7. rjp newborn infant dan pediatric
TRANSCRIPT
-
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
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
2/27
CHILD VS ADULT
Anatomy
Physiology
Psychology• Assessment
• Equipment
•
Skills• Pharmacology
Anak-anak dan dewasa terdapat perbedaan
penatalaksanaan
Ingat : Anak bukan miniatur dewasa
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
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
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
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
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
5/27
Paediatric Airway
• +arge head with prominent occiput
• Relati8ely large tongue
•
9loppy epiglottis• Anterior laryn:
• )onical narrow airway
• Poor chest mechanics• Increased ," consumption
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
6/27
Child airway
• #abies are nose breather
• $rachea is cm long in neonates
•
)ricoid is the narrowest part• *se only uncu55ed tracheal tubes
• $ube I; /mm2 < age years6 =
* ID = internal diameter
A
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
7/27
Anatomy
Comparation• Adult • )hildren
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
8/27
AIRWAY + BREATHING
• Early control o5 airway essential
• Intubation by most e:perienced
• )er8ical spine immobilisation – cer8ical spine assessment di55icult
• ecompress stomach
– air swallowing common in children – impro8e 8entilation
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
9/27
C!i$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
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
10/27
)irculation
• palpation of pulse
• heart rate
•
auscultation of heart sound• capillary rell
• peripheral temperature
• blood pressure
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
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
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
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$e ,ears+ 9 – 112 & – 1
'doles"ent 112 – 128 66 – 80
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
13/27
PAT!A"S #$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$ST
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
14/27
R$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
• $his should be repeated a5ter assessment i5 there
is no impro8ement in 8ital signs
• The most common mistake in the t/eatment o.
hy;o7olaemic shocked child/en is .ailu/e to gi7e
enough .luid
C/ystalloid
19 ml:kg
Colloid
19 ml:kg
Blood
U/gent
Su/gical o;inion
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
15/27
eight /kg2
@1?1?-"?
"?
ay
1??m+6kg1???m+ = 3? m+6kg
13?? ml = "? m+6kg
%our
m+6kg?m+ = " m+6kg
B? m+ = 1 m+6kg
aintenance 5luid requirements
H%ur$* 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
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
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
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
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
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
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'
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
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 $atie(t'
Dall#a( / Sii#e'1 -'2i / Nei#a(1 a(d Saari(e( / Sii#e'
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
20/27
1. #lood required <%ct 1 L %ct "
%ct (
4 E#0
". #lood required /PR)2 < /%ct 1 L %ct "2 : body weight /kg2 : 1.3 /#2 < /%ct 1 L %ct "2 : body weight /kg2 : ".3
%ct1 H %aematocrit be5ore trans5usion> the measured
haematocrit
%ct" H %aematocrit required a5ter trans5usion> the desiredhaematocrit
%ct( H %aematocrit o5 the blood to be gi8en /B?C i5 packed cells2
E#0 H Estimated blood 8olume
BL--D REPLACE.ENT T- USE HAE.-T-CRIT LEVEL
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
21/27
Electrolytes
Sodium H (- mEq6kg6day
Potassium H "-( mEq6kg6day)hloride H "-( mEq6kg6day
)alcium H 13?-3?? mg6kg6day
Phosphorus H ?.3-" mmol6kg6day
agnesium H ?."3-?.3 mEq6kg6day
.ai(te(a(ce electr!lyte re3&ire#e(t i( childre(
S!&rce % 4 Alla( Pa'chall
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
22/27
H*"% Natremia
1. Estimated 5luid de5icit
". Resucitation 5rom shock H &S 6 R+
(. )alculated de5icit hourly I0 rateaintenance = de5icit &a- 6 " hours
mEq &a= < /esired &a= - ,bser8ed &a=2 : weight /kg2 : ?.B
. In5use 3 ?.3 &S or 3 &S or 3 +R
3. Add 1? L "? mq kcl6l based on renal 5unction and M= le8el
H*"%ka$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?
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
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
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
24/27
VENTRICULAR FIBRILLATION
• UNCOMMON IN CHILDREN
• RECOVERING FROM HYPOTHERMIA
• POISONED BY TRICYCLIC ANTI-DEPRESSANT
• CARDIAC DISEASE
ELECTROLYTE IMBALANCE
HHM-ERC.2000 21
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
25/27
PR(T(C(# F(R
-$&TR%CU#AR F%BR%##AT%(&
PR$C(RD%A# TU+P
DC shock 1
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
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!
-
8/19/2019 7. RJP Newborn Infant Dan Pediatric
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