7. rjp newborn infant dan pediatric

8/19/2019 7. RJP Newborn Infant Dan Pediatric

1/27

RESUSITASI JANTUNG PARU OTAK

PADA NEWBORN, INFANTDAN PEDIATRIC

Bagian Anestesiologi dan Reanimasi

FK Unsyiah – RSUZABanda Aceh


2/27

CHILD VS ADULT

Anatomy

Physiology

Psychology• Assessment

• Equipment

•

Skills• Pharmacology

Anak-anak dan dewasa terdapat perbedaan

penatalaksanaan

Ingat : Anak bukan miniatur dewasa


3/27

PRIMARY ASSESSMENT

COMPLETED IN LESS THAN ONE MINTE

1. AIRA!

". #REA$%I&'

(. )IR)*+A$I,&

. ISA#I+I$! / &ER0,*S S!S$E 2

3. E4P,S*RE

HHM-ERC.2000 9


4/27

T!e ra"id #$ini#a$ assessment %& in in&ant %r #!i$d

Airway and Breathing

ork o5 breathing

Respiratory rate6rhythm

Stridor6whee7e

Auscultation

Skin colour

Circulation %eart rate

Pulse 0olume

)apillary re5ill time

Skin temperature

Disability ental status6conscious

Posture

Pupils

The whole assessment should take less than a minute


5/27

Paediatric Airway

• +arge head with prominent occiput

• Relati8ely large tongue

•

9loppy epiglottis• Anterior laryn:

• )onical narrow airway

• Poor chest mechanics• Increased ," consumption


6/27

Child airway

• #abies are nose breather

• $rachea is cm long in neonates

•

)ricoid is the narrowest part• *se only uncu55ed tracheal tubes

• $ube I; /mm2 < age years6 =

* ID = internal diameter

A


7/27

Anatomy

Comparation• Adult • )hildren


8/27

AIRWAY + BREATHING

• Early control o5 airway essential

• Intubation by most e:perienced

• )er8ical spine immobilisation – cer8ical spine assessment di55icult

• ecompress stomach

– air swallowing common in children – impro8e 8entilation


9/27

C!i$d 'reat!ing • Aerophagia o5ten occurs in respiratory

distress gastric distension

• istended gaster restricts lung e:pansion• Insert nasogastric tube> aspirate gently>

a8oid pressing the epigastrium


10/27

)irculation

• palpation of pulse

• heart rate

•

auscultation of heart sound• capillary rell

• peripheral temperature

• blood pressure


11/27

Heart Rate and Respiration Rate

Age Awake Heart rate Sleeping Heart rateOutput

Respiration rate

Infant 120 – 160 / min 80 – 180 / min 30 – 60 / min

Todler 90 – 140 / min 0 – 120 / min 24 – 40 / min

!res"#ool a$e 80 – 110 / min 60 – 90 / min 22 – 34 / min

%"#ool a$e & – 100 / min 60 – 90 / min 18 – 30 / min

'doles"ent 60 – 90 / min &0 – 90 / min 12 – 16 / min


12/27

Normal blood pressure

Age Systolic Pressure Diastolic pressure

(eonat)s 1 mont#+ 8& – 100 &1 – 6&

Infant 6 mont#+ 8 – 10& &3 – 66

Todler 2 ,ears+ 9& – 10& &3 – 66

%"#ool a$e ,ears+ 9 – 112 & – 1

'doles"ent 112 – 128 66 – 80


13/27

PAT!A"S #$AD%&' T( CARD%() R$SP%RAT(R"

ARR$ST *

F#U%D

#(SS

B#((D #(SS

'ASTR($&T$R%T%S

BUR&

#(SS

+A#D%STR%BUT%(&

S$PT%C S(CK

CARD%AC D%S$AS$

A&AP"#A,%S

R$SP%RAT(R"

D%STR$SS

F(R$%'& B(D"

CR(UP

AST+A

R$SP%RAT(R"

D$PR$SS%(&

C(&-U#S%(&S

RA%S$D %CP

P(%S(&%&'

C%RCU#AT(R"

FA%#UR$

R$SP%RAT(R"

FA%#UR$

CARD%AC ARR$ST


14/27

R$SUSC%TAT%(& .o/ S(CK

!eight in kg 0 1 2age in yea/s 3 45

$stimated 6lood 7olume 0 89 ml:kg 6ody weight

Assess

/es;onse

Assess

/es;onse

($uid )%$ume and t*"e• An initial 5luid bolus o5 "? ml6kg is gi8en as 5ast

as possible

• $his should be repeated a5ter assessment i5 there

is no impro8ement in 8ital signs

• The most common mistake in the t/eatment o.

hy;o7olaemic shocked child/en is .ailu/e to gi7e

enough .luid

C/ystalloid

19 ml:kg

Colloid

19 ml:kg

Blood

U/gent

Su/gical o;inion


15/27

eight /kg2

@1?1?-"?

"?

ay

1??m+6kg1???m+ = 3? m+6kg

13?? ml = "? m+6kg

%our

m+6kg?m+ = " m+6kg

B? m+ = 1 m+6kg

aintenance 5luid requirements

H%ur$* and Dai$* Maintenan#e ($uid Re+uirements

%& C!i$dren

!r e"a#$le %a "3 kg child would required

1??? ml = 3?? ml = 1?? ml < 1B?? ml


16/27

)linical 5indings

C body weight loss

Estimation 5luid de5isit

Pulse#lood pressure

Respiration

Skin turgor

ucous membranes

Peripheral per5usion*rine

ild

-3C

?-3?ml6kg

&ormal&ormal

&ormal

&ormal

oist

&ormalReduced

oderate

B-DC

B?-D? ml6kg

> eak&ormal o5 low

eep

F

ry

Poor ,liguria

Se8ere

1?C

1??-11? ml6kg

> 5eebleReduced

eep G rapid

F F

0ery dry

Poor> cool> e:tremitasarked oliguria

Assessment %& t!e degree %& de!*drati%n

yd/ation*

S!&rce% Nel'!( W


17/27

anagement o5 dehidration

a. Estimated 5luid de5icit

b. Rehydration

9or e:ample H a 1? kg child is assessed to se8eredehydration with an estimated 1?C

ehydration 1?C> 1? kg

E9 H 1?? ml : 1? < 1??? ml

Initial 5luid resusitation H "?ml6kg /"?-(?2

Reassess the clinical state

Impro8ed &on impro8ement

9irst Jh H 3?C rest 5luid de5icit =

5luid maintenance

Second 1Bh H 3?C rest 5luid de5icit =

5luid maintenance

Repeat H "? ml6kg6"?-(?

Resassess

- Res;i/ation- Ci/culation- +ental status

)hoice o5 the 5luid H

Rehydration H Isotonic crystalloid

aintenance H %ypotonic crystalloid


18/27

Age

Premature in5ant

&ewborn

In5ant @ 1 y

)hild 1 y

E#0 /m+6kg2

D?-1??

J?-D?

K3-J?

K?-K3

E'ti#ated )l!!d *!le EBV, i( $ediatric $atie('

BL--D REPLACE.ENT

Age

Premature

&ewborn

( mo

1 y

B y

ean

3

3

(B

(J

(J

Range

?-3

3-B3

(?-"

(-"

(3-(

Acceptable hct /C2

(3

(?-(3

"3

"?-"3

"?-"3

&ormal hct /C2

N!r#al / acce$ta)le he#at!crit Hct, *al&e' i( $ediatric $atie(t'


19/27

Age

1 day

1 week1 mo

( mo

?.3 L 3 y

3 L D y

1" L 1 y

girls

boys

ean

1J

1K1

1".3

1(

1(.3

1(.3

1

+ower limit

1(.3

1(1(

D

11.3

1"

1"

1".3

&ormal hemoglobin /g61??m+2

.ea( / l!wer (!r#al he#!0l!)i( le*el'

i( $ediatric $atie(t'

Dall#a( / Sii#e'1 -'2i / Nei#a(1 a(d Saari(e( / Sii#e'


20/27

1. #lood required <%ct 1 L %ct "

%ct (

4 E#0

". #lood required /PR)2 < /%ct 1 L %ct "2 : body weight /kg2 : 1.3 /#2 < /%ct 1 L %ct "2 : body weight /kg2 : ".3

%ct1 H %aematocrit be5ore trans5usion> the measured

haematocrit

%ct" H %aematocrit required a5ter trans5usion> the desiredhaematocrit

%ct( H %aematocrit o5 the blood to be gi8en /B?C i5 packed cells2

E#0 H Estimated blood 8olume

BL--D REPLACE.ENT T- USE HAE.-T-CRIT LEVEL


21/27

Electrolytes

Sodium H (- mEq6kg6day

Potassium H "-( mEq6kg6day)hloride H "-( mEq6kg6day

)alcium H 13?-3?? mg6kg6day

Phosphorus H ?.3-" mmol6kg6day

agnesium H ?."3-?.3 mEq6kg6day

.ai(te(a(ce electr!lyte re3&ire#e(t i( childre(

S!&rce % 4 Alla( Pa'chall


22/27

H*"% Natremia

1. Estimated 5luid de5icit

". Resucitation 5rom shock H &S 6 R+

(. )alculated de5icit hourly I0 rateaintenance = de5icit &a- 6 " hours

mEq &a= < /esired &a= - ,bser8ed &a=2 : weight /kg2 : ?.B

. In5use 3 ?.3 &S or 3 &S or 3 +R

3. Add 1? L "? mq kcl6l based on renal 5unction and M= le8el

H*"%ka$emiaM H ?.3 L 1 meq6kg /ma:."? meq2 6 " hour

Repeat H - J hours as need

onitoring H E)'

H*"erka$emia)a)l H ?.1 L ?.(ml6kg a. 1?C solution

)a'luconas H ?.(-1ml6kg a.1?C solution

&abic H 1-" mEq6kg = mild to moderate hyper8entilation

'lucosa = insulin H ?>3g 6kg 'lucose = ?.1*6kg insulin 6 (?-B?


23/27

THE MANA,EMENT O( CARDIAC ARREST

$%REE )ARIA) ARRES$ R%!$S H

1. AS!S$,+E

". 0E&$I)*+AR 9I#RI++A$I,&

(. E / P.E.A. 2

HHM-ERC.2000 20


24/27

VENTRICULAR FIBRILLATION

• UNCOMMON IN CHILDREN

• RECOVERING FROM HYPOTHERMIA

• POISONED BY TRICYCLIC ANTI-DEPRESSANT

• CARDIAC DISEASE

ELECTROLYTE IMBALANCE

HHM-ERC.2000 21


25/27

PR(T(C(# F(R

-$&TR%CU#AR F%BR%##AT%(&

PR$C(RD%A# TU+P

DC shock 1


26/27

DRU'S %& AS"ST(#$ 0entilate with%igh concentration ,"

Adrenaline1? µg6kg I0 or I,

Adrenaline

1?? µg6kg I0 or I,

Intubate

I0 or I, access

)onsider I0 5luids and

Alkalising agents( min or

B? 4 3H1 )PR cycles

( min or

B? 4 3H1 )PR cycles

I

II

BEFORE THE ADMINISTRATION OF ANY DRUG :

THE PAT. MUST BE RECEIVING CONTINUOUS

AND EFFECTIVE BLS !

HHM-ERC.2000 2!


27/27

PR(T(C(# F(R $+D 2P)$)A5

Intubate

I0 or I, access

Ad/enaline

=99 g:kg %- o/ %(

( min or

B? 4 3H1 )PR

cycles

-entilate with

high concent/ation (1

Ad/enaline

=9 g:kg %- o/ %(

Fluids

19 ml:kg %- o/ %(

C(&S%D$R

y;o7olaemia

Tension ;neumotho/a>

Ca/diac tam;onade

D/ug o7e/dose$lect/olyte im6alance

and treat a""r%"riate$*

HHM-ERC.2000 19

7. rjp newborn infant dan pediatric

Documents