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.
