What Is Child CPR?

Three aspects of CPR technology

Cardiopulmonary resuscitation in children

Cardiopulmonary Resuscitation (CPR) in children refers to sudden cardiac arrest and sudden respiratory and circulatory cessation. This requires cardiopulmonary resuscitation; CardiopulmonaryResuscitation (CPR) is a method that involves the use of a simple set of techniques to sustain life.

Overview of pediatric CPR

Three aspects of CPR technology

Basic life support for cardiopulmonary resuscitation in children

1. Basic life support Basic life support for children includes a range of skills to support or restore effective ventilation or circulatory function in children with respiratory or cardiac arrest. Any trained medical or non-medical staff can provide basic life support, which is very important for the ultimate recovery of injured children. When the heartbeat breathing stops or is suspected to stop, the child also needs to be quickly sent to a medical facility that can provide further life support.

Pediatric Cardiopulmonary Resuscitation Advanced Life Support

2. Advanced life support (advancedlifesupport) is the second stage of cardiopulmonary resuscitation. Experienced medical personnel participate in the rescue work at this time, and often have a clear division of labor to coordinate the processing of breathing, chest heart compression, auxiliary drug application, infusion, monitoring and Necessary records.

Pediatric cardiopulmonary resuscitation stability and monitoring after resuscitation

3 Stabilization and resuscitation monitoring refers to further treatment and monitoring to stabilize patients after resuscitation.

Cardiopulmonary resuscitation in children

There are many causes of cardiac arrest in children, such as neonatal asphyxia, sudden infant death syndrome, laryngeal spasm, laryngeal obstruction, foreign bodies in the trachea, gastroesophageal reflux, severe pneumonia and respiratory failure, drugs, severe arrhythmia, poisoning, metabolism Diseases, myocarditis, cardiomyopathy, heart failure, cardiovascular interventional procedures, various accidental injuries, etc. Cardiac arrest is difficult to predict, but the high-risk factors that trigger it should be paid enough attention. The most dangerous factors include:

1. The state of the cardiovascular system is unstable, such as massive blood loss, refractory heart failure, hypotension, and recurrent arrhythmias.

2. Rapidly progressing lung diseases, such as severe asthma, laryngitis, severe pneumonia, and hyaline membrane disease.

3 Early after surgery, such as the use of general anesthesia and a large number of sedatives is enough to change the child's ability to reflect various stimuli.

4 The endotracheal tube of a child with an artificial airway was blocked or disengaged.

5. When the child's nervous system disease has deteriorated sharply, such as a comatose patient often does not have sufficient respiratory drive to ensure normal ventilation.

In addition, some clinical operations can aggravate or trigger cardiac arrest in children with high risk factors, including:

(1) Airway attraction: can cause hypoxia, alveolar collapse, and reflex bradycardia;

(2) Improper chest physiotherapy (such as back pat, turning over, suctioning sputum, etc.) can make more secretions overflow, block the airway, and cause fatigue in children;

(3) Withdrawal of any form of respiratory support (such as the application of respirators): the patient must switch from previous artificial respiration to spontaneous breathing work, such as reducing oxygen concentration, withdrawing from CPAP or mechanical ventilation, and extubation Wait;

(4) Application of sedatives: such as respiratory depression caused by the application of anesthetics, sedatives and cough medicines; (5) Various operations: such as holding the breath during waist puncture, which can cause cardiac arrest;

(6) Increased excitability of the vagus nerve: Some clinical procedures can cause increased excitability of the vagus nerve, such as the placement of the nasogastric tube

Placement, tracheal intubation, etc.

In addition, high-risk infants due to swallowing-breathing incoordination can also cause cardiac arrest. Particular attention should be paid to the decompensation of circulation, including poor peripheral circulation, bradycardia, changes in breathing patterns or apnea, cyanosis, and decreased responsiveness to stimuli. When there is the above performance, the related operations should be stopped as much as possible, and life support should be given.

Diagnosis of CPR in children

Clinical manifestation

For a sudden coma, some had transient seizures, stopped breathing, looked dull or cyanotic, dilated pupils, and the reflection of light disappeared. The aorta (carotid, femoral) pulsations disappeared, and auscultatory heart sounds disappeared. Such as ECG examination can be seen isoelectric lines, electro-mechanical separation or ventricular fibrillation. The diagnosis of cardiac arrest is not difficult. Generally, the diagnosis can be made when the child is suddenly comatose and the large blood vessel pulsation disappears. It is not necessary to repeatedly touch the pulse or listen to the heart sound to avoid delaying the rescue time.

rescue

Older children's heart rate is <30 beats / min, and neonatal heart rate is <60 beats / min.

Neonates have no spontaneous breathing or are ineffective wheezing, positive spontaneous ventilation resuscitation can be performed when there is spontaneous breathing but the heart rate is <100 beats / min and there is still central cyanosis with 80% oxygen concentration.

Cardiopulmonary resuscitation in children

For cardiac arrest and respiratory arrest, first aid is very necessary. It should be done in seconds to keep the airway open, establish breathing, and establish an artificial circulation in order to ensure blood perfusion and oxygen supply to important organs such as the heart and brain .

Cardiopulmonary resuscitation in children to keep the airway open

(A) keep the airway open (Airway, A)

Hypoxemia and apnea in children may cause or cause sharp exacerbations and cardiac arrest. Therefore, the establishment and maintenance of airway opening and maintaining adequate ventilation are the most important elements of basic life support. First, the secretions, foreign bodies or vomites in the airways should be removed, and the upper airways such as the mouth and nose should be attracted if possible. Tilt the child's head back, raise the lower jaw, place one hand on the child's forehead, tilt the head toward the back in the middle position, and slightly extend the neck. Put a few fingers of the other hand under the chin of the mandible, lift the mandible outward and upward, taking care not to close the mouth or push the soft tissue under the jaw, so as not to block the airway. When the cervical spine is completely immobile, the airway is opened by pushing the lower jaw. Oropharyngeal catheters can also be placed to keep the oropharynx open. Open the airway by pushing the lower jaw

Pediatric CPR establishes breathing

(B) establish breath (Breathing, B)

When there is no spontaneous breathing after the airway is unobstructed, artificial assisted ventilation should be used to maintain gas exchange. Common methods are:

1. Mouth-to-mouth artificial respiration This method is suitable for on-site first aid. The operator takes a deep breath first. If the patient is a baby under 1 year, cover the nose and mouth of the baby. If it is an older baby or child, seal it with the mouth to mouth. Hold the thumb and forefinger firmly on the nose of the child. , Keep his head tilted back; blow air, and at the same time see the chest of the child lifted. After you stop blowing, release your nostrils to allow the child to exhale naturally and expel air from the lungs. Repeat the above operation, children 18 to 20 times / minute, infants can speed up slightly. Mouth to mouth

Even if the operation is correct, the oxygen concentration is low (<18%), the operation time is too long, and the surgeon is easily fatigued. Therefore, other methods of assisted breathing should be obtained as soon as possible.

2. Resuscitation balloon applications In most pediatric emergencies, infants and young children can be effectively ventilated with airbag masks. A commonly used balloon ventilation device is a self-expanding balloon, which delivers an oxygen concentration of 30% to 40%. The tail of the airbag can be equipped with an oxygen storage device to ensure the delivery of high concentrations of oxygen. The airbag with oxygen storage device can provide 60% to 95% oxygen concentration. The airbag is often equipped with a pressure limiting valve device with a pressure level of 35 to 40 cm H20. Cover the mouth of the child with a mask attached to the resuscitation skin. The correct size of the mask should ensure that the air is sealed on the face, covering the mouth and nose from the bridge of the nose to the chin, but revealing the eyes. Use one hand to fix the mask on your face and tilt your head or jaw upward. For infants, the 4 and 5 fingers of the surgeon hook up the mandible angle and lift up, and the root of the third finger is against the lower jaw to ensure that the mask is in close contact with the face. When the mask inhales oxygen, a certain degree of head extension can ensure that the airway is unobstructed. Babies and young children should preferably stay in the middle inhalation position, and do not stretch their heads excessively, so as to avoid airway compression obstruction.

3 Endotracheal intubation artificial respiration method When permanent ventilation is needed, or the mask does not provide sufficient ventilation, an endotracheal tube needs to be used instead of the mask. Children younger than 8 years of age use non-capsule endotracheal intubation, children older than 8 years of age use captive intubation. The size of the inner diameter of the intubation can be estimated by the formula: inner canal (n dish) 2 (16+ age of the child) / 4. After intubation, skin pressure can be continued, or mechanical ventilation can be connected with an artificial respirator.

Pediatric cardiopulmonary resuscitation cycle support

(3) Circulation Support (C)

Chest air compression should be considered when the airway is unobstructed and the resuscitation is still not satisfactory after breathing is established. When pressing on a newborn or a baby, use one hand to support the back of the child, and place two fingers on the other hand under the nipple line to press (Figure 18-2), or use two palms and four fingers to support both sides of the back. Press with both thumbs (Figure 18-3). For children 1 to 8 years old, the head of the child can be fixed with one hand for ventilation; the root of the palm of the other hand is placed in the lower half of the sternum (avoid the xiphoid process), and the long axis of the palm root is consistent with the long axis of the sternum (Figure 18-4). For older children (> 8 years), the method of chest compression is the same as that of adults. The child should be placed on a hard board, the root of one palm should be placed on the back of the other, and the lower half of the sternum should be pressed vertically. The ratio of each compression to relaxation is 1: 1, the compression depth is 1/3 to 1 of the thickness of the chest, and the frequency is 100 times in the newborn and 80 times in the elderly. The combination of chest heart compression and breathing is 3: 1 in newborns and 5: 1 in older children. One minute after the compression, determine whether there is improvement, and observe the carotid artery (for children 1 to 8 years old), femoral artery pulsation, pupil size, and skin color. In the clinic, when aortic pulsation is touched, the compression is effective; if the percutaneous oxygen saturation is monitored, the increase in the value is also effective.

Further treatment of CPR in children

(IV) Further processing

Most children, especially newborns, have an unobstructed airway and the heartbeat can recover after breathing is established. If the chest heart compression is still ineffective, try the drug. In cardiac arrest, it is best to administer intravenously, but because it is difficult to establish venous access, some drugs can be given to the trachea, such as atropine, epinephrine, lidocaine, etc. The optimal dosage of intratracheal medication in children is not certain. The intratracheal dosage should be greater than the intravenous dosage to achieve the same effect. The drug is well absorbed when injected from the bone marrow cavity. Intramedullary injection has the same effect as intravenous injection. Commonly used drugs are:

1. The most common arrhythmias in epinephrine pediatric patients are cardiac arrest and bradycardia. Adrenaline has iE 'diaphragmatic strength and positive frequency effects. Dosage: 0.01 mg / kg, (1: 10000 solution 0.1 ml / kg), intravenous or bone marrow cavity administration, or intratracheal administration of 0.1 mg / kg. Can be repeated once every 5 minutes.

2. The main cause of cardiac arrest in pediatric patients with sodium bicarbonate is respiratory failure. Rapid and effective ventilation is necessary to control acidosis and hypoxemia caused by cardiac arrest. The application of sodium bicarbonate can promote the production of CO2, and CO2 passes through the cell membrane more easily than HCO3, which can cause transient intracellular acidosis, which leads to myocardial insufficiency. In view of these potential toxicities, sodium bicarbonate should not be used when mild to moderate acidosis, especially when hypoventilation is present. Improved ventilation and dilatation can generally resolve acidosis. The dose of sodium bicarbonate is 1 ml / kg, which can be administered intravenously or in the bone marrow cavity.

3 Atropine pointer: for hypoperfusion and hypotension bradycardia, prevention of vagus bradycardia caused by tracheal intubation, and rare symptomatic bradycardia caused by atrioventricular block Dosage: 0.02 mg / kg, administered intravenously, intratracheally or in the bone marrow cavity, and can be reused every 5 minutes. The maximum dose should not exceed 1 mg for children and no more than 2 mg for adolescents.

4 Glucose should be tested quickly at bedside when infants are undergoing cardiac resuscitation, and glucose should be given immediately when there is hypoglycemia. Dosage: 0.5 to 1. Og / kg, injected intravenously with 25% glucose.

5. Calcium can be given only when hypocalcemia is suspected. It can also be considered for the treatment of hyperkalemia, hypermagnesemia, and excessive calcium channel blockers. Dosage: 100 to 200 mg / kg of calcium gluconate (1 to 2 ml / kg of 10% calcium gluconate); 20 to 50 mg / kg of calcium chloride (0.2 to 0.5 ml / kg of 10% calcium chloride).

6. Lidocaine is available when ventricular fibrillation is present. Dose: The loading amount is 1 mg / kg. After the loading amount is given, the vein will be maintained. The dose is 20-50ug / (kg.min).

(V) Other treatments

Hypotension, cardiac arrhythmia, intracranial hypertension, etc. that occur in children after resuscitation should be prevented and treated separately.