p ediatric a dvanced l ife s upport by r2 張家穎. 小兒生命之鏈 預防措施 早期 cpr...
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Basic Life SupportBasic Life Support
• Pediatric assessment triangle
Appearance, Breathing, Circulation• Airway
Breathing
Circulation
D: disability, differential diagnosis
Exposure.
ABreathingC• Nasal flaring.• 胸凹• 點頭式呼吸• Use of accessory mus
cles.
AGE RR
Neonate 40~60
Infant 30~60
Toddler 25~40
Schooler 20~30
Adolescent 12~18
ABCirculation
• Pink
• Pale
• Mottling skin.
• Cyanosis.
• Capillary refill time: normal <2 sec.
• DBP: 70+ age *2
AGE HR BP
Pre-
maturity
DBP~
Gestational age
Neonate 80~200 SBP 50~90
1~10 y/o 100~180 DBP:
70+age*2
>10 y/o 60~140 SBP>90C apillary refill time:
Normal : <2 sec.
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
ABreathingCDE
• Adequate ventilation.
• Indications for endotracheal tube insertion:
Fail to keep patent airway.
Respiratory failure
Severe shock
GCS< 9
IICP
ABCirculationDE~1• Chest compression. (HR<60)
> 8 y/o <8 y/o Newborn
Check pulse Common carotid a.
Common carotid a.
Brachial a.
Umbilical a.
Position 胸骨下半段 胸骨下半段 兩乳頭連線下一指幅
Method 兩手指互扣 單手掌跟 兩手指兩手環抱 , 以拇指壓
Depth 4~5 cm 胸壁厚度 1/2~1/3
胸壁厚度 1/2~1/3
Ratio 15:2 5:1=100:20 3:1=90:30
ABCirculationDE~2
• HR: fast, slow, asystole• Fast: Stable Unstable narrow: drug: adenosin: 0.1 0.2 0.2 mg/Kg shock: synchronized shock: 0.5 1 J/Kg. wide: synchronized shock: 0.5 1 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: 2 4 4J/Kg. PEA: 4H4T
CCB is contraindicated!!!
電 電 電 藥 電 藥 電
xylocaine: 1mg/kg. amiodarone 5mg/kg.
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
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%.
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?
Trauma
• Usually multiple organ trauma.
FAST- subxiphoid, subcostal, suprapubic
• Pneumothorax, hemothorax, pulmonary contussion.
• 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.