Pediatric Cardiopulmonary Resuscitation

William E. Hauda II

Airway Anatomy

Positioning Intubation

ForeignBody „Management Breathing

Mouth, .to, „Mouth, Bag-VaJveMask Mechanical, .Ventilation

Circulation

External, .Cardiac ..Compression

VascularAccess Fluids

Pharmacologic .Agents Epinephrine

Atropine

Dysrhythmias

Cardioversion,. DefibrillatiPn,... and. Pacing Paddielize

Interface

Electrode.Position

Defibrillation

Cardioversion

Transcutaneous .Pacing

Summaryof .ManagementGuidelines TerminationM .ofEfforts Coping ..with theDeath .of..a..Child Chapter. References

This chapter reviews cardiopulmonary resuscitation (CPR) in children and notes pertinent differences compared with adults. Perhaps the greatest difference between adult and pediatric arrest is etiology. The most common cause of primary cardiac arrest in adults is coronary artery disease. Children usually develop cardiac arrest secondary to respiratory arrest and shock syndromes. Children have very poor survival rates from cardiac arrest, because it is often associated with prolonged hypoxia or shock.1,2 Following a cardiac arrest, the survival rate without devastating neurologic sequelae in children is only 2 percent. 3 The best chance for a good outcome is to recognize impending respiratory failure or shock and intervene to prevent the development of cardiopulmonary arrest.

Age-related differences must still be considered with the pediatric population. 4 An appropriate drug dose for a 6-month-old may be excessive for a 1-month-old and yet inadequate for a 5-year-old. Other aspects of resuscitation, such as endotracheal tube size, tidal volumes, cardiac compression rates, and respiratory rates, also vary with a child's age. All emergency medicine practitioners who treat children must be familiar with appropriate size of equipment and rapidly determine the correct dosage of medication for any given child.

The priorities of resuscitation are airway, oxygenation, ventilation, and shock management. These factors are easily compromised in children, but, with prompt intervention, cardiopulmonary arrest may be prevented.4 International consensus guidelines for basic life support procedures 5 are listed in Table 10-1,.

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