• Pediatric emergencies are very diverse; It can be respiratory, cardiac, endocrine, traumatic and infectious.
• Many pediatric arrests are respiratory arrests, not cardiac.
• Respiratory arrest is mostly observed after preexisting chronic lung disease or pathologies that cause shock and acute airway obstruction.
• Asystole is the most common rhythm disturbance detected on ECG in the admissions of children with arrest to the hospital.
resuscitation
• The aim of pediatric resuscitation is to stabilize the child and maintain long-term homeostasis, maintaining oxygenation and perfusion of the whole body. A certain chain of events must be followed.
• This chain starts with ABC: airway, respiration and circulation. In addition to the airway, A' also includes assessment of responsiveness ('Are you okay?'), activation of emergency medical services (EMS), and activation of high-risk events such as trauma, respiratory distress, chronic life-threatening events. It also represents the anticipation of the situations that create it.
• Respiratory Support: If no foreign body is detected and a child is unable to breathe spontaneously, immediate action should be taken to initiate the child's breathing. The most common cause of airway obstruction in an unresponsive child is fluid. In the evaluation, the opening of the airway (chin thrust if the head is back, chin up or if the cervical spine is unstable - and the heaving of the chest anteriorly, as well as observing for foreign bodies, resting the mouth and nose for breathing, and the child's airflow from the airways feeling is involved. This should be done in less than 10 seconds. If a foreign body is seen, it should be removed immediately. If no foreign body is seen, blind aspiration and routine finger aspiration are not recommended. If it is observed that the child is not breathing, 2 breaths should be given immediately. If unsuccessful, the airway is repositioned and ventilation is attempted again. If the chest wall still does not lift, foreign body should be suspected and foreign body removal maneuvers should be performed. For infants less than one year old, five back blows and five chest presses are applied. In conscious children older than one year of age, 5 abdominal compressions (Heimlich maneuver} are performed while the child is standing or sitting. If the child is unconscious, this maneuver should be performed while the child is lying on his back.
• Cardiovascular Support: After ventilation is initiated in resuscitation, circulatory support must be provided in order to maintain the blood flow that provides oxygen to the tissues. Circulation is evaluated by lifesavers without looking at the pulse, but healthcare professionals and trained parents should check the pulse. Chest compressions should be performed if the pulse is absent or less than 60 bpm with poor perfusion.
• In case of cardiopulmonary arrest, if vascular access cannot be established within 60 seconds, intraosseous access to the anterior tibia should be established. The intraosseous route is similar to the intravenous route. In this way, various laboratory tests can be performed and drugs and fluid used in emergency resuscitation can be administered. In addition, certain drugs can be administered with an endotracheal tube. Drugs effective in this way are lidocaine, atropine, naloxone and epinephrine (ELVAN). Epinephrine should be given 10 times more than the intravenous dose.
• Since many intubations are performed urgently in critically ill children, patients should be intubated with sedation, analgesia or paralysis (sequential serial intubation) (unless the patient has conditions such as apnea or arrest that require urgent intubation). Aspiration of gastric contents is prevented by esophageal compression (Sellick maneuver)
• Endotracheal intubation is avoided and cricothyroidotomy is performed in complete airway obstructions.
Basic life support in children
Flowchart of tachycardia in children
Flowchart of bradycardia in children
