Suportul Vital de Baza Pediatric Curs Studenti 2014 Bis

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  • SuportulSuportul vital devital de bazbaz pediatricpediatric

    Dr. TatianaDr. Tatiana CiomCiomrtanrtan

    20142014

    Pediatric Chain of survivalPediatric Chain of survival

    Berg M et al. Circulation 2010;122:S862-S875

  • Pediatric Chain of survivalPediatric Chain of survival

    Berg M et al. Circulation 2010;122:S862Berg M et al. Circulation 2010;122:S862--S875S875

    2007 AHA Guidelines.2007 AHA Guidelines. PediatricsPediatrics 2006;117;e9892006;117;e989--e1004e1004

    AlgoritmAlgoritm dede resuscitareresuscitareDiferenDiferenee copilcopil -- adultadult

    Stop cardiac asfixic(cel mai frecvent la copil)

    Stop cardiac de orginecardiac (TV, FV)

    (cel mai frecvent la adult)

    MCE + Ventilaie MCEAABBCC

    CCAABB

  • 1 salvator: pentru COLAPS BRUSCactivai sistemul de urgen, aducei DEA / defibrilatorul

    2

    Nu rspundeNu respir sau gasping

    Activai sistemul de urgenAducei DEA / defibrilatorul

    1

    3Verificai pulsuln 10 secunde Are puls 1 respiraie la fiecare 3 sec.+ MCE dac pulsul este < 60/min cu

    perfuzie periferic slab,n ciuda unei bune oxigenri i ventilaii

    Verificai pulsul la fiecare 2 min.

    3a

    Nu are puls

    1 salvator: cicluri de 30 compresii toracice i 2 respiraii2 salvatori: cicluri de 15 compresii toracice i 2 respiraii

    4

    SuportulSuportul vital devital de bazbaz pediatricpediatric

    Dup 2 min, activai sistemul de urgen i aducei DEA / defibrilatorul(dac nu ai fcut-o deja)

    Folosii DEA ct mai curnd posibil

    5

    Realizate de ctre personalul medical Topjian A, Berg R. Circulation 2012;125:2374-2378

  • SuportulSuportul vital devital de bazbaz pediatricpediatric

    Dup 2 min, activai sistemul de urgen i aducei DEA / defibrilatorul(dac nu ai fcut-o deja)

    Folosii DEA ct mai curnd posibil

    5

    ocabil Neocabil

    Topjian A, Berg R. Circulation 2012;125:2374-2378

    Verificai ritmulRitm ocabil?

    6

    Administrai 1 ocReluai imediat

    MCE timp de 2 min

    7Reluai imediat MCEVerificai ritmul la fiecare 2 min;continuai pn vine echipa deresuscitare sau victima se mic

    8

    Realizate de ctre personalul medical

    Salvatori neprofesioniti: Activai sistemul de urgen (chemai alt salvator,chiar dac este neprofesionist),

    Asigurai sigurana victimei i a salvatorului, Verificai rspunsul la stimuli, Verificai respiraia, Evaluai necesitatea MCE - dac victima nurspunde i nu respir, se presupune c este necesarMCE

    SuportulSuportul vital devital de bazbaz pediatricpediatric

  • CirculationCirculation. 2000;102:I. 2000;102:I--253253--II--290290

    Respir normal?

    Privii, ascultai i simii dac respir normal

  • Poziie desiguran

    Respir normal1

    43

    2

    2007 AHA Guidelines.2007 AHA Guidelines. PediatricsPediatrics 2006;117;e9892006;117;e989--e1004e1004

    Poziie de siguran

    Respir normal

  • CirculationCirculation. 2000;102:I. 2000;102:I--253253--II--290290

    Nu respir normal

    Extensia capului +ridicarea brbiei

    Atenie la cderealimbii posterior risc de obstruarea CRSPip Guedel

    mpingerea mandibulei anterior

    PermeabilizareaPermeabilizareaccilorilor aerieneaeriene superioaresuperioare

  • VentilaVentilaiaia gurgur lala gurgur

    Pensai nasul Inspirai normal Punei buzele pe gura pacientului Expirai timp de 1 secund verificai c

    toracele se ridic Lsai toracele s revina la poziia iniial Repetai

    ERC guidelines. Resuscitation 2010; 81:1219ERC guidelines. Resuscitation 2010; 81:121912761276

    VentilaVentilaiaia gurgur lala gurgur

    Nolan et alNolan et al ERC guidelines. Resuscitation 2010; 81:1219ERC guidelines. Resuscitation 2010; 81:121912761276

  • SuportSuport ventilatorventilator avansatavansat

    Ventilaia cubalon i masc

    Masca laringian

    Berg M et al. Circulation 2010;122:S862-S875

    VentilaVentilaiaia cucu balonbalon ii mascmasc

  • MCEMCE

    Nolan et alNolan et al ERC guidelines. Resuscitation 2010; 81:1219ERC guidelines. Resuscitation 2010; 81:121912761276

  • CaracteristiciCaracteristici ale MCE deale MCE de calitatecalitate frecven de minimum 100/min, profunzime de minimum 1/3 din

    diametrul antero-post. toracic(4 cm la sugari, 5 cm la copii),

    dup fiecare compresie lsaitoracele s revin,

    minimalizai ntreruperile, evitai ventilaia excesiv.

    Berg M et al. Circulation 2010;122:S862-S875

    MCE la sugarMCE la sugar 11 salvatorsalvator

  • Berg M et al. Circulation 2010;122:S862-S875

    MCE la sugarMCE la sugar 22 salvatorisalvatori

    MCE laMCE la copilcopil

    Nolan et alNolan et al ERC guidelines. Resuscitation 2010; 81:1219ERC guidelines. Resuscitation 2010; 81:121912761276

  • Aspiraia de corp strin - tratamentEvaluai severitatea

    Tuse ineficient Tuse eficient

    IncontientPermeabilizai CRS5 respiraii salvatoareMCE

    Contient5 x Manevra Heimlich(sugar lovirea spatelui,copil compresieabdominal brusc

    Facilitai tuseaVerificai continuueventuale semne dedeteriorare sau pn lanlturarea obstruciei

  • ManevraManevra HeimlichHeimlich

    http://www.nucleusinc.com

    LaLa sugarisugarihttp://www.apollolife.com

    ManevraManevra HeimlichHeimlichLa adultLa adult ii copilcopil

    http://www.allinahealth.org

    http://anuandong.blogspot.ro

  • Vrst Palparepuls

    MCE:Resp /Ritm

    Poziie Respiraiisalvatoare

    DEA

    Sugar< 1 an

    arterabrahial

    15:2 /100/min

    Vrful a 2 degetepe 1/3 inferioara sternului

    Ventilaiegur lagur-i-nas

    Nu

    Copil1 an -pubertate

    arteracarotid

    30:2 /100/min1 salvator

    Podul palmei pe1/3 inferioar asternului,degetele ridicate

    Ventilaiegur lagur

    DaPadele +programpediatric

    SuportulSuportul vital devital de bazbaz pediatricpediatric-- rezumatrezumat --

    ** 2 salvatori: dac exist masc laringian sau SET sau traheostomie,MCE cu 100/min continuu, simultan cu ventilaii 8 10/min.

    http://stemlynsblog.org/paediatric-arrest-but-what-about-the-parents