Resuscitation and Emergency Drugs

Abstract

Cardiac arrest in children is usually asystolic due to hypoxia and the end-point of decompensated respiratory or circulatory failure. Prognosis of arrests in children is better than adults. 5–15% of cardiac arrests in children are due to a primary cardiac event with underlying cardiac disease. High quality CPR includes minimal interruption to chest compressions and ventilation. The compression rate during CPR for all ages is between 100 and 120 per minute, and the ratio of compressions to ventilations is 15:2. Although manual defibrillators are preferred for children, automatic external defibrillators can be used, preferably with attenuator pads for children younger than 8 years. Vascular access is challenging during emergencies and intra-osseous access using a drill device has become the initial technique to use. The neonatal resuscitation guidelines are appropriate for newborns with a transitional circulation, and in locations where the neonatal guidelines are commonly used, such as the delivery room, nursery or NICU. Although the APGAR score is always recorded, it does not determine the need for resuscitation. Ventilation to reverse hypoxia and bradycardia is the most important aspect of neonatal resuscitation, but may be difficult due to their small size and poor lung compliance before expansion of the lungs and resorption of lung fluid.

Review Questions

• 1. The emergency bell in the PACU is alarming. You arrive to find a child who is not responsive, grey, apneic, and has no pulse. Nursing staff are performing CPR. They tell you that the child has just had a tonsillectomy. Describe your resuscitation of the child.

• 2. You are asked to provide assistance to resuscitate a baby. One minute after birth the baby has irregular respiratory effort, is blue all over, limp and has no reaction to suction. The umbilical cord stump pulse is felt at 60/min.

  Describe your resuscitation of the baby.

  This baby needs resuscitation because it has poor respiratory effort, is blue and bradycardic. The baby has already been dried, suctioned and stimulated and 1 min has gone by. A 30 s trial of mask ventilation should be the next step. If the heart rate still doesn’t increase above 60, cardiac massage needs to be started and intubation considered.

  How is the Apgar score calculated, and what does it mean?

  Virginia Apgar was an American anesthetist who devised the score in 1952. This baby gets 1 for HR, 1 for respiratory effort, but 0 for tone, color and response to suction. Its score is 2. Remember—the Apgar does not determine the need for resuscitation.

• 3. You have performed a caudal block under GA with 1 mL/kg of ropivacaine 0.2% in a 4 year old who weighs 20 kg. One minute after completion of the block you see multiple ventricular ectopic beats. As you are checking the patient’s blood pressure, the ECG changes to this VF. What is the likely diagnosis? Describe your initial management of the patient

• 4. The resuscitation trolley is brought into the theatre. The defibrillator is an AED but does not have pediatric pads. Can this be used? Where would you place the pads?