Basic And Advanced Cardiopulmonary Resuscitation In Pediatrics

Basic and advanced cardiopulmonary resuscitation in Pediatrics

Introduction

What is cardiorespiratory arrest in children? Who can perform cardiopulmonary resuscitation? How it is performed? What is the difference between basic and advanced cardiopulmonary resuscitation? First we will knew that a cardiorespiratory arrest is the global cessation of circulation causing tissue hypoxia and absence of its functions;Therefore, CPR (cardiopulmonary resuscitation) are considered as the maneuvers that are performed to ensure oxygenation of the organs when blood circulation has been stopped. The basic CPR can be done by any person who has a general knowledge of this issue, however the advanced CPR must be carried out by highly trained health personnel with skills to perform the procedures required in timely time.

Authors like Palacios et al. ״ They concluded that the successful application of RCP maneuvers are not in the quality of pre -hospitable health care, or the provision of material resources but also of the teaching of first aid and emergency care maneuvers ”. It causes me great need to constantly be trained to act immediately and correctly before all the pathologies that put the lives of human beings at imminent risk.

Throughout this article we will address step by step the protocol that must be followed when we are facing a child with cardiorespiratory arrest to be able to put it into practice effectively. So the general objective of this article is to create a RCP management guide in which it can be known that it is a cardiorespiratory arrest in pediatrics, such as knowing that we are facing this pathology, in what time and how to act to be able to safeguard lifeof the patient.

On the other hand, within the specific objectives it has been possible to determine the possible causes and symptoms presented by a child with cardiorespiratory arrest;Also, know the medications and their therapeutic dose of choice for advanced cardiopulmonary resuscitation.

A retrospective descriptive study was carried out, based on the analysis of several previous studies articles carried out internationally in pediatric hospitals from 2015 to the present.

Keywords: cardiopulmonary resuscitation, cardiac arrest, intubation, cardiac massage, advanced resuscitation, adrenaline, atropine, amiodarone, defibrillations.

Developing

Cardiac arrest in children

The main cause in children is of respiratory origin, causing hypoxemia, and hypoperfution in vital organs, until reaching cardiac arrest. According to a study conducted at the Virgen de la Salud University Hospital in Toledo, pediatric patients have extra hospitable cardiorespiratory unemployment in 8-20% cases for every 100000 children, while 1 is recorded.5- 4.5% intra hospital cases. The Spanish Emergency Society of Pediatrics (3), affirms that the cardiac arrest of sudden origin is rare being 3 being 3.8 % in infants and 19 % in adolescents.

Causes:

• Respiratory:

• Obstruction of the airway
• Laryngitis-crop
• tracheobronchitis
• asthma
• Pneumonia
• Drowning
• Trauma
• Hemoneumothorax
• Chest wall lesions

Clinical signs:

• There is no response to stimuli,
• Normal breathing lack
• Heart rate less than 60 beats per minute or absent.

Basic cardiopulmonary resuscitation

Procure patient safety and the person who is going to revive it, immobilize the child in case of trauma. Prior to resuscitation maneuvers we must take into account the following ABC sequence:

"A (airway), B (breathing and ventilations), C (chest circulation and compressions)".

• Value state of consciousness, place supine on a flat surface.
• Airway: tilting the head back by placing the hand on the forehead and we raise the chin. Do not compress soft tissues to avoid obstructing the airway. Keep the airway open, periodically check if you are breathing and not have a good respiratory mechanics, start ventilation. Give 5 insufflations and check that the thorax rises, keep a good seal with the lips. If there is the presence of a foreign body try to extract it. If there are 5 failed attempts for good ventilation, thoracic compressions must be initiated.
• Thoracic compressions: Pressure will be placed in the lower third of the sternum to be able to depress at least one third of the anteroposterior diameter of the thorax, in order to perform the following compression the pressure should be released completely. The frequency of thoracic compressions will be 100 to 120 per minute, and will be carried out as follows;15 thoracic compressions and 2 ventilations. Keeping so until it is decided to interrupt the CPR.
• Every two seconds, vital signs must be assessed, using a maximum time of 10 seconds for this. At the minute of starting resuscitation to call emergencies;It is recommended to keep the CPR, until the specialized team arrives.

Advanced cardiopulmonary resuscitation

The RCPA covers a set of maneuvers and techniques with the objective of restoring spontaneous circulation and breathing, ensuring that the adverse effects are minimal and maximum should be performed up to 8 minutes of presented the event.

• Ensure airway: with endotracheal intubation or laryngeal mask, with 100% Fio2.
• Channel peripheral or intrarósea or central and administer drugs and fluids.
• If you fail to channel venous access quickly, medication by the endotracheal tube can be placed: adrenaline 0.1 mg/kg;atropine 0.03 mg/kg;Lidocaine 2 to 3 mg/kg.
• Motorization continues to assess resuscitation.
• Maintain thoracic compressions prior to endotracheal intubation and until a heart rate greater than 60 beats/minute.

Treatment:

• Drugs used in the RCPA

• ADENOSINE: Used for supraventricular tachycardia, initial dose 0.1 mg/kg IV maximum 2 doses.
• ADRENALINE: ELECTION MEDICINE FOR RCP. Dose: 0.01 mg/kg (0.1 mg of the dilution at 1/10000). The endotracheal dose is 0.1 mg/kg. The dose will be repeated every 3 to 5 minutes if cardiorespiratory arrest persists.
• Atropine: reduces vagal tone, accelerates sinus rhythm by increasing heart rate. Dose: 0.02 to 0.1 mg/kg.
• Amiodarone: used for the treatment of ventricular and supraventricular tachycardia. Dose: 5 mg/kg i, you can repeat every 5 minutes with a maximum dose of 15 mg/kg.
• Lidocaine: Prevents ventricular fibrillation. Dose: 1 mg/kg in bolo IV, it can be repeated until a dose of 3 mg/kg can be reached.
• Sodium bicarbonate: During cardiac arrest, mixed acidosis is presented, this effective medication being to correct this. Dose: 1 meq/kg.
• Liquids: Crystalloids are recommended such as: physiological saline, ringer and hem lactate.

Discussion

Cardiopulmonary resuscitation is a complex but indispensable procedure to save people’s lives, so we should all be in the ability to be able to make basic pediatric CPR and health personnel must be highly trained to be able to perform an adequate advanced CPR. However, the much of the population has little knowledge or erroneous information about these maneuvers, because in the country in development in which we find there is little interest in this issue that could save our lives. The idea of creating a group of people with CPR capacity should not be ruled out.

In the hospitable field, the training of a team with a coordinator who directs, supervises and distributes activities according to the skills of each member in such a way that it works in an orderly and correct manner is fundamental, remembering that a bad execution of the RCP protocols would carryto the death of the patient. Know how to act rightly, acquire knowledge skills and technology have saved the lives of many children.

Conclusions

It has been said repetitively that CPR is an indispensable procedure to prevent children’s health and well -being. Basic cardiopulmonary resuscitation includes general knowledge, in order to identify the decrease in vital functions, so it requires acting immediately performing chest insufflations and compressions that anyone should be in the ability to do it until the health personnel go to the place. On the other hand, advanced CPR demand to develop broad skills and knowledge in this topic to maintain respiratory, hemodynamic and neurological stability avoiding irreversible injuries due to hypoxia. Finally after analyzing this article I conclude that knowledge and time is fundamental since, as Mahatma Gandhi (4): “Health is real wealth and not gold pieces."

Bibliography

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