CARDIO RESPIRATORY

ARREST
 RECOGNISING CARDIAC ARREST:

• UNLIKE CARDIAC ARREST IN ADULTS, WHICH IS VERY COMMON DUE TO ACUTE CORONARY
SYNDROME, CARDIACARREST IN PEDIATRICS IS MORE COMMONLY THE CONSEQUENCE OF
RESPIRATORY FAILURE OR SHOCK.
• THUS, CARDIACARREST CAN OFTEN BE AVOIDED IF RESPIRATORY FAILURE OR SHOCK IS
SUCCESSFULLY MANAGED
• LESS THAN 10% OF THE TIME, CARDIAC ARREST IS THE CONSEQUENCE OF VENTRICULAR
ARRHYTHMIA AND OCCURS SUDDENLY.IT MAY BE POSSIBLE TO IDENTIFY A REVERSIBLE CAUSE
OF CARDIAC ARREST AND TREAT IT QUICKLY.
• THE REVERSIBLE CAUSES ARE ESSENTIALLY THE SAME IN CHILDREN AND INFANTS AS THEY ARE
IN ADULTS.
 CARDIO PULMONARY ARREST:

• IN CHILDREN,
RESPIRATORY CAUSE MORE THAN CARDIAC CAUSE.
• IN ADULTS,
CARDIAC CAUSE MORE THAN RESPIRATORY CAUSE.
• USUAL COMMON CAUSES:
1) RESPIRATORY FAILURE
2) TERMINAL STAGE OF SHOCK.
• CPR SHOULD BEGIN WITH CHEST COMPRESSION.
• CHEST COMPRESSIONS ARE SERIAL RHYTHMIC COMPRESSIONS OF THE CHEST THAT ALLOW
BLOOD FLOW TO VITAL ORGANS (HEART, LUNGS AND BRAIN) IN AN ATTEMPT TO KEEP THEM
VIABLE UNTIL ALS (ADVANCED LIFE SUPPORT) IS AVAILABLE.
• ADEQUATE CHEST COMPRESSION IS GIVEN BY PUSHING HARD, TO A DEPTH OF ATLEAST ONE-
THIRD OF ANTEROPOSTERIOR DIMENSION OR APPROXIMATELY 1,1/2 INCHES (4 CM) IN INFANTS
AND 2 INCHES(5 CM) IN CHILDREN.
• THE RATE SHOULD BE 100-120 COMPRESSIONS PER MINUTE, ALLOWING FULL CHEST RECOIL AND
MINIMIZING INTERRUPTIONS IN CHEST COMPRESSIONS
• COMPRESSION OF THE XIPHOID PROCESS SHOULD BE AVOIDED
• CHEST COMPRESSION IN INFANTS LESS THAN 1 YEAR
• TWO-THUMB TECHNIQUE: THE INFANT’S CHEST IS ENCIRCLED WITH BOTH HANDS;
FINGERS ARE SPREAD AROUND THE THORAX AND THE THUMBS BROUGHT TOGETHER
OVER THE LOWER HALF OF THE STERNUM, AVOIDING THE XIPHISTERNUM.
• WHILE ONE PROVIDER SHOULD PROVIDE CHEST COMPRESSIONS. THE OTHER MAINTAINS
THE AIRWAY AND PROVIDES VENTILATION AT A RATIO OF 15:2
• TWO-FINGER TECHNIQUE: IF THE RESCUER IS ALONE OR UNABLE TO PHYSICALLY
ENCIRCLE THE CHEST, THE CHEST IS COMPRESSED WITH TWO FINGERS, PLACING THEM
VERTICALLY OVER THE STERNUM JUST BELOW THE INTERMAMMARY LINE
• CHEST COMPRESSION TECHNIQUE IN THE CHILD (1-8 YEARS AGE)
• THE HEEL OF ONE HAND SHOULD BE PLACED OVER LOWER HALF OF STERNUM, AVOIDING PRESSURE OVER
XIPHOID, AND WITH FINGERS LIFTED ABOVE THE CHEST WALL TO PREVENT COMPRESSION OF RIB CAGE.
• CHEST COMPRESSION ABOVE 8 YEARS
• THIS IS ACHIEVED BY PLACING THE HEEL OF ONE HAND OVER THE LOWER HALF OF STERNUM AND THE HEEL
OF THE OTHER HAND OVER THE FIRST HAND INTERLOCKING THE FINGERS OF BOTH HANDS, WITH FINGERS
LIFTED ABOVE THE CHEST WALL. EXTERNAL CHEST COMPRESSION IN CHILDREN AND INFANTS SHOULD
ALWAYS BE FOLLOWED BY RESCUE BREATHING.
• FOR ONE HEALTHCARE PROVIDER, THE COMPRESSION-VENTILATION RATIO SHOULD BE 30:2 FOR ALL AGE
GROUPS AND FOR TWO RESCUERS THE COMPRESSION-VENTILATION RATIO SHOULD BE 30:2 IN ADULTS AND
15:2 IN INFANTS, CHILDREN AND ADOLESCENTS.
 POST RESUSCITATION CARE:

• AFTER THE RETURN OF SPONTANEOUS CIRCULATION FOLLOWING SUCCESSFUL

CPR, THE FOLLOWING ARE TO BE CORRECTED AND MONITORED:
• • MAINTENANCE OF BP.
• • CORRECTION OF HYPOXIA
• • CORRECTION OF HYPO/HYPERCAPNIA.
• • TARGETED TEMPERATURE MANAGEMENT (THE BODY TEMPERATURE TO 36-37.5 °C)
• HELPS REDUCE METABOLIC ACTIVITY IN BRAIN & LEADS TO RECOVERY IF THERE WAS
ANY BRAIN DAMAGE THAT OCCURRED DURING CARDIAC ARREST.
• • CONTINUOUS EEG MONITORING TO DETECT NON CONVULSIVE SEIZURESE
• DELAYING THE PROGNOSIS FOR 72 HOURS AFTER THE EVENT
• HIGH QUALITY CARDIOPULMONARY RESUSCITATION (CPR) IS THE FOUNDATION OF
RESUSCITATION.
• EXCELLENT POST CARDIAC ARREST CARE IS CRITICALLY IMPORTANT.
 BRADYCARDIA:

• PAEDIATRIC BRADYCARDIA HEART RATE LESS THAN 60/MIN BASICS:

• 1. LOOK / TREAT THE CAUSE: CONDITIONS LIKE HYPOXIA,HYPOTHERMIA &
MEDICATIONS.
• 2. MAINTAIN A PATENT AIRWAY.
• 3. OXYGEN SUPPORT ONLY WHEN NECESSARY.
• 4. CONNECT A CARDIAC MONITOR AND CONTINUOUSLY MONITOR THEVITAL
PARAMETERS.
• 5. INTRAVENOUS/INTRAOSSEOUS ACCESS.
• 6. 12 LEAD ECG.
 MEDICATIONS
1)EPINEPHRINE.
• INCREASES HR, CONTRACTILITY & CAUSE VASOCONSTRICTION.
• DOSE IS 0.1ML/KG (0.01 MG/KG).
• STRENGTH IS 1: 10,000.
• IF NO RESPONSE, REPEAT AFTER 3 TO 5 MINUTES.
2. ATROPINE.
• ENHANCES AV CONDUCTION, USED IN PRIMARY AV BLOCKS / HIGH VAGAL
TONE.
• DOSE: 0.02MG/KG,
• THE MINIMUM DOSE IS 0.1 MG, MAXIMUM IS 0.5 MG.
• IF NO RESPONSE, REPEAT THE DOSE.
• IF STILL NO RESPONSE IN AV BLOCK, THEN PACING
(TRANSTHORACIC/TRANSVENOUS) IS DONE
 TACHYCARDIA

• NARROW QRS COMPLEX,LESS THAN 0.08 S

• WIDE QRS COMPLEX GREATER THAN 0.08 SEC
• NARROW QRS COMPLEXES ARE SINUS TACHYCARDIA AND PSVT
• SINUS TACHYCARDIA:CONSISTENT HISTORY(INFECTION,FEVER)
• HR< 180/MIN IN CHILDREN ,HR<220/MIN IN ADULTS
• VARIABLE RR INTREVAL,CONSTANT PR INTREVAL
• P WAVE PRESENT
• TREAT THE CAUSE(FEVER,HYPOXIA,HYPOGLYCEMIA)
• PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA
• ABRUPT ONSET /INCONSISTENT HISTORY
• HR>180/MIN IN CHILDREN,>220/MIN IN ADULTS
• FIXED RR INTERVAL
• P WAVE ABSENT
• TREATMENT OF PSVT
• VAGAL MANOEUVRE: IT’S DECREASES THE RATE OF CONDUCTION THERE BY
DECREASING THE HEART RATE.ICE PACK TO UPPER HALF OF THE FACE AVOIDING
NOSE AND MOUTH. OLD CHILD:VALSALVA MANOEUVRE
• DRUG OF CHOICE:IV ADENOSINE 0.1 MG/KG RAPID BOLUS. ADENOSINE QUICKLY
PUSHED BY FIRST SYRINGE AND3 -5ML OF NORMAL SALINE IN SECOND SYRINGE
IMMEDIATELY.
• IF NO RESPONSE,ADENOSINE IV 0.2 MG/KG RAPID BOLUS (MAX:12MG)
• SYNCHRONISED CARDIOVERSION:IF NO RESPONSE TO ADENOSINE OR NO IV ACCESS..
0.5J/KG TO1J/KGTO 2J/KG
• WIDE COMPLEX QRS> 0.08 S
• VENTRICULAR TACHYCARDIA :SHOCKABLE RHYTHMS
• TREATMENT OF CHOICE
• SYNCHRONISED CARDIOVERSION:0.5J/KG TO 1 J/KG TO MAXIMUM 2J/KG
• IF NO RESPONSE TO CARDIOVERSION:AMIODARONE 5 MG/KG IV OVER 20 TO 60
MINUTES
• PROCAINAMIDE:15 MG/KG IV OVER 20 TO 30 MINUTES
• DO NOT COMBINE AMIODARONE AND PROCAINAMIDE
TACHYCARDIA
THANK YOU