movement • Normal breathing (no gasp)

  20. Found Reassess breathing Give rescue breaths (20 cpm) Reassess If signs of circulation are Absent or pulse is very slow + poor perfusion • Deliver external chest compression • Depress 1/3 to ½ of A/P Ø thorax • Rate : 100/min (actual 60-80 min) • Ratio : 5 compressions for 1 rescue breath

  21. Circulation ECC in Infant Two-fingers technique Two-thumbs technique

  22. Circulation ECC in Child < 8 years

  23. Circulation ECC in Child > 8 years Ratio 15:2

  24. Reassess • ECC produces a palpable central pulse • Reassess briefly after one minute and summon help • Continue CPR non-stop

  25. Activate EMS System • Take the child with you to continue CPR • Informations • Detailed location, phone number • Type of accident, number and age of victims • Severity and urgency (ALS) • Confirm reception of message

  26. Duration of CPR • ROSC and spontaneous respiration • Qualified team arrives • Rescuer exhausted

  27. Automated External Defibrillator (AED) • Evaluates the victim’s ECG • Determines if a “shockable” rhythm is present • Charges the “appropriate” dose • When activated by operator, delivers a shock • Provides synthesised voice prompts to assist the operator

  28. AED in children? Class Indeterminate recommendation in children < 8 years • Recommended (Class IIb) for children older than 8 years in the pre-hospital setting (ILCOR 2000) • Most arrests in young children are of respiratory origin • In this class of age arrests rhythms are mainly asystole and PEA • VF may occur in up to 25% of cardiac arrest when SIDS are excluded • Prompt defibrillation is the definitive treatment for VF and pulseless VT • CPR remains the most important step of Paeds-BLS

  29. Recommendation (Circulation 2003; July) ILCOR consensus statement for AED in children • May be used for children 1-8 years of age with no signs of circulation • Should deliver a child dose • Arrhythmia detection algorithm with high specificity for paediatric shockable rhythms (i.e not recommend shock delivery for non-shockable rhythms) • Insufficient evidence to support recommendation for or against the use of AEDs in children < 1 year of age • For single rescuer, 1 minute of CPR before any other action (i.e. activating EMS or AED attachment) • Defibrillation is recommended for documented VF/pulseless VT. (Class I)

  30. Assess Airway Assess Airway Assess breathing adequacy 5 Chest Thrusts 5 Abdominal Thrusts CHILD INFANT 5 Back Blows 5 Back Blows If conscious level deteriorated Unconscious FBAO Algorithm FBAO in conscious victim

  31. FBAO in unresponsive child Unconscious Victim Unable to achieve chest movements on 5 attempts of breaths Attempt 5 Rescue Breaths Attempt 5 Rescue Breaths Open Airway Open Airway 5 Back Blows 5 Back Blows Check mouth Check mouth 5 Chest Thrusts 5 Chest thrusts 5 Abdominal Thrusts

  32. Recovery position • To avoid the back-fall of the tongue in the pharynx and hence obstruction of AW • To avoid risk of aspiration of vomit, secretions…

  33. Recovery position • Principles • As near a true lateral position as possible • Patent airway maintained • Child easily observed and monitored • Child stable cannot roll over • Free drainage of vomit/secretion • No pressure on chest (impeding breathing) • Can be turn easily on their back for BLS

  34. ?

  35. Conclusions We discuss about… • Results of BLS • Sequence of Paeds-BLS • Use of AED in children • FBAO