this powepoint describe changes between 2010 and 2015 guidlines for BLS, PALS in pediatric age group

1. Updates of 2015 PALSUpdates of 2015 PALS
guidelinesguidelines
Marwa Elhady
lecturer of pediatrics
Faculty of medicine for girls
Al-Azhar University
2016

2. ‫تعالى‬ ‫قال‬‫جميعا‬ ‫الناس‬ ‫أحيا‬ ‫فكأنما‬ ‫أحياها‬ ‫)ومن‬ : )‫تعالى‬ ‫قال‬‫جميعا‬ ‫الناس‬ ‫أحيا‬ ‫فكأنما‬ ‫أحياها‬ ‫)ومن‬ : )

3. IntroductionIntroduction
Objectives
What is
CPR??
What is
CPR??
overview on
CPR 2015
overview on
CPR 2015
Explanations
& New
studies
Explanations
& New
studies
overview on
CPR 2010
overview on
CPR 2010
2015 AHA Guidelines
update for CPR & BLS for
pediatric in comparison with
2010
Summary of High-Quality
CPR Components for BLS
Providers in pediatrics
Summary of High-Quality
CPR Components for BLS
Providers in pediatrics

4. Introduction:

6. Start CPR ImmediatelyStart CPR Immediately
Brain damage starts in 4-6 minutes
Brain damage is certain after 10
minutes
Better chance of survival
Without CPR
SO

8. Checking Vital SignsChecking Vital Signs
A – Airway
Open the airway
Head tilt chin lift
B – Check For Breathing
Look, listen and feel for breathing
No longer than 10 seconds
If the victim is not breathing, give two
breaths (1 second or longer)

9. Mouth to Mouth Barrier DevicesMouth to Mouth Barrier Devices
Shields Masks

10. After giving breaths…
Locate proper hand position for chest
compressions
C – Chest compression

12. Checking for CPRChecking for CPR
EffectivenessEffectiveness
Does chest rise and
fall with rescue
breaths?
Have a second
rescuer check pulse
while you give
compressions

13. 1- Ensure chest compression of
adequate rate
2- Chest compression of adequate depth
3-Allow full chest recoil in between
compressions
4-Minimizing interruptions of chest
compressions
5- Avoid excessive ventilation
Components of high quality CPR

14. Old
BLS 2010

16. BLS 2015 (1 rescue)BLS 2015 (1 rescue)

17. BLS 2015 (2 rescue)BLS 2015 (2 rescue)

18. Basic Life Support
BLS
Basic Life Support
BLS

19. ITEM 2015 ( UPDATE( 2010 ( Old ) Explanation
New
algorithms
Two algorithms
for 1-Rescuer and
Multiple-Rescuers
Handheld cellular
telephones with
speakers allow
single rescuer
to activate an
emergency
response while
beginning CPR
One algorithm
for one or
Multiple-
Rescuers
CPR have been
separated to
better guide
rescuers

20. ITEM 2015 ( UPDATE(
as 2010 ( Old)
Explanation
C-A-B
Sequence
Chest compression first
CPR should begin with 30
compressions (if 1 rescuer) or 15
compressions (if 2 rescuer)
rather 2 breaths
Beginning CPR
by compressions
rather than
breaths
(C-A-B rather
than A-B-C).
leads to a shorter
delay to 1st
compression
providing vital
blood flow to
heart & brain.

21. ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Chest
Compression
Depth
depress the chest
at least 1/3 the
anteroposterior
diameter in
pediatric
approximately
1.5 inches (4 cm)
in infants to 2
inches (5 cm) in
children
Max limit is 2.4
inches (6 cm) as
adult
compress at
least 1/3 of the
anteroposterior
diameter of the
chest
No maximum
limit
Studies showed
that
compressions
deeper than 2.4
inches (6 cm) is
harmful.

22. ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Chest
Compression
Rate
Use the
recommended
adult chest
compression
rate of 100
to 120/min for
infants and
children
Push at a rate
of at least 100
compressions
per minute.
To maximize
educational
consistency and
retention,
pediatric experts
adopted
the same
recommendation
for compression
rate as is made
for adult BLS.

24. ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Compression
-Only CPR
rescue breaths
and chest
compressions
should be
provided
But if rescuers
are unwilling or
unable to deliver
breaths
compression-
only CPR
can be effective
in patients with
cardiac arrest.
Optimal CPR
includes both
compressions
and
ventilations
When cardiac
etiology was
present,
outcomes were
similar whether
conventional or
compression-
only CPR was
provided.
compressions
alone are
preferable to no
CPR.

25.  Reaffirming the C-A-B sequence as the preferred
sequence for pediatric CPR
 New algorithms for 1-rescuer and multiple-rescuer
pediatric HCP with use of cell phone
 Establishing an upper limit of 6 cm for chest
compression depth in an adolescent
 Mirroring the adult BLS recommended chest
compression rate of 100 to 120/min
 Strongly reaffirming that compressions and
ventilation are needed for pediatric BLS.
Summary of Key Issues and Major
Changes

27. Pediatric Advanced life support
PALS
Pediatric Advanced life support
PALS

28. • Fluid resuscitation in febrile illness
• Atropine use before tracheal intubation
• Use of amiodarone and lidocaine in shock- refractory
VF/pVT
• TTM after resuscitation from cardiac arrest in infants
and children
• Post–cardiac arrest management of blood pressure.
updates are provided about:

29. ITEM 2015 (UPDATE( Explanation
Fluid
Resuscitation
Early, rapid IV administration
of isotonic fluids for septic
shock.
(20 mL/kg)
If febrile illness with limited
access to critical care resources
(ie, MV and inotropics)
administration of bolus IV fluids
with extreme caution, as it may
be harmful.
In resource-
limited settings,
excessive fluid
boluses to febrile
children may
lead to
complications
where the
appropriate
equipment and
expertise might
not be present to
effectively
address them.

30. ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Atropine for
ETT
no evidence
support routine
use of atropine
as a
premedication to
in ER pediatric
intubations.
Considered in
situations with
increased risk of
bradycardia.
atropine 0.1
mg IV was
recommended
to prevent
bradycardia
Recent evidence
is conflicting
Recent studies
did use atropine
doses less than
0.1 mg without
an increase in
the likelihood of
arrhythmias.

31. ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Invasive
hemodynamic
monitoring
during CPR
If invasive
hemodynamic
monitoring is
in place at the
time of a
cardiac arrest
in a child,
use it to guide
CPR quality.
Chest
compressing to
a specific
systolic blood
pressure target
has not been
studied in
humans but
may improve
outcomes in
animals.
Recent evidence
of improved
outcome when
CPR technique
was adjusted on
the basis of
invasive
hemodynamic
monitoring.

32. ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
antiarrhythmic
medications
for shock
refractory VF
or pulseless VT
Amiodarone
or lidocaine is
equally
acceptable for
the treatment
of shock-
refractory VF
or pulseless
VT in
children
Amiodarone
was
recommended
for shock
refractory VF
or pulselessVT.
Lidocaine can
be given if
amiodarone is
not available.
Recent evidence
that lidocaine
was associated
with higher rates
of survival
compared with
amiodarone,.

33. ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Vasopressors
for
Resuscitation
It is
reasonable to
give
epinephrine
during cardiac
arrest
Epinephrine
should be given
for pulseless
cardiac arrest.
Recent evidence
that epinephrine
was associated
with improved
ROSC and
survival in
cardiac arrest

34. ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
ECPR
Compared
With
Standard
Resuscitation
ECPR may be
considered for
children with
underlying
cardiac
conditions
who have an
IHCA,
provided
appropriate
protocols,
expertise, and
equipment are
available.
Extracorporeal
life support
should be
considered only
for children in
cardiac arrest
refractory to
standard
resuscitation
attempts, with
a potentially
reversible cause
of arrest.
One
retrospective
registry review
showed better
outcome with
ECPR for
patients with
cardiac disease
than for those
with non cardiac
disease.

35. ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Targeted
Temperature
Management
For comatose
children
maintain
either 5 days
normothermia
(36°C -37.5°C)
or
Initial 2 days
hypothermia
(32°C - 34°C)
followed by 3
days
normothermia
Therapeutic
hypothermia
(32°C to 34°C)
may be
considered for
children who
remain
comatose after
resuscitation
from cardiac
arrest.
Recent evidence
show no
difference in
functional
outcome at 1
year between use
therapeutic
hypothermia
(32°C to 34°C)
or
normothermia
(36°C to 37.5°C)

36. ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Intra-arrest
and Post-
arrest
Prognostic
Factors
Multiple
factors should
be considered
to predict
outcomes of
cardiac arrest.
And
for decision to
continue or
terminate
resuscitation.
Practitioners
should consider
multiple
variables
to
prognosticate
outcomes
and
use judgment to
titrate efforts
appropriately.
No single intra-
arrest or post–
cardiac arrest
variable has
been found that
reliably predicts
favorable or
poor outcomes

37. ITEM 2015 (UPDATE( Explanation
Post–Cardiac
Arrest Fluids
and Inotropes
fluids and
inotropes/vasopressors
should be used to maintain a
systolic blood pressure above
the fifth percentile for age.
Intra-arterial pressure
monitoring
should be used to continuously
monitor blood pressure and
identify and treat hypotension.
children who
had hypotension
had worse
survival and
worse neurologic
outcome

38. ITEM 2015
(UPDATE(
2010 ( Old ) Explanation
Post–Cardiac
Arrest Pao2
and Paco2
avoid
Hypoxemia.
titrate oxygen
administration
to achieve
(sat. > 94%).
target PaCO2
appropriate for
each patient.
Avoid
hypercapnia or
hypocapnia.
maintain an
oxyhemoglobin
saturation of 94%
or greater.
No
recommendations
were
made about
PaCO2.
normoxemia
associated with
improved
outcome
compared with
hyperoxemia
Worse patient
outcomes
associated with
hypocapnia.

39.  Restrictive fluid volumes in febrile illness.
 Routine use of atropine as a premedication for emergency
ETT in non-neonates is controversial.
 If invasive arterial blood pressure monitoring is already
in place, use it to adjust CPR.
 Epinephrine continues to be recommended as a
vasopressor in pediatric cardiac arrest
 fluids and inotropes used to maintain a systolic blood
pressure above the fifth percentile for age.
 Maintain O2 sat >94%, Avoid hype or hypocapnia.
 Therapeutic hypothermia have no advantage than
normothermia
 ECPR is considered in children with cardiac disease
Summary of Key Issues and Major
Changes