Pediatric Cardiac Arrest Management
- Introduction
- Newborn
- A recently born infant; usually considered the first few hours of life
- Neonate
- Considered the first 28 days of life
- Newborn
- Initial Care of the Neonate
- Physiologic Response to Birth
- Respiratory adaptations
- Cardiovascular adaptations
- Temperature regulation
- Routine care
- Support
- Dry
- Warm
- Position
- Airway
- Stimulation
- Assessment
- Physiologic Response to Birth
- Consider Age-Related Variations for Pediatric and Geriatric Patients for Assessment and Management of Cardiac Compromise
- Pediatric
- Cardiac problems typically associated with congenital heart condition
- Cardiovascular compromise often caused by respiratory compromise
- Pediatric
- General pathophysiology, assessment and management
- Epidemiology
- Incidence
- Approximately 6% of deliveries require life support
- Incidence of complications increases as birth weight decreases
- Morbidity/ mortality
- Neonatal mortality risk can be determined via graphs based on birth weight and gestational age
- Resuscitation is required for about 80% of the 30,000 babies who weigh less than 1500 grams at birth
- Risk factors
- Antepartum factors
- multiple gestation
- inadequate prenatal care
- mother’s age <16 or >35
- history of perinatal morbidity or mortality
- post-term gestation
- drugs/ medications
- toxemia, hypertension, diabetes
- perinatal infections
- known fetal malformations/“high risk” OB patient
- Intrapartum factors
- premature labor
- meconium-stained amniotic fluid
- rupture of membranes greater than 18 hours prior to delivery
- use of narcotics within four hours of delivery
- abnormal presentation
- prolonged labor or precipitous delivery
- prolapsed cord
- bleeding
- Antepartum factors
- Treatment strategies
- Preparation of resuscitation equipment
- Determine appropriate destination
- Incidence
- Assessment of the newborn
- Time of delivery
- Normal/ abnormal vital signs
- Airway and ventilation
- Respiratory rate
- Respiratory effort
- Circulation
- Heart rate
- Color/ cyanosis
- normal
- central versus peripheral
- mucosal membranes
- End organ perfusion
- compare strength of central pulses versus peripheral
- capillary refill
- APGAR
- Appearance - skin color
- completely pink - 2
- body pink, extremities blue - 1
- blue, pale - 0
- Pulse rate
- above 100 - 2
- below 100 - 1
- absent - 0
- Grimace - irritability
- cries - 2
- grimaces - 1
- no response - 0
- Activity - muscle tone
- active motion - 2
- some flexion of extremities - 1
- limp - 0
- Respiratory - effort
- strong cry - 2
- slow and irregular - 1
- absent - 0
- Appearance - skin color
- Treatment
- Prior to delivery, prepare environment and equipment
- During delivery, suction mouth and nose as head delivers
- After delivery
- Airway and ventilation
- drying
- head and face
- body
- warming
- appropriate techniques
- minimize heat loss via head
- position
- suction
- technique
- mouth first, than nares
- nasal suctioning is a stimulus to breathe
- equipment
- bulb suction
- suction catheters
- meconium aspirator
- technique
- stimulation
- flicking soles of feet
- stroking back
- blow-by oxygen
- never withhold oxygen
- oxygen should be warmed
- use when
- newborn is cyanotic and
- heart rate > 100 and
- adequate respiratory rate and effort
- 5 liters/ minute maximum
- complications due to hypothermia
- direct rather than tangential flow on face
- appropriate techniques
- bag-valve-mask
- mask characteristics
- appropriate size
- minimize dead-space
- bag characteristics
- pop-off valve should be disabled
- risk of pneumothorax with excessive pressures
- initial breath may require high pressures
- use when
- apneic
- inadequate respiratory rate or effort
- heart rate less than 100
- technique
- initial ventilations require higher pressure to expand lungs
- rate
- mask characteristics
- drying
- Circulation
- vascular access
- indications
- to administer fluids
- to administer medications
- peripheral vein cannulation
- intraosseous cannulation
- indications
- chest compression (in addition to assisted ventilation with BVM) Refer to current ILCOR/AHA guidelines
- vascular access
- Non-pharmacological
- temperature control
- positioning
- Transport consideration
- rapid transportation of the distressed infant
- position newborn on their side to prevent aspiration
- adequate securing of ETT
- Psychological support/ communication strategies
- Airway and ventilation
- Epidemiology
- Specific situations
- Meconium stained amniotic fluid
- Epidemiology
- Incidence
- may occur either in utero or intrapartum
- Risk factors
- fetal distress during labor and delivery
- post-term infants
- thin particulate meconium versus thick
- Incidence
- Anatomy and physiology review
- Pathophysiology
- Hypoxia or physiologic cause
- Aspiration of meconium stained amniotic fluid
- Complete airway obstruction
- Atelectasis
- right-to-left shunt across the foramen ovale
- Incomplete airway obstruction
- Ball valve type obstruction
- developing pneumothorax
- chemical pneumonitis
- Complete airway obstruction
- Patient deterioration
- hypoxia
- hypercapnia
- acidosis
- Assessment findings
- Thin and watery
- Thick and particulate
- Management considerations for thick or particulate meconium
- Airway and ventilation
- do not stimulate the infant to breathe
- ventilate with 100% oxygen
- Circulation
- Transport consideration
- identify facility to handle high-risk newborn
- Psychological support/ communication strategies
- do not discuss "chances of survival" with family
- explain what is being done for the newborn
- Airway and ventilation
- Epidemiology
- Apnea in the neonate
- Epidemiology
- Incidence
- Morbidity/ mortality
- Risk factors
- prematurity
- in newborn, prolonged or difficult labor and delivery
- drug exposure
- maternal Infection
- Anatomy and physiology review
- Assessment findings
- Failure to breathe spontaneously after stimulation
- Respiratory pauses greater than 20 seconds
- Management considerations
- Airway and ventilation
- stimulate the baby to breathe
- flicking the soles of the feet
- rubbing the back
- ventilate with BVM
- disable pop-off valve
- subsequent ventilations with minimal pressure to cause chest rise
- suction as needed
- complications
- tube dislodgement
- tube occlusion by mucous or meconium
- complications
- stimulate the baby to breathe
- Airway and ventilation
- Epidemiology
- Meconium stained amniotic fluid
- monitor heart rate continuously
- circulatory access
- peripheral iv
- intraosseous
- Non-pharmacological
- Transport consideration
- Psychological support/ communication strategies
- relatively good outcome if treated early and aggressively
- explain what is being done for the infant
- Bradycardia in the neonate
- Epidemiology
- Incidence
- most commonly caused by hypoxia
- increased intracranial pressure
- hypothyroidism
- acidosis
- Morbidity/ mortality
- minimal risk if hypoxia is corrected quickly
- risk level relative to underlying causation if not due to hypoxia
- Incidence
- Anatomy and physiology review
- Pathophysiology -- Primarily caused by hypoxia
- Assessment findings
- Assess upper airway for obstruction
- secretions
- tongue and soft tissue positioning
- foreign body
- Assess patient for hypoventilation
- Palpate umbilical stump or brachial artery
- Assess upper airway for obstruction
- Management considerations
- Airway and ventilation
- suction
- positive pressure ventilation with 100% oxygen
- endotracheal intubation
- Circulation
- heart rate less than 100 -- BVM ventilation with 100% oxygen and reassess
- heart rate less that 60 -- begin chest compressions
- heart rate between 60 and 80 but not responding to assisted ventilations with BVM -- begin chest compressions
- discontinue chest compressions when heart rate reaches 100
- Non-pharmacological -- maintain temperature
- Transport consideration -- identify facility to handle high-risk newborn
- Psychological support/ communication strategies
- Airway and ventilation
- Epidemiology
Content Creator: Ariel Wei
CAPCE Course Number: 21-EMTP-F3-6102
NJ Course Number: 141125
Total CE Hours: 1
Level: Basic
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.