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pediatric basic & advanced cardiopulmonary life support

Also see: - basic life support - advanced cardiac life support Management: - initiate cardiopulmonary resuscitation (CPR) if there are no signs of life & a pulse is not palpated within 10 seconds - provide conventional CPR (chest compressions with rescue breathing) - compress at least one third of the anterior-posterior dimension of the chest - newborns with poor muscle tone & breathing & meconium in the amniotic fluid should receive CPR under a radiant warmer for faster oxygen delivery [2] - consider using cuffed tracheal tubes in infants & young children - cuff pressure should not exceed 25 cm H2O - appropriate sized tubes by age are as follows: - 3 mm for age 1 year - 3.5 mm for age 1-2 years - age in years/4 + 3.5 mm for age >2 years - modify or discontinue cricoid pressure if it impedes preintubation ventilation or intubation - monitor capnography to confirm endotracheal tube position, recognizing that end-tidal CO2 in infants & children might be below detectable limits for colorimetric devices (85% sensitivity & 100% specificity). - consider use of an esophageal detector device in children weighing >20 kg. - use capnography monitoring to assess effectiveness of chest compressions - avoid excessive ventilation, which can decrease cerebral perfusion pressure, rates of return of spontaneous circulation (ROSC), & survival rates - after ROSC, titrate oxygen concentration to limit the risk for toxic oxygen byproducts - for pediatric septic shock, include therapy directed at normalizing central venous oxygen saturation to 70% - do not routinely use bicarbonate or calcium for pediatric cardiac arrest: both agents are associated with decreased survival

General

basic life support (BLS) advanced cardiac life support (ACLS)

References

  1. Kleinman ME et al. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010 Nov; 126:e1261 PMID: 20956433
  2. Physician's First Watch, Oct 20, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. (in 15 parts, see Table of Contents) Circulation November 3, 2015, Volume 132, Issue 18 suppl 2 http://circ.ahajournals.org/content/132/18_suppl_2.toc
  3. Atkins DL, de Caen AR, Berger S, et al. 2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality. Circulation. 2017 Nov 6 PMID: 29114009 http://circ.ahajournals.org/content/early/2017/11/06/CIR.0000000000000540.long