Presentation on theme: "European Resuscitation Council"— Presentation transcript:
1 European Resuscitation Council EPLSCardiac arrestand arrhythmiasEuropean Resuscitation Council
2 ObjectivesTo know basic elements to evaluate patients with rythm disturbanceTo know advanced treatment of paediatric cardiac arrestTo know emergency treatment of most frequent pediatric disrrhythmias
3 General Considerations In children arrhythmias are more often the consequence of hypoxaemia, acidosis and hypotensionPrimary cardiac diseases are rareMonitoring cardiac rythm is mandatory in advanced life support to evaluate cardiac function and response to therapy
4 Three Classes of Rhythm Disturbances Absent pulse – cardiac arrest rhythmsSlow pulse – bradyarrhythmiasFast pulse - tachyarrhythmias
5 “Treat the patient not the monitor” Factors InvolvedCareful evaluation of patient clinical statusABC !!!Rapid evaluation of the rhythm on the monitorFirst law:“Treat the patient not the monitor”
6 Useful Questions for a Child With Arrhythmia Is the pulse present ?Is the child in shock ?Is the heart rate fast or slow ?Is the rhythm regular or irregular ?Are QRS complexes narrow or wide ?
7 Cardiac Rate Age Tachycardia Bradycardia < 1 y > 180 bpm < 80 bpm> 1 y >160 bpm < 60 bpm
23 Slow Pulse - Bradyarrythmias Most frequent pre-terminal rhythm in the critically ill childIn paediatric age, most frequently caused by hypoxia, acidosis, hypotension, hypothermia and hypoglycaemia, rather than of primary cardiac originIncreased vagal tone and CNS insults also may lead bradycardia
24 1st choice if vagal tone or AV block Bradycardia <60 bpmOxygenate/ventilatePoor perfusion ?During CPRIntubationVascular Access IO/IVTreat possible causesConsider continuous infusion adrenaline/dopamineConsider cardiac pacingChest CompressionAdrenalineAtropine1st choice if vagal tone or AV blockreassess
25 Drugs for Bradycardia Oxygen !!!!!! Adrenaline Atropine I.V/ I.O mcg/kg (1:10000 , 0.1 ml/kg)E.T mcg/kg (1:1000, 0.1ml/kg)AtropineI. V mg/kgMinimum dose : mgMax single dose : 0.5 mg child1 mg adolescentCan be repeated 1 time after 5 min.Max dose mg c / a
33 Synchronized Cardioversion 1st dose 1 J/Kgif necessary up to 2 J/Kg
34 Ventricular tachycardia Fast Pulse - Wide QRSVentricular tachycardia
35 PROBABLE VENTRICULAR TACHYCARDIA Immediate Cardioversion NOSee CRA algorithmPalpable pulse?YESNOYESPoor perfusionConsult pediatric cardiologistCardioversion with sedation0.5 to 1 J/kgImmediate Cardioversion0.5 – 1 J/kgSedation if possibleConsider other medicationsAmiodarone 5 mg/kg IV in minProcaïnamide 15 mg/kg IV in minLidocaïne 1 mg/kg IV bolusDon’t associate Amiodarone and Procaïnamide*Consider reversible causesHypoxemiaHypovolaemiaHyperthermiaHyper/hypokaliemiaTamponadeTension PneumothoraxToxics / MedicationsThrombo-embolismPain
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