Cardiopulmonary resuscitation

Chapter 8 Cardiopulmonary resuscitation





INTRODUCTION


While few resuscitation situations involving children arise without warning, it remains imperative that children’s nurses are skilled in the area of basic life support (Simpson 1994, Carter & Dearmun 1995). Paediatric basic life support (BLS) is described as the provision of cardiopulmonary resuscitation (CPR) with no devices or with bag-valve-mask ventilation or barrier devices, until advanced life support (ALS) can be provided (International Guidelines 2000). However, ‘if basic life support is not effectively delivered to the child, attempts at advanced life support are likely to prove futile’ (Simpson 1994, p 39).


As accidents remain the commonest cause of death in children and as the life expectancy of children with a variety of chronic illnesses is increasing, the need for parents, and also other members of the general public, to learn basic paediatric life support is becoming increasingly important (Carter & Dearmun 1995, Whitton 1995).


It is important to recognise that practising CPR using a baby or child manikin is the most effective way of ensuring that children’s nurses have appropriate skills to help an infant or child in need. In addition, these skills, in order to be fresh, require to be updated regularly.


All nurses must be aware of the emergency call telephone number and procedure for their individual clinical areas.


Sudden cardiac arrest is a rare event in the paediatric population; most children will show signs of physiological deterioration, sometimes hours prior to the event (Tibballs et al 2005). As outcome from cardiac arrest is poor, it is important that deteriorating patients are recognised and appropriate interventions made. A number of early warning systems to detect clinical deterioration have been developed and are now used within adult medicine (Parr et al 2001, Hodgetts et al 2002). Early warning systems are now being developed throughout paediatric medicine (Tibballs et al 2005, Duncan et al 2006, McCabe et al 2009). Most paediatric hospitals are now using or developing early warning systems, it is important that the nurse is familiar with their format and use.





FACTORS TO NOTE


Babies and children differ from adults in a number of ways:












Ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) has been reported in 10–20% of paediatric cardiac arrests (Mogeyzel et al 1995, Young & Seidel 1999). It is most likely to occur in children who are hypothermic, have structural cardiac disease or have taken an overdose of tricyclic antidepressants.



BASIC PAEDIATRIC LIFE SUPPORT



METHOD


If the lone rescuer has been taught adult basic life support then they may use the adult sequence with the addition of providing five initial breaths and performing 1 min of basic life support prior to going for help (Resuscitation Council (UK) 2005).


The following recommendations should be used by those who have a duty of care to respond to paediatric emergencies.






Opening the airway








For infants, place the head in the neutral position and deliver breaths by covering the mouth and nose. It has been suggested that in some infants it is not possible for an adult to effectively cover both mouth and nose for ventilation (Tonkin et al 1995). If the nose and mouth cannot be covered by the rescuer’s mouth, breaths could be delivered by covering either the nose or the mouth (if the nose is used, the mouth should be closed to prevent air escaping) (ERC 2005, AHA 2005).





Deliver five initial rescue breaths (ERC 2005, Resuscitation Council (UK) 2005). If chest movement is not witnessed, reposition the airway. If this is unsuccessful, the possibility of a foreign body should be considered.


Mar 7, 2017 | Posted by in NURSING | Comments Off on Cardiopulmonary resuscitation

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