2. Session Objectives
–Identify at risk children requiring
resuscitation
–Familiarize with the General Approach
Resuscitation
–Demonstrate skills for paediatric
resuscitation
–Understand the importance of
teamwork and effective
communication during resuscitation
2
3. Definition
• Resuscitation is a series of
actions which are used to
assist or revivebabies from a
potential or apparent death .
5. Anticipation
• STAY PREPARED FOR RESUSCITATION
• Recognise risk factors
• Communicate during patient transfer
• Sometimes the need for resuscitation can be
predicted, but often it cannot,
8. FURNISHED SPACE
• Clean environment, Water, Soap, gloves
• Firm stable surface and good lighting
• Overheard radiant warmer, Room temperature at > 25
degrees C
• Oxygen supply ( humidified/heated/ blended if possible)
• Timer/clock
• Working Suction
9. SKILLED PERSONNEL
– A multidisciplinary team.
– Trained according to accepted standard of care
– Ongoing training and refresher course
– Available at point of care
– Teamwork
– Communication
10. EMERGENCY TROLLEY
• DEFIBRILLATOR
• Bag valve mask device-240-250ml + reservoir bag
• Face masks of different size
• Oropharyngeal
airways
• Portable Oxygen supply
• Stethoscope and a torch
• Pulse oximeter
• Suction devices and catheters
• timer/clock
• ET tubes, laryngeal mask, introducers, Suction devices
Laryngoscope with straight blade, extra batteries
• Drugs, IV fluids,
16. Assessment
• Rapid assessment and triaging of babies
• Safety, stimulate and shout
• Need for resuscitation must be identified immediately
• Safety is important especially in an external
environment because the rescuer should not become
the second victim.
• Stimulate - gently shake and ask e.g. Are you alright?
• Summon someone to call for help while you start
resuscitation.
• If alone call for help yourself
if no one comes within a minute of CPR.
• If in a hospital, help is usually a shout away
18. Airway
• Open the airway – head tilt/chin lift or jaw thrust
• Neutral position in infants and sniffing position
in children
• Check patency -LOOK, LISTEN and FEEL.
• Look for chest movement
• Listen for breath sounds with ear just above the
nose
• Feel the breath on your cheek above the mouth
• Use Oropharyngeal airways, ETT etc where
required
22. Breathing
• If patient’s airway is patent and patient
breathing-turn the child to his/her side and
put him/her in recovery position and
maintain the open airway.
• If breathing is still ineffective, start Positive
pressure ventilation
24. ▪ Position the head in neutral
position -use towel under
shoulders; jaw thrust, chin lift
▪ Position the mask on the face
▪ Firm seal between the mask
and the face
▪ Squeeze bag to produce a
gentle chest rise
▪ Give 30-40 breaths per
minute.
▪ Increasing heart rate is a sign
of successful oxygenation
▪ Monitor SPO2 if possible
How to ventilate with bag and mask
Note ‘C’ or ‘E’ grip
26. Use of oxygen
• Start ventilating with room air
• If O2 not available continue ventilating with
room air
• If no improvement in HR, colour connect to
oxygen
• If lone helper do not stop resuscitation to
look for oxygen
• Increase gradually to maintain targeted
saturations
27. Troubleshooting
• If no response to PPV
-check airway-position,seal
-obstruction>>>suction
-pneumothorax?
-check equipment
28. Circulation
Aim to Improve cardiac output
Start chest compressions if
● No signs of life-no movement, not
coughing ,absent or abnormal breathing
● No pulses- use brachial in infants and
carotid or femoral in children
● Pulse less than 60b/minute
29. Chest Compressions
Technique
● Hand encircling technique-infants
● 2 finger technique- For lone rescuer
● Two hands or the one hand technique- Older
children.
30. Chest compressions
• Compress the lower half of the sternum to a
depth of at least one third of the chest diameter
• Chest wall should completely recoil before the
next compression.
• Ratio 15: 2 for all age groups
• Compressions should be continuous because
pausing unnecessarily will decrease coronary
perfusion pressure to zero and several
compressions will be required before adequate
coronary perfusion recurs.
• Rate of 100-120beats/minute for all ages
37. Drugs
• Adrenaline 1:10 000
-0.1ml/kg iv
-1ml/kg via trachea
• 10% Dextrose-
-2-4mls/kg iv
• Normal saline-if no response to resusc and evidence of
volume loss/shock
-10ml/kg over 30 mins up to 2 boluses, monitor response
• Naloxone-0.1mg/kg( 0.25mls/hr) im/iv
38. Post Resuscitation Care
• Continue monitoring of vital signs in all babies
• Admit/Refer
• Keep baby warm
• Continue support measures during transportation
• Counsel the parents
• Document
• Review
39. When to call of resuscitation
Consider stopping if:
• No spontaneous respirations/gasping after 20
mins of effective resuscitation
• No HR or HR <60b/min after 10 mins of
effective resuscitation
40. When not to resuscitate
Consider not starting when:
● Futile
-dead baby,lethal anomalies
● Poor prognosis
-BW<500g
-trisomy 13/18
41. Summary
• Resuscitation is a basic life saving skill that we should all
possess and keep perfecting.
• It is an art and science
• Anticipation and preparedness
• Teamwork
• Reviewing
• Keep parents informed
• Ongoing training-simulations/drills
• Don’t miss the demonstration
42.
43. Acknowledgements
• ,
• Department of Paediatrics SMCH
• Department of Paediatrics Mpilo
Hospital
• MOHCC Family Health Department
• MOHCC Manicaland Province
• Paediatric Association of Zimbabwe
• American Academy of Paediatrics
• Helping Babies Breathe course
• Liverpool School of Tropical
Medicine: Life Saving Skills Course
• UNICEF Zimbabwe
