2011年1月25日 星期二

小兒急救 - 新版的指引

Updated Recommendations for Pediatric Resuscitation

The 2010 International Liaison Committee on Resuscitation Pediatric Task Force has updated the 2005 treatment recommendations for pediatric resuscitation. Highlights include the following:
  • Initiate cardiopulmonary resuscitation (CPR) if there are no signs of life and a pulse is not palpated within 10 seconds.
  • Provide conventional CPR (chest compressions with rescue breathing).
  • Compress at least one third of the anterior-posterior dimension of the chest.
  • Consider using cuffed tracheal tubes in infants and young children; cuff pressure should not exceed 25 cm H2O. Appropriate sized tubes by age are as follows:
    # 3 mm for age ≤1 year
    # 3.5 mm for age 1–2 years
    # Age in years/4 + 3.5 mm for age >2 years
  • Modify or discontinue cricoid pressure if it impedes preintubation ventilation or intubation.
  • Monitor capnography to confirm endotracheal tube position, recognizing that end-tidal CO2 in infants and children might be below detectable limits for colorimetric devices (85% sensitivity and 100% specificity).
  • Consider use of an esophageal detector device in children weighing >20 kg.
  • Use capnography monitoring to assess effectiveness of chest compressions.
  • Avoid excessive ventilation, which can decrease cerebral perfusion pressure, rates of return of spontaneous circulation (ROSC), and survival rates.
  • After ROSC, titrate oxygen concentration to limit the risk for toxic oxygen byproducts.
  • For pediatric septic shock, include therapy directed at normalizing central venous oxygen saturation to ≥70%.
  • Do not routinely use bicarbonate or calcium for pediatric cardiac arrest: Both agents are associated with decreased survival.
Comment:
These consensus recommendations are based on a thorough evaluation of the literature, and emergency physicians should know them.


Katherine Bakes, MD
Published in Journal Watch Emergency Medicine January 21, 2011

Citation(s): Kleinman ME et al. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010 Nov; 126:e1261.

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