Pediatric Emergencies and Resuscitation

Pediatric Emergencies and Resuscitation - Clinical Notes
These notes are designed for medical students and pediatricians, covering essential aspects of pediatric emergencies and resuscitation. Content is based on current international guidelines and evidence-based practice. (use horizontal view for mobile Phones)

1. Initial Assessment and Response

1.1 Pediatric Assessment Triangle (PAT)

The PAT provides rapid evaluation of a child's physiological status through three components:

  • Appearance: Tone, interactivity, consolability, look/gaze, speech/cry
  • Work of Breathing: Abnormal airway sounds, abnormal positioning, retractions, nasal flaring
  • Circulation to Skin: Pallor, mottling, cyanosis

1.2 Primary Survey (ABCDE)

A - Airway

  • Assess patency
  • Look for foreign bodies
  • Check positioning
  • Consider cervical spine protection if trauma

B - Breathing

  • Respiratory rate (age-specific norms)
  • Work of breathing
  • Breath sounds
  • SpO2 monitoring

C - Circulation

  • Heart rate (age-specific norms)
  • Pulse quality
  • Capillary refill time
  • Blood pressure

D - Disability

  • AVPU scale or Glasgow Coma Scale
  • Pupillary response
  • Posturing

E - Exposure

  • Temperature
  • Rashes
  • Injuries
  • Prevent heat loss

2. Pediatric Basic Life Support (BLS)

2.1 High-Quality CPR Components

Component Infant (<1 year) Child (1 year to puberty)
Compression depth 4 cm (1.5 inches) 5 cm (2 inches)
Compression rate 100-120/min
Compression technique Two fingers or two thumbs encircling Heel of one or two hands
Compression:Ventilation ratio 30:2 (single rescuer), 15:2 (two rescuers)

2.2 Sequence of BLS

  1. Ensure scene safety
  2. Check responsiveness
  3. Call for help/activate emergency response
  4. Check breathing and pulse (≤10 seconds)
  5. Begin compressions if no pulse or pulse <60/min with poor perfusion
  6. Provide rescue breaths
  7. Continue cycles of compressions and ventilations

3. Pediatric Advanced Life Support (PALS)

3.1 Airway Management

Progressive approach to airway management:

  • Basic Airway Maneuvers:
    • Head tilt-chin lift (non-trauma)
    • Jaw thrust (trauma)
    • Oropharyngeal airway (unconscious)
    • Nasopharyngeal airway (conscious/semiconscious)
  • Advanced Airway:
    • Endotracheal intubation
    • Supraglottic airway devices
    • Proper tube size selection: Age/4 + 4 (uncuffed)

3.2 Vascular Access

Priority Order:

  1. Peripheral IV (first choice)
  2. Intraosseous access (if IV unsuccessful after 90 seconds)
  3. Central venous access (special circumstances)

4. Shock Recognition and Management

4.1 Types of Shock

Type Characteristics Initial Management
Hypovolemic Decreased preload, tachycardia, poor perfusion Crystalloid bolus 20mL/kg
Cardiogenic Poor contractility, hepatomegaly, crackles Support perfusion, consider inotropes
Distributive Vasodilation, warm shock initially Fluids + vasopressors if needed
Obstructive Decreased cardiac filling, distended neck veins Treat underlying cause

4.2 Fluid Resuscitation

Key Points:

  • Initial bolus: 20mL/kg isotonic crystalloid
  • Reassess after each bolus
  • Watch for signs of fluid overload
  • Consider blood products in hemorrhagic shock

5. Cardiac Arrhythmias

5.1 Tachyarrhythmias

Assessment and management of common pediatric tachyarrhythmias:

  • Supraventricular Tachycardia (SVT):
    • Regular, narrow complex tachycardia
    • Rate usually >220/min in infants
    • Initial management: vagal maneuvers
    • Adenosine if stable with IV access
  • Ventricular Tachycardia (VT):
    • Wide complex tachycardia
    • Synchronized cardioversion if unstable
    • Consider antiarrhythmics if stable

5.2 Bradyarrhythmias

Management algorithm:

  1. Identify symptomatic bradycardia (HR <60 with poor perfusion)
  2. Ensure adequate oxygenation and ventilation
  3. Begin chest compressions if HR remains <60
  4. Consider:
    • Epinephrine
    • Atropine (if vagal or AV block)
    • Transcutaneous pacing

6. Post-Resuscitation Care

6.1 Systematic Approach

  • Ventilation and Oxygenation:
    • Target SpO2 94-99%
    • Avoid hyperoxia and hyperventilation
    • Monitor ETCO2
  • Hemodynamic Monitoring:
    • Maintain adequate blood pressure
    • Consider vasoactive support
    • Monitor urine output
  • Neurological Care:
    • Consider therapeutic hypothermia
    • Seizure monitoring and management
    • Regular neurological assessments

6.2 Common Complications

Watch for and prevent:

  • Respiratory failure
  • Metabolic derangements
  • Renal dysfunction
  • Coagulopathy
  • Multiple organ dysfunction syndrome

7. Quality Improvement in Pediatric Resuscitation

7.1 Team Dynamics

  • Clear role assignment
  • Closed-loop communication
  • Regular team training
  • Debriefing after events

7.2 Documentation

Essential elements to record:

  • Timing of interventions
  • Medication doses and routes
  • Response to interventions
  • Team member roles
  • Family presence and communication

References and Further Reading:

  • Current Pediatric Advanced Life Support (PALS) Guidelines
  • European Resuscitation Council Guidelines
  • Local and institutional protocols


Tags:

Powered by Blogger.