Phil Jevon qualified as an RGN in He worked on CCU between the years and during which time he gained considerable experience in coronary care nursing. Holding the hospital cardiac arrest bleep, he attends paediatric arrests. Read an Excerpt Click to read or download. See All Customer Reviews.
Shop Textbooks. Read an excerpt of this book! Add to Wishlist. USD Sign in to Purchase Instantly. Temporarily Out of Stock Online Please check back later for updated availability. Once spontaneous circulation is restored, a continuous infusion of adrenaline may be required. Its haemodynamic effects are dose-related; there is also considerable variability in response between children; therefore, titrate the infusion dose to the desired effect.
High infusion rates may cause excessive vasoconstriction, so compromising extremity, mesenteric, and renal blood flow. High-dose adrenaline can cause severe hypertension and tachyarrhythmias. Adrenaline and other catecholamines is inactivated by alkaline solutions and should never be mixed with sodium bicarbonate. Amiodarone is a non-competitive inhibitor of adrenergic receptors: it depresses conduction in myocardial tissue and therefore slows AV conduction, and prolongs the QT interval and the refractory period.
Lidocaine has been suggested by COSTR as an alternative but most practitioners will have followed the guidance that has stated amiodarone is the drug of choice. The European Resuscitation Council advises that the clinician should use the drug with which they are familiar and for which they have knowledge of expected and unexpected listed side effects. Lidocaine is a commonly used local anaesthetic as well as being a Class-1b antiarrhythmic drug. Toxicity can occur if there is underlying renal or hepatic disease. Atropine accelerates sinus and atrial pacemakers by blocking the parasympathetic response.
It may also increase AV conduction. Atropine is recommended only for bradycardia caused by increased vagal tone or cholinergic drug toxicity. Calcium is essential for myocardial function, but the routine use of calcium does not improve the outcome from cardiopulmonary arrest. Data from neonates, children and adults indicate that both hyper- and hypo- glycaemia are associated with poor outcome after cardiopulmonary arrest, and but it is uncertain if this is causative or merely an association.
Do not give glucose-containing fluids during CPR unless hypoglycaemia is present. There is no evidence for giving magnesium routinely during cardiopulmonary arrest.
There is no clear evidence for giving sodium bicarbonate routinely during cardiopulmonary arrest. Sodium bicarbonate may also be considered in case of haemodynamic instability and co-existing hyperkalaemia, or in the management of tricyclic antidepressant drug overdose. Excessive quantities of sodium bicarbonate may impair tissue oxygen delivery and cause hypokalaemia, hypernatraemia, hyperosmolality and cerebral acidosis. It can be used in supraventricular tachycardia SVT and or VT resistant to other medications in the haemodynamically stable child.
However, paediatric data are sparse and procainamide should be used cautiously. Vasopressin is an endogenous hormone that acts at specific receptors, mediating systemic vasoconstriction via V 1 receptor and the reabsorption of water in the renal tubule by the V 2 receptor. Some studies have reported that terlipressin a long-acting analogue of vasopressin with comparable effects improves haemodynamics in children with refractory, vasodilatory septic shock, but its impact on survival is less clear.
Defibrillators are either automated or manually operated, and may be capable of delivering either monophasic or biphasic shocks. Manual defibrillators capable of delivering the full energy requirements from neonates upwards must be available within hospitals and in other healthcare facilities caring for children at risk of cardiopulmonary arrest. Automated external defibrillators AEDs are pre-set for all variables including the energy dose.
Select the largest possible available paddles to provide good contact with the chest wall. The ideal size is unknown but there should be good separation between the pads. To decrease skin and thoracic impedance, an electrically conducting interface is required between the skin and the paddles. Preformed gel pads or self-adhesive defibrillation electrodes are effective and are recommended for maximal delivery of the energy.
Self-adhesive pads facilitate continuous good quality CPR. Apply the paddles firmly to the bare chest in the antero-lateral position, one paddle placed below the right clavicle and the other in the left axilla Fig. If the paddles are too large and there is a danger of charge arcing across the paddles, one should be placed on the upper back, below the left scapula and the other on the front, to the left of the sternum. This is known as the antero-posterior position and is also acceptable. The ideal energy dose for safe and effective defibrillation is unknown. Biphasic shocks are at least as effective and produce less post-shock myocardial dysfunction than monophasic shocks.
If no manual defibrillator is available, use an AED that can recognise paediatric shockable rhythms. For children older than 8 years, use a standard AED with standard paddles. Experience with the use of AEDs preferably with dose attenuator in children younger than 1 year is limited; its use is acceptable if no other option is available. A, B and C: Commence and continue with basic life support. The reversible causes of cardiac arrest can be considered quickly by recalling the 4Hs and 4Ts:. If signs of life become evident, check the monitor for an organised rhythm; if this is present, check for signs of life and a central pulse and evaluate the haemodynamics of the child blood pressure, peripheral pulse, capillary refill time.
Position the cardiac monitor leads or self-adhesive pads soon as possible to enable differentiation between a shockable and a non-shockable cardiac rhythm. Defibrillation paddles can be used to determine a rhythm if monitor leads or self-adhesive pads are not immediately available. Invasive monitoring of systemic blood pressure may help to improve the effectiveness of chest compression if present but it must never delay the provision or hamper the quality of basic or advanced resuscitation.
Shockable rhythms are pVT and VF. These rhythms are more likely after sudden collapse in children with heart disease or in adolescents. Most cardiopulmonary arrests in children and adolescents are of respiratory origin. It commonly follows a period of hypoxia or myocardial ischaemia, but occasionally can have a reversible cause i. Primary VF occurs in 3. It has a much poorer prognosis than primary VF.
Extracorporeal life support should be considered for children with cardiac arrest refractory to conventional CPR with a potentially reversible cause, if the arrest occurs where expertise, resources and sustainable systems are available to rapidly initiate extracorporeal life support ECLS. Check for signs of life and the central pulse of any child with an arrhythmia; if signs of life are absent, treat as for cardiopulmonary arrest. If the child has signs of life and a central pulse, evaluate the haemodynamic status.
Whenever the haemodynamic status is compromised, the first steps are:. Cardiac pacing either transvenous or external is generally not useful during resuscitation. It may be considered in cases of AV block or sinus node dysfunction unresponsive to oxygenation, ventilation, chest compressions and other medications; pacing is not effective in asystole or arrhythmias caused by hypoxia or ischaemia. If SVT is the likely rhythm, vagal manoeuvres Valsalva or diving reflex may be used in haemodynamically stable children.
They can also be used in haemodynamically unstable children, but only if they do not delay chemical or electrical cardioversion. Adenosine is usually effective in converting SVT into sinus rhythm. It is given by rapid, intravenous injection as close as practicable to the heart see above , and followed immediately by a bolus of normal saline. If the child has signs of decompensated shock with depressed conscious level, omit vagal manoeuvres and adenosine and attempt electrical cardioversion immediately.
Electrical cardioversion synchronised with R wave is also indicated when vascular access is not available, or when adenosine has failed to convert the rhythm. If unsuccessful, give amiodarone or procainamide under guidance from a paediatric cardiologist or intensivist before the third attempt. Verapamil may be considered as an alternative therapy in older children but should not be routinely used in infants. Amiodarone has been shown to be effective in the treatment of SVT in several paediatric studies. If the child is haemodynamically stable, early consultation with an expert is recommended before giving amiodarone.
An expert should also be consulted about alternative treatment strategies because the evidence to support other drugs in the treatment of SVT is limited and inconclusive. In children, wide-QRS complex tachycardia is uncommon and more likely to be supraventricular than ventricular in origin. Ventricular tachycardia occurs most often in the child with underlying heart disease e. Synchronised cardioversion is the treatment of choice for unstable VT with signs of life.
Consider anti-arrhythmic therapy if a second cardioversion attempt is unsuccessful or if VT recurs. Amiodarone has been shown to be effective in treating paediatric arrhythmias, although cardiovascular side effects are common. Whilst maintaining the child's airway, breathing and circulation, contact an expert before initiating therapy. Depending on the child's clinical history, presentation and ECG diagnosis, a child with stable, wide-QRS complex tachycardia may be treated for SVT and be given vagal manoeuvres or adenosine.
Cardiac arrest from major blunt or penetrating trauma is associated with a very high mortality. There is little evidence to support any additional specific interventions that are different from the routine management of cardiac arrest; however, the use of resuscitative thoracotomy may be considered in children with penetrating injuries. For infants and children with a cardiac diagnosis and an in-hospital arrest ECMO should be considered as a useful rescue strategy if sufficient expertise and resources are available.
There is insufficient evidence to suggest for or against the use of ECMO in non-cardiac arrest or for children with myocarditis or cardiomyopathy who are not in arrest. There is an increased risk of cardiac arrest in children with pulmonary hypertension. After prolonged, complete, whole-body hypoxia-ischaemia ROSC has been described as an unnatural pathophysiological state, created by successful CPR.
Myocardial dysfunction is common after cardiopulmonary resuscitation. Although the measurement of blood pressure has limitations in determining perfusion of vital organs, it is a practical and valued measurement of haemodynamic status. Alternative perfusion endpoints such as serum lactate levels, measures of cardiac output, mean blood pressure can be targeted but the evidence for each of them individually is still equivocal.
The optimal strategy to avoid hypotension i. The need to use agents to maintain a normal blood pressure is a poor prognostic factor. Finally, subgroups of children might respond differently to components of the above interventions, such as cardiac patients or trauma patients who may be particularly sensitive to preload status and changes in afterload. Any interventions must be monitored and adapted according to the child's physiological responses. Reassessment of the child is key in improving their outcome.
It is sensible to aim in general for normocapnia, although this decision might be in part influenced by context and disease. For instance, it is unclear if a strategy of permissive mild hypercapnia could be beneficial in ventilated children with respiratory failure. Mild hypothermia has an acceptable safety profile in adults and and neonates.
Furthermore, hyperthermia occurred frequently in the post-arrest period; hyperthermia is potentially harmful and should be avoided. Both hyper- and hypoglycaemia may impair outcome of critically ill adults and children and should be avoided, , , and but tight glucose control may also be harmful. Although several factors are associated with outcome after cardiopulmonary arrest and resuscitation there are no simple guidelines to determine when resuscitative efforts become futile. The role of the EEG as a prognostic factor is still unclear. Problems with the literature in this area to identify individual factors are that the studies have largely not been designed in this context and therefore there may be bias as to its use in determining poor or good outcomes.
Guidance on the termination of resuscitation attempts is discussed in the chapter on Ethics in Resuscitation and End-of-Life Decisions. In some Western societies, the majority of parents want to be present during the resuscitation of their child. Furthermore, they may have the opportunity to say goodbye to their child.
Families who are present at their child's death show better adjustment and undergo a better grieving process. Parental presence in the resuscitation room may help healthcare providers maintain their professional behaviour, whilst helping them to see the child as a human being and a family member. When parents are in the resuscitation room, a member of the resuscitation team should be allocated to them and explain the process in an empathetic manner, ensuring that they do not interfere with or distract the resuscitation process.
If the presence of the relatives is impeding the progress of the resuscitation, they should be sensitively asked to leave. When appropriate, physical contact with the child should be allowed and, wherever possible, the parents should be allowed to be with their dying child at the final moment. The leader of the resuscitation team, not the parents, will decide when to stop the resuscitation; this should be expressed with sensitivity and understanding. After the event, the team should be debriefed, to enable any concerns to be expressed and for the team to reflect on their clinical practice in a supportive environment.
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Paediatric Advanced Life Support A Practical Guide for Nurses 2nd Edition
Paediatric life support. Resuscitation, October , Pages - Introduction These guidelines on paediatric life support are based on three main principles: 1 the incidence of critical illness, particularly cardiopulmonary arrest, and injury in children is much lower than in adults; 2 the illnesses and pathophysiological responses of paediatric patients often differ from those seen in adults; 3 many paediatric emergencies are managed primarily by providers who are not paediatric specialists and who have limited paediatric emergency medical experience.
Summary of changes since Guidelines Guideline changes have been made in response to convincing new scientific evidence and, by using clinical, organisational and educational findings, they have been adapted to promote their use and ease for teaching. Management of foreign bodies in the airway. Prevention of cardiac arrest. Advanced life support during cardiac arrest. Post resuscitation care. In managing the seriously ill child If there are no signs of septic shock, then children with a febrile illness should receive fluid with caution and reassessment following its administration.
In some forms of septic shock, restricting fluids with isotonic crystalloid may be better than the liberal use of fluids. In the paediatric cardiac arrest algorithm Many of the features are now common with adult practice. In post resuscitation care Preventing fever in children who have return of spontaneous circulation ROSC from an out-of-hospital setting. Targeted temperature management of children post ROSC should comprise treatment with either normothermia or mild hypothermia.
There is no single predictor for when to stop resuscitation. Terminology In the following text the masculine includes the feminine and child refers to both infants and children unless noted otherwise. BLS for those with a duty to respond The following sequence is to be followed by those with a duty to respond to paediatric emergencies usually health professionals Fig.
Rescue breaths for an infant Fig. Take a breath and cover the mouth and nose of the infant with your mouth, making sure you have a good seal. If the nose and mouth cannot be covered in the older infant, the rescuer may attempt to seal only the infant's nose or mouth with his mouth if the nose is used, close the lips to prevent air escape.
Maintain head position and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out. Take another breath and repeat this sequence five times. Rescue breaths for a child over 1 year of age Fig. Pinch the soft part of the nose closed with the index finger and thumb of your hand on his forehead.
Allow the mouth to open, but maintain chin lift.
Paediatric Advanced Life Support - Philip Jevon - Häftad () | Bokus
Take a breath and place your lips around the mouth, making sure that you have a good seal. Maintain head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out. Identify effectiveness by seeing that the child's chest has risen and fallen in a similar fashion to the movement produced by a normal breath.
For both infants and children, if you have difficulty achieving an effective breath, the airway may be obstructed: Open the child's mouth and remove any visible obstruction. Do not perform a blind finger sweep. Reposition the head. Ensure that there is adequate head tilt and chin lift but also that the neck is not over-extended. If head tilt and chin lift has not opened the airway, try the jaw thrust method.
Make up to five attempts to achieve effective breaths, if still unsuccessful, move on to chest compressions. Chest compressions For all children, compress the lower half of the sternum. Chest compression in infants Fig. Chest compression in children over 1 year of age Fig 65 and Fig 66 To avoid compressing the upper abdomen, locate the xiphisternum by finding the angle where the lowest ribs join in the middle.
More healthcare workers arrive and can either assist or take over. You become exhausted. When to call for assistance It is vital for rescuers to get help as quickly as possible when a child collapses. When more than one rescuer is available, one starts resuscitation while another rescuer goes for assistance. To minimise interruption in CPR, it may be possible to carry an infant or small child whilst summoning help.
If you are on your own, witness a child suddenly collapse and you suspect a primary cardiac arrest, call for help first and then start CPR as the child will likely need urgent defibrillation. This is an uncommon situation. Recovery position An unconscious child whose airway is clear, and who is breathing normally, should be turned on his side into the recovery position. There are important principles to be followed. Place the child in as near true lateral position as possible, with his mouth dependent, which should enable the free drainage of fluid.
Pals (Pediatric Advanced Life Support) Provider Manual And Pals Course Guide
The position should be stable. In an infant, this may require a small pillow or a rolled-up blanket to be placed along his back to maintain the position, so preventing the infant from rolling into either the supine or prone position Avoid any pressure on the child's chest that may impair breathing. It should be possible to turn the child onto his side and back again to the recovery position easily and safely, taking into consideration the possibility of cervical spine injury by in-line cervical stabilisation techniques.
Regularly change side to avoid pressure points i. The adult recovery position is suitable for use in children. Foreign body airway obstruction FBAO Back blows, chest thrusts and abdominal thrusts all increase intra-thoracic pressure and can expel foreign bodies from the airway. Recognition of foreign body airway obstruction When a foreign body enters the airway the child reacts immediately by coughing in an attempt to expel it. Conscious child with FBAO If the child is still conscious but has absent or ineffective coughing, give back blows.
A seated or kneeling rescuer should be able to support the infant safely across their lap. Support the infant's head by placing the thumb of one hand, at the angle of the lower jaw, and one or two fingers from the same hand, at the same point on the other side of the jaw. Do not compress the soft tissues under the infant's jaw, as this will worsen the airway obstruction. Deliver up to five sharp back blows with the heel of one hand in the middle of the back between the shoulder blades. The aim is to relieve the obstruction with each blow rather than to give all five.
A small child may be placed across the rescuer's lap as with the infant. If this is not possible, support the child in a forward leaning position and deliver the back blows from behind. This is achieved safely by placing your free arm along the infant's back and encircling the occiput with the hand.
Support the infant down your arm, which is placed down or across your thigh. Identify the landmark for chest compressions on the lower half of the sternum, approximately a finger's breadth above the xiphisternum. Give five chest thrusts; these are similar to chest compressions but sharper and delivered at a slower rate. Clench your fist and place it between the umbilicus and the xiphisternum. Grasp this hand with the other hand and pull sharply inwards and upwards. Repeat up to five times. Ensure that pressure is not applied to the xiphoid process or the lower rib cage—this may cause abdominal trauma.
Do not leave the child at this stage; proceed as follows: Airway opening Open the mouth and look for any obvious object. Follow the sequence for single rescuer CPR step 7B above for approximately a minute or 5 cycles of 15 compressions to 2 ventilations before summoning the EMS if this has not already been done by someone else. When the airway is opened for attempted delivery of rescue breath, check if the foreign body can be seen in the mouth.
If an object is seen and can be reached, attempt to remove it with a single finger sweep. If it appears the obstruction has been relieved, open and check the airway as above; deliver rescue breaths if the child is not breathing. If the child regains consciousness and exhibits spontaneous effective breathing, place him in a safe position on his side recovery position and monitor breathing and the level of consciousness whilst awaiting the arrival of the EMS.
Paediatric advanced life support Assessment of the seriously ill or injured child—The prevention of cardiopulmonary arrest In children, secondary cardiopulmonary arrests, caused by either respiratory or circulatory failure, are more frequent than primary arrests caused by arrhythmias. A indicates airway. B indicates breathing. C indicates circulation. D indicates disability. E indicates exposure. The signs of respiratory failure, as features of those physiological responses, may include: Respiratory rate outside the normal range for the child's age—either too fast or too slow.
Additional noises such as stridor, wheeze, crackles, grunting, or the loss of breath sounds. Decreased tidal volume marked by shallow breathing, decreased chest expansion or decreased air entry at auscultation. These are detectable in step C of the assessment and include: Increasing tachycardia compensatory mechanism to increase tissue oxygen delivery. Bradycardia an ominous indicator of the loss of compensatory mechanisms. Alteration in the level of consciousness a sign that compensatory mechanisms are failing owing to poor perfusion of the brain. Diagnosing circulatory failure: Assessment of C Circulatory failure is characterised by a mismatch between the metabolic demand by the tissues, and the delivery of oxygen and nutrients by the circulation.
Signs of circulatory failure might include: Increased heart rate bradycardia is an ominous sign of physiological decompensation. Decreased peripheral perfusion prolonged capillary refill time, decreased skin temperature, pale or mottled skin —signs of increased vascular resistance.
Bounding pulses, vasodilation with widespread erythema may be seen in conditions with decreased vascular resistance. Weak or absent peripheral pulses. Decreased intravascular volume. Decreased urine output. Other systems may be affected, for example: The respiratory rate may be increased initially, as an attempt to improve oxygen delivery, later becoming slower; this is usually accompanied by decompensated circulatory failure. The level of consciousness may decrease owing to poor cerebral perfusion. Poor cardiac functioning can lead to other signs, such as pulmonary oedema, enlarged liver, raised jugular veins.
Diagnosing cardiopulmonary arrest Signs of cardiopulmonary arrest include: Unresponsiveness to pain coma. Apnoea or gasping respiratory pattern. Absent circulation. Pallor or deep cyanosis. Management of respiratory and circulatory failure In children, there are many causes of respiratory and circulatory failure and they may develop gradually or suddenly.
Optimise ventilation. For intubated children, it is standard practice that their end tidal carbon dioxide levels are monitored. End tidal carbon dioxide monitoring can be used in non-intubated critically ill patients. Very rarely, a surgical airway may be required. Secure intravascular access. This may be achieved by peripheral intravenous IV or by intraosseous IO route.
If already in situ, a central intravenous catheter should be used. Consider carefully the use of fluid bolus in primary cardiac functioning disorders, e. Do not give a fluid bolus in severe febrile illness when circulatory failure is absent. Blood gas and lactate measurement may be helpful. Airway Open the airway by using basic life support techniques. Supraglottic airways devices SADs including LMA Although BVM ventilation remains the recommended first line method for achieving airway control and ventilation in children, the SADs represent a range of acceptable airway devices that may assist providers trained in their use.
Tracheal intubation Tracheal intubation is the most secure and effective way to establish and maintain the airway, prevent gastric distension, protect the lungs against pulmonary aspiration, enable optimal control of the airway pressure and provide positive end expiratory pressure PEEP. Tracheal tube sizes Table 6. Cuffed versus uncuffed tracheal tubes Uncuffed tracheal tubes have been used traditionally in children up to 8 years of age but cuffed tubes may offer advantages in certain circumstances e.
Confirmation of correct tracheal tube placement Displaced, misplaced or obstructed tubes occur frequently in the intubated child and are associated with an increased risk of death. Detection of end-tidal CO 2 preferably by capnography or by capnometry or colorimetry if the child has a perfusing rhythm this may also be seen with effective CPR, but it is not completely reliable. Observation of symmetrical chest wall movement during positive pressure ventilation. Observation of mist in the tube during the expiratory phase of ventilation. Absence of gastric distension. Equal air entry heard on bilateral auscultation in the axillae and apices of the chest.
Absence of air entry into the stomach on auscultation. Improvement or stabilisation of SpO 2 in the expected range delayed sign! Improvement of heart rate towards the age-expected value or remaining within the normal range delayed sign! Breathing Oxygenation Give oxygen at the highest concentration i. Ventilation Healthcare providers commonly provide excessive ventilation during CPR and this may be harmful. Bag mask ventilation BMV Bag mask ventilation BMV is effective and safe for a child requiring assisted ventilation for a short period, i.
Monitoring of breathing and ventilation 1. Peripheral pulse oximetry, SpO 2 Clinical evaluation to determine the degree of oxygenation in a child is unreliable; therefore, monitor the child's peripheral oxygen saturation continuously by pulse oximetry. Circulation Vascular access Vascular access is essential to enable drugs and fluids to be given, and blood samples obtained. Intravenous access and other routes Peripheral IV access provides plasma concentrations of drugs and clinical responses equivalent to central or IO access.
Fluids and drugs When a child shows signs of circulatory failure caused by hypovolaemia, controlled volume administration is indicated. Atropine Atropine accelerates sinus and atrial pacemakers by blocking the parasympathetic response. Calcium Calcium is essential for myocardial function, but the routine use of calcium does not improve the outcome from cardiopulmonary arrest.
Glucose Data from neonates, children and adults indicate that both hyper- and hypo- glycaemia are associated with poor outcome after cardiopulmonary arrest, and but it is uncertain if this is causative or merely an association. Magnesium There is no evidence for giving magnesium routinely during cardiopulmonary arrest. Sodium bicarbonate There is no clear evidence for giving sodium bicarbonate routinely during cardiopulmonary arrest. Vasopressin—Terlipressin Vasopressin is an endogenous hormone that acts at specific receptors, mediating systemic vasoconstriction via V 1 receptor and the reabsorption of water in the renal tubule by the V 2 receptor.
Defibrillators Defibrillators are either automated or manually operated, and may be capable of delivering either monophasic or biphasic shocks. Position of the paddles Apply the paddles firmly to the bare chest in the antero-lateral position, one paddle placed below the right clavicle and the other in the left axilla Fig. Energy dose in children The ideal energy dose for safe and effective defibrillation is unknown. Advanced management of cardiopulmonary arrest Fig. Give one shock. Resume CPR as soon as possible without reassessing the rhythm.
Give adrenaline every alternate cycle i. Cardiac monitoring Position the cardiac monitor leads or self-adhesive pads soon as possible to enable differentiation between a shockable and a non-shockable cardiac rhythm. Non-shockable rhythms Most cardiopulmonary arrests in children and adolescents are of respiratory origin.
Shockable rhythms Primary VF occurs in 3. Extracorporeal life support Extracorporeal life support should be considered for children with cardiac arrest refractory to conventional CPR with a potentially reversible cause, if the arrest occurs where expertise, resources and sustainable systems are available to rapidly initiate extracorporeal life support ECLS. Arrhythmias Unstable arrhythmias Check for signs of life and the central pulse of any child with an arrhythmia; if signs of life are absent, treat as for cardiopulmonary arrest.
Whenever the haemodynamic status is compromised, the first steps are: 1 Open the airway. Tachycardia Narrow complex tachycardia If SVT is the likely rhythm, vagal manoeuvres Valsalva or diving reflex may be used in haemodynamically stable children. Wide complex tachycardia In children, wide-QRS complex tachycardia is uncommon and more likely to be supraventricular than ventricular in origin.
Stable arrhythmias Whilst maintaining the child's airway, breathing and circulation, contact an expert before initiating therapy. Special circumstances Life support for blunt or penetrating trauma Cardiac arrest from major blunt or penetrating trauma is associated with a very high mortality. Extracorporeal membrane oxygenation ECMO For infants and children with a cardiac diagnosis and an in-hospital arrest ECMO should be considered as a useful rescue strategy if sufficient expertise and resources are available.
Pulmonary hypertension There is an increased risk of cardiac arrest in children with pulmonary hypertension. Post-resuscitation care After prolonged, complete, whole-body hypoxia-ischaemia ROSC has been described as an unnatural pathophysiological state, created by successful CPR. Myocardial dysfunction Myocardial dysfunction is common after cardiopulmonary resuscitation.
Temperature control and management post ROSC Mild hypothermia has an acceptable safety profile in adults and and neonates. Glucose control Both hyper- and hypoglycaemia may impair outcome of critically ill adults and children and should be avoided, , , and but tight glucose control may also be harmful. Prognosis of cardiopulmonary arrest Although several factors are associated with outcome after cardiopulmonary arrest and resuscitation there are no simple guidelines to determine when resuscitative efforts become futile.
Parental presence In some Western societies, the majority of parents want to be present during the resuscitation of their child. Conflict of interest statement The authors declare no conflict of interest. References 1 D. Zideman, R. Bingham, T. Beattie, et al. Guidelines for paediatric life support: a statement by the paediatric life support working party of the European Resuscitation Council. Paediatric life support: including the recommendations for resuscitation of babies at birth.
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