Critical care handbook of the massasusetts General hospital 6th Edition PDF free download
Critical care handbook of the massasusetts General hospital 6th Edition PDF free download A sudden cardiac arrest is uncommon in children. Cardiac arrest is usually the terminal event of progressive respiratory failure or shock. Any emergency set up should be well equipped with procedures for cardiopulmonary resuscitation (CPR).
1. Mild neck extension is preferable (Child’s head and occiput are proportionately large causing neck flexion). One can use a folded towel placed under the neck and shoulder.
2. Open the airway by head tilt—chin lift method. If cervical injury is suspected, open the airway using a jaw thrust without head tilt.
3. Clear airway from secretions, vomits and remove foreign bodies. In neonates and infants this can be effectively done with bulb mucus sucker (Fig. 2.1.1).
4. Oropharyngeal and nasopharyngeal airways for maintaining an open airway.
i. Oropharyngeal airway in unconscious patient, i.e. with no gag reflex. The size is determined by the distance from the central incisors to the angle of the mandible.
ii. Nasopharyngealairwayisbettertoleratedthanoralairwaybypatients who are not deeply unconscious. The size is determined by the distance from the tip of the nose to the tragus of the ear.
Critical care handbook of the massasusetts General hospital 6th Edition PDF free download BBreathing
Figure 2.1.1 Bulb mucus sucker
2.1 Cardiopulmonary Resuscitation
1. Use 100 percent oxygen during resuscitation.
2. Bag-mask ventilation can be as effective as endotracheal intubation:
i. Use a self-inflating bag with a volume of 450 to 500 ml (Fig. 2.1.2)
ii. Maintain oxygen flow of 15 l/min into a reservoir attached to a bag
iii. The mask should fit over the mouth and nose to provide a tight seal
and avoid any air leakage.
3. Ventilation through an endotracheal tube (ETT) (Fig. 2.1.3).
Size for children 1 to 10 years of age is determined as ETT internal diameter (mm) = (age in years/4) +
4. laryngeal Mask Airway (lMA): When endotracheal intubation is not possible lMA is an acceptable adjunct for experienced providers.