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    Pediatric Emergencies: DR Khalid Rashed

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    Muhamad Farid
    The document discusses pediatric emergencies including cardio-respiratory arrest, basic life support procedures like airway management, breathing, circulation, use of AEDs and drugs. It also covers shock, drowning, burns including clinical assessment and management with fluid resuscitation, antibiotics, analgesia and skin grafting for severe burns.

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    © All Rights Reserved
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    Pediatric Emergencies: DR Khalid Rashed

    Uploaded by

    Muhamad Farid
    61 views32 pages
    The document discusses pediatric emergencies including cardio-respiratory arrest, basic life support procedures like airway management, breathing, circulation, use of AEDs and drugs. It also covers shock, drowning, burns including clinical assessment and management with fluid resuscitation, antibiotics, analgesia and skin grafting for severe burns.

    Original Title

    Pediatric Emergencies 1

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    The document discusses pediatric emergencies including cardio-respiratory arrest, basic life support procedures like airway management, breathing, circulation, use of AEDs and drugs. It also covers shock, drowning, burns including clinical assessment and management with fluid resuscitation, antibiotics, analgesia and skin grafting for severe burns.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    61 views32 pages

    Pediatric Emergencies: DR Khalid Rashed

    Uploaded by

    Muhamad Farid
    The document discusses pediatric emergencies including cardio-respiratory arrest, basic life support procedures like airway management, breathing, circulation, use of AEDs and drugs. It also covers shock, drowning, burns including clinical assessment and management with fluid resuscitation, antibiotics, analgesia and skin grafting for severe burns.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 32

    PEDIATRIC EMERGENCIES

    Dr Khalid Rashed
    CARDIO-RESPIRATORY ARREST
    • Definition: Pale or blue child with no respiration,
    carotid and femoral pulses are not palpable,
    inaudible heart sounds or severe bradycardia
    • Treatment: CPR
    • basic life support (BLS), Paediatric advanced life
    support (PALS)
    -
    Basic life support (BLS)

    • Circulation – Airways – Breathing (CABd) VS


    (ABCD)
    1. Airway
    • Immobilize the cervical spine
    • Clear the oropharynx with a suction catheter.
    • Place in supine position on hard flat surface
    • Open airway
    1. Airway
    (Head Tilt – Chin Lift Maneuver)
    1. Airway
    (Jaw- thrust Maneuver)
    2. Breathing
    • Check breathing by looking for respiratory
    movements, listen and feel for expired air
    • If No Breath: give 2 effective breaths by
    2. Breathing

    – Mouth to mouth
    – Bag and mask.
    – Endotracheal tube.
    Bag and mask.

    1-Select the appropriate sized mask


    2-Be sure there is a clear airway
    3-Position of the baby head: the neck should be slightly
    extended .
    4-The mask is held on the face with the thumb and
    index finger encircling much of the rim of the mask
    ( C – shaped ), while the ring and fifth fingers bring
    the chin forward ( E – shaped ).
    5-An air-tight seal between the rim of the mask and the
    face is essential
    • After effective breathes:
    • Child starts breathing: put child in recovery
    position. Observe.
    • No breathing after 2 effective breathes: start
    immediate combined ventilations and cardiac
    compressions
    3 -Circulation
    – External cardiac massage by 2 fingers compression
    on lower sternum or heel of hand on the lower third
    of the sternum in a child.
    – Consider press hard, fast & allow full chest recoil.
    – Rate 60 – 100 compressions per/minutes.
    – Ratio of compression to ventilation is 15-30 : 2
    (infant – children)
    • Palpate femoral pulse to see the response
    AEDs
    AEDS
    4- Drugs
    • Epinephrine 1:10.000, 0.1 – 0.3 ml/kg in
    asystole repeated q 3-5 min.
    • Calcium chloride 10 %, 0.2 ml/kg in asystole.
    • Atropine 0.01 – 0.03 mg/kg in severe
    bradycardia .
    • Lignocaine 1 mg/kg in ventricular tachycardia
    • Dopamine 5 – 20 µg/kg/min to restore blood
    pressure.
    SHOCK
    SHOCK
    • Inadequate oxygen & nutrient delivery to meet
    tissue demand.
    • Compensated (body maintain vital organs
    perfusion)
    • Decompensated (poor perfusion & hypotension).
    Aetiology of shock
    • Hypovolemic shock (commonest): loss of fluid &
    electrolytes: Dehydration, hemorrhage and burn.
    • Cardiogenic shock: myocarditis, arrhythmias and
    cardiac tamponade.
    • Distributive shock; Anaphylaxis, Neurogenic
    shock in overdose of hypnotics, tranquilizers &
    spinal cord injuries. Drugs, early sepstic shock .
    • Septic shock (2nd common ) Fulminate sepsis/
    immunocompromised
    • Obstructive shock
    • Venous: Pneumothorax -Pulmonary embolism
    -Cardiac tamponade.
    • Arterial: -Critical aortic stenosis. -Critical aortic
    coarctation -Critical pulmonary stenosis
    Clinical Picture
    • Tachycardia, tachypnea, pallor, delayed capillary
    refill & restlessness (early).
    • Skin mottling ,cold extremities& poor capillary
    refill, hypotension is late sign
    • Disturbed level of conscious, agitation followed
    by confusion and coma.
    • Signs of organ dysfunction/failure if shock
    persists.
    • ABCs + Reassess & Reassess
    • Flat position with elevated legs.
    • Clear airways , Consider intubation.
    • Oxygen(very important) & assisted ventilation.
    • I.V infusion with normal saline as CPR.
    • Inotropes as dopamine, dobutamine, adrenaline…
    • ICU management
    DROWNING
    DROWNING
    • Laryngeal spasm can lead to cerebral anoxia
    and death (dry drowning).
    • Water entering the lungs can lead to
    respiratory failure and cardiac arrest.
    • If the water is polluted the child can die later
    by pulmonary edema or pneumonia
    • Immediate cardiac massage.
    • Clear airway and ventilation.
    • Poor outcome is expected when:
    – Water temperature below 21oC.
    – Submersion is over 5 minutes.
    – The pupils are dilated and fixed.
    BURNS
    BURNS
    • According to the role of (9) the body surface area
    (BSA) is divided as follows in children more than
    10years:
    • - Head = 9 %, - Arm = 9 % - Anterior trunk = 18
    %. Posterior trunk = 18 % - Legs = 18 % -
    Genitalia = 1 %.
    • In children younger than 10 years, subtract 0.5 %
    from each leg for every year & the same % to the
    head.
    CLINICAL TYPES (DEGREE OF BURN)

    • 1st degree: superficial epidermis, pain &


    erythema.
    • 2nd degree: entire epidermis (partial thickness),
    pain & erythema blisters.
    • 3rd degree: entire dermis (full thickness)
    involving nerve eroding (painless).
    • 4th degree: if full thickness plus SC tissue
    involvement.
    Management
    • First aid measures: cold water, cardio respiratory resuscitation.
    • Hospital admission: for second (10 % body surface area) and
    third degree burn (5% body surface area).
    • Emergency management: I.V. fluids (Parkland formula :
    4 mL/kg/%BSA/24 h, 1/2 in the first 8 h and 1/2 in the next 16 h)
    • Monitor urine output, use sterile towels for exposed burn,
    antibiotics if secondary infection occurred &
    analgesia/narcotic.
    • Skin will regenerate in the first and second degree burns, but
    graft is required for the 3rd & 4th degree.
    • H2 blocker/antacid for stress ulcer prophylaxis.

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