340 Paediatric Emergencies

CARDIOPULMONARY RESUSCITATION

5 Look for signs of respiratory failure:

(i) Increased effort of breathing:

(a) respiratory rate outside normal range for age (too fast or too

slow)

(b) intercostal, subcostal or sternal recession, stridor and wheeze

(c) grunting and gasping respiratory effort (signs of severe

respiratory distress, especially in infants).

(ii) Efficacy of breathing:

(a) reduced oxygen saturations as measured by pulse oximetry

(b) shallow breathing, decreased chest expansion with reduced,

asymmetrical or abnormal breath sounds. Beware the silent

chest.

(iii) Effects of hypoxia:

(a) initial tachycardia, followed by pre-terminal bradycardia if

hypoxia prolonged

(b) initial skin pallor with vasoconstriction. Cyanosis is a pre-

terminal sign

(c) altered level of consciousness leading to coma.

6 Look for signs of circulatory failure (shock):

(i) Increased heart rate (bradycardia is an ominous sign of

decompensation).

(ii) Decreased systolic blood pressure.

(iii) Decreased peripheral perfusion, poor (prolonged) capillary refill,

cool, pale or mottled skin.

(iv) Weak or absent pulses.

(v) Decreased urine output and a metabolic acidosis.

MANAGEMENT

This is based on the International Liaison Committee on Resuscitation (ILCOR)

2010 International Consensus on CPR Science with Treatment Recommenda-

tions (CoSTR). Similar principles and practice apply to those for adult

resuscitation (see p. 2).

1 Specific points relevant to paediatric resuscitation are outlined below.

Figure 11.1 shows drug doses, endotracheal tube sizes, and defibrillator

settings, and Figure 11.2 is the advanced life support (ALS) algorithm for

children:

Warning: decreased or minimal effort of breathing heralds pre-terminal

! respiratory failure as the child nears exhaustion.