Paediatric Advanced Life Support

Paediatric Advanced Life Support......Page 1
Paediatric Advanced Life Support......Page 2
Contents......Page 4
Foreword......Page 6
Contributors......Page 7
Causes of death in childhood......Page 8
Asystole......Page 10
Pulseless electrical activity......Page 11
Importance of treating children differently from adults......Page 12
Anatomical......Page 13
Physiological......Page 14
Cardiopulmonary resuscitation: standards forclinical practice and training......Page 15
Resuscitation officer......Page 16
Prevention of cardiopulmonary arrest......Page 17
Do Not Attempt Resuscitation orders......Page 18
Auditing and reporting standards......Page 19
References......Page 20
Learning objectives......Page 22
Airway and breathing equipment......Page 23
Circulation equipment......Page 24
Aids to estimating paediatric drug doses and equipment sizes......Page 25
Oakley chart......Page 26
Broselow/Hinkle Paediatric Emergency System......Page 27
Routine checking of resuscitation equipment......Page 28
References......Page 29
Learning objectives......Page 30
ABCDE approach......Page 31
Assessment of the airway......Page 33
Look......Page 35
Listen......Page 36
Management of respiratory compromise......Page 37
Look......Page 38
Management of circulatory compromise......Page 39
Assessment of disability......Page 40
Exposure......Page 41
References......Page 42
Introduction......Page 43
Sequence of actions in basic life support......Page 44
Open the airway......Page 46
Not breathing normally?......Page 48
No signs of life?......Page 49
When to get help......Page 50
Procedure for mouth and nose ventilation infant......Page 51
Ineffective delivery of breaths......Page 53
Complications of gastric inflation......Page 54
Compression:ventilation ratios......Page 55
Chest compressions in an infant......Page 56
Chest compressions in an older child......Page 57
Rate of chest compression......Page 58
Indications......Page 59
A suggested technique......Page 60
Complications......Page 61
Recognition of foreign body airway obstruction......Page 62
Treatment of a choking infant......Page 63
Treatment of a choking child......Page 66
Summary......Page 68
References......Page 69
Learning objectives......Page 73
Airway......Page 74
Causes of airway obstruction......Page 75
Complete airway obstruction......Page 76
Head tilt?chin lift......Page 77
Suction......Page 78
Principles of cricoid pressure......Page 80
Cautions......Page 81
Oropharyngeal airway......Page 82
Nasopharyngeal airway......Page 84
Role of the laryngeal mask airway......Page 85
Principles of tracheal intubation......Page 86
Equipment......Page 87
Cuffed versus uncuffed tracheal tubes......Page 88
Laryngoscope......Page 89
Procedure for tracheal intubation......Page 91
Confirming correct tube placement......Page 92
Ineffective ventilation following tracheal intubation......Page 93
Method......Page 94
The face mask......Page 95
The self-inflating bag......Page 96
Method......Page 98
Gastric inflation......Page 100
Principles of oxygenation administration......Page 101
Description......Page 102
Procedure......Page 103
Summary......Page 106
References......Page 107
Introduction......Page 110
Nervous control of the heart rate......Page 111
The ECG and its relation to cardiac contraction......Page 112
Suggested ECG electrode placement for cardiac monitoring......Page 113
Problems encountered with ECG monitoring......Page 114
Circulation status......Page 115
Clinical status......Page 116
Heart rate......Page 117
Width of the QRS complex......Page 118
Supraventricular tachycardia......Page 119
Treatment of supraventricular tachycardia......Page 120
Treatment of VT......Page 121
References......Page 122
Learning objectives......Page 123
Treatment......Page 124
Automated external defibrillators......Page 125
Monophasic and biphasic waveforms......Page 126
Shock energy......Page 127
Size of self-adhesive defibrillation pads and defibrillation paddles......Page 128
Minimising the risk of bystanders receiving a shock......Page 130
Resuscitation Guidelines 2010......Page 131
Procedure for manual defibrillation using self-adhesive pads......Page 132
Points to note......Page 133
Procedure......Page 134
Procedure......Page 136
References......Page 138
Learning objectives......Page 141
Self-adhesive defibrillation pads......Page 143
Minimise interruptions......Page 144
Assess the rhythm......Page 145
Asystole......Page 146
Shockable ventricular fibrillation/pulseless ventricular tachycardia......Page 147
Intraosseous infusion......Page 148
Introduction......Page 164
Incidence......Page 165
Mortality rates......Page 166
Clinical features and diagnosis......Page 167
Treatment of anaphylaxis......Page 169
Adrenaline......Page 171
Inhaled beta-2-agonist......Page 173
Summary......Page 174
References......Page 175
Learning objectives......Page 178
Treatment......Page 179
Physiological effects of hypothermia......Page 180
Core rewarming methods......Page 181
Drowning......Page 182
Resuscitation......Page 183
Resuscitation......Page 184
Factors affecting severity of the injury......Page 185
Clinical effects on the child......Page 186
Poisoning......Page 187
Activated charcoal......Page 188
Antidote for opiates including methadone......Page 189
Cardiopulmonary resuscitation......Page 190
Resuscitation......Page 191
Treatment of hypokalaemia <2.5 mmol/L or cardiacarrhythmias present......Page 192
Treatment for hyperkalaemia in a child not in cardiac arrest......Page 193
Summary......Page 194
References......Page 195
Learning objectives......Page 197
Airway......Page 198
Circulation......Page 199
Glucose control......Page 201
Maintaining renal function......Page 202
Guidelines for referral to a paediatric intensive care unit......Page 203
Applicability......Page 204
Medical staffing......Page 205
Environment and support services......Page 206
Operational issues......Page 207
Summary......Page 209
References......Page 210
Introduction......Page 212
Ideal layout for the family room......Page 213
What to tell the family......Page 214
Good communication techniques......Page 215
Telephone notification of family members......Page 216
Viewing the child’s body......Page 217
Role of the police and coroner......Page 218
Information for the family......Page 219
Transport arrangements......Page 220
Importance of written guidelines and policies......Page 221
Benefits......Page 222
References......Page 223
Learning objectives......Page 225
What post-resuscitation records should include......Page 226
National Cardiac Arrest Audit......Page 227
References......Page 228
Introduction......Page 229
Defining accountability......Page 230
Accountability to society......Page 232
Accountability to the patient......Page 234
Accountability to the profession......Page 236
Issues related to Do Not Attempt Resuscitation orders......Page 237
The Human Rights Act 1998 and DNAR orders......Page 238
Documentation......Page 239
Standard of care......Page 240
Identifying risk activities......Page 241
References......Page 242
Introduction......Page 244
Healthcare staff’s perception of competency at resuscitation......Page 245
Recommendations concerning resuscitation training......Page 246
Methods of resuscitation training......Page 247
Skill stations......Page 248
Simulated cardiac arrest scenarios......Page 249
Simulation in resuscitation training......Page 250
Ethos......Page 251
Assessment......Page 252
Assessment......Page 253
Key learning objectives of paediatric resuscitation training......Page 254
Airway management models......Page 255
Advanced life support manikins......Page 256
Summary......Page 257
References......Page 258
Index......Page 260