PEDIATRIC RESUSCITATION (also
see Chapter 76
)
It is now well understood and accepted that pediatric resuscitation
is an area of knowledge and skill with specific diagnostic and therapeutic considerations.
No longer is it acceptable to treat pediatric patients as "little adults."[250]
[251]
Recognition of this change is evident in
the
guidelines and in the AHA BLS instructor's manual and the ACLS textbook, both of
which devote specific sections to pediatric BLS and ACLS. In addition, training
programs incorporating this body of knowledge and skill have been developed with
the Textbook of Pediatric Basic Life Support,[252]
Instructor's Manual for Pediatric Basic Life Support,
[253]
and Textbook of Pediatric
Advanced Life Support.[254]
This discussion
highlights the major areas of essential information, again, as in the previous portion
of this chapter, with specific regard to application by anesthesiologists in the
operating room or ICU setting. The AHA textbooks should be consulted for further
specific details.
Basic Life Support
Primarily for convenience and uniformity in teaching, infants
are considered to be 0 to 1 years of age and children are 1 to 8 years old. Table
78-3
depicts similarities and differences in the performance of CPR in
these two groups. In infants, the brachial pulse is often more easily located and
palpated than the carotid pulse, and it is
therefore recommended for assessment of pulselessness. The tips of two fingers can
be used for chest compressions over the lower half of the patient's sternum, with
a compression depth of a third to half the depth of the chest (≅0.5 to 1.0 inch),
a compression rate of at least 100/min, and a compression-ventilation ratio of 5:1.
The 5:1 ratio is used whether one or two rescuers are performing CPR. In children,
the heel of one hand can be used to deliver chest compressions over the lower half
of the patient's sternum at a rate of 100/min, a depth of a third to half the depth
of the chest (≅1.0 to 1.5 inches), and a compression-ventilation ratio of 5:1.
Chest radiographs and right heart angiograms in infants, children, and young adults
1 day to 19 years old have confirmed that the heart lies under the lower part of
the sternum in all age groups[255]
[256]
;
therefore, this location is the proper one for external chest compression.
