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The code leader must ensure that high-quality basic cardiopulmonary resuscitation (CPR) be integrated into advanced life-support measures in order to ensure a good outcome during resuscitation.
Initiate chest compressions before ventilations in order to immediately provide blood flow to the heart and brain (2015 American Heart Association [AHA] C-A-B recommendations).
When two or more health care providers are performing CPR on an infant or child (without signs of puberty), the correct compression-to-ventilation ratio is 15:2 (15 compressions followed by 2 ventilations). In all other circumstances, the universal compression-to-ventilation ratio is 30:2.
Perform 2-minute cycles of uninterrupted CPR before stopping compressions to reassess the child.
Automated external defibrillators (AEDs) can be safely and effectively used in infants and children of all ages. If possible, use a pediatric attenuator device for children weighing less than 25 kg.
Ventricular fibrillation and pulseless ventricular tachycardia are treated with single shocks followed immediately by 2-minute cycles of CPR in order to maintain myocardial and brain perfusion after each defibrillation.
Length-based tapes facilitate medication dosing and device size selections.
Intraosseous (IO) lines can be used in any age pediatric patient for any medication that can be delivered via the intravenous (IV) route.
IV or IO medication administration is preferred over the endotracheal route.
Pulseless electrical activity (PEA) requires the identification and correction of reversible causes, the most common of which is hypovolemia. Therefore, always consider a rapid fluid bolus in any child presenting in a PEA rhythm.
The quality of chest compressions can be monitored with continuous monitoring of end-tidal CO2 (ETCO2). An ETCO2 less than 10 to 15 mmHg may indicate low cardiac output secondary to inadequate depth of chest compressions during CPR, whereas >10 to 15 mmHg suggests effective chest compressions during CPR. An abrupt rise in ETCO2 during chest compressions may suggest the return of spontaneous circulation (ROSC).
After ROSC, avoid the risk of hyperoxia reperfusion injury. Titrate the oxygen fraction of inspired oxygen (FiO2) administration to maintain oxygen saturations of 94% to 99%.
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Sudden cardiac arrest due to a primary cardiac dysrhythmia is rare in children.1 Unrecognized and progressive respiratory distress and shock are the most common etiologies of cardiopulmonary arrest (CPA) in children. The outcome for out-of-hospital CPA is poor, with only 4% to 13% of children surviving to hospital discharge.2 The survival rate of in-hospital CPA is approximately 27% to 33%.2,3 Early recognition of a child in respiratory distress and/or compensated shock is essential to prevent the progression to CPA.
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THE IMPORTANCE OF INCORPORATING HIGH-QUALITY BASIC LIFE SUPPORT INTO ADVANCED LIFE-SUPPORT MEASURES
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The 2015 AHA CPR and Pediatric Advanced Life Support (PALS) guidelines continue to emphasize the importance of immediate high-quality basic life support by lay rescuers and by health care providers. The major change regarding the sequence of actions for CPR in the previous 2010 AHA ...