Pediatric AED (automated external defibrillator) and manual monitor/ defibrillator pads are designed to be used on infants and children up to about 8 years old. Older children and adults should use adult pads only. Pediatric pads are about half the size of adult pads and often have a small, heavy box near the plug in connector to the AED called a 'dose attenuator.' This attenuator steps down the shock dosage (Joules) delivered to be more appropriate for a pediatric patient.
Since pediatric patients require less energy to convert their ventricular fibrillation, or in other words- DE-fibrillate them, (see blog entry 'how exactly does an AED help', or video 'how an AED works' for background on this process), it is advantageous to use the smaller dose if possible, as there would be less tissue burning from the shock itself.
If no pediatric pads are available, adult pads can still be used, because the ultimate priority is to stop the ventricular fibrillation and save the patient's life, and a higher dose will do that as well.
Perhaps counter-intuitively, pediatric pads should never be used on adult patients, as the relatively small dose can actually make the ventricular fibrillation worse, and even harder to correct.
Author: Scott Carpenter
Agonal gasping (in the context of Basic Life Support) is a condition in which the victim of cardiac arrest has occasional (perhaps once every 10 seconds) 'gasping' breaths. This breathing pattern is usually accompanied by a snoring type sound, and perhaps a slight shrugging of the shoulders.
When a healthcare provider shakes a victim ("hey, hey, are you ok?"), they should also be checking for breathing. Essentially, there are 3 types of breathing for this scenario.
1) Breathing like you are doing now,
2) No breathing at all (apnea), or
3) Agonal gasps. Agonal essentially means 'associated with death.'
Agonal gasping should not be confused with normal breathing, and in fact, is a signal that the patient may not have a pulse. It should be treated the same as if the patient is not breathing at all. This gasping is due to residual nervous system activity only, and is very shallow. No air is actually entering the lungs proper, and no true gas exchange is taking place within the lungs.
Agonal gaspers have a greater likelihood of recovery than patients who present with apnea (no respiratory effort at all.) Agonal gaspers are more likely to be in ventricular fibrillation, and their arrest time is generally not as long. For a good synopsis of factors affecting survival, you can read more on this topic here- http://depts.washington.edu/survive/event-factors.php
Author: Scott carpenter
Image Credit: user: Rama / Wikimedia Commons / CC-BY-SA-3.0 / GFDL
Heartsaver CPR Courses VS B.L.S. for Healthcare
Author: Scott Carpenter
Part one of this post is here: http://www.carpentercprsolutions.com/-blog/key-components-of-high-quality-cpr-revisited-part-1
On to part two!:
4) INTERRUPTIONS IN CPR SHOULD BE MINIMAL, AND SWITCH PROVIDERS EVERY 2 MINUTES!
When a patient has no pulse, and no one is pushing on the chest, brain cells are dying. It is as simple as that. ALL interruptions in CPR should be 10 seconds or less.
When the CPR compressor gets tired, there is a tendency to be ‘lazy’ and not allow complete chest recoil. Doing compressions is hard work, and studies show a noticeable decline in CPR quality within a minute or two. The person doing CPR generally does not notice this decline, so it is important to switch out every two minutes (or 5 cycles of 30 compressions and 2 breaths)
5) AVOID HYPERVENTILATION!
Giving breaths too fast and too forcefully forces air down the esophagus and contributes to stomach inflation and regurgitation, making the job of CPR harder. This is the simple ‘book answer,’ and it is true. What is also important to know is that hyperventilation increases the amount of positive pressure in the chest. As discussed previously, in order for CPR to be effective, there needs to be negative pressure (a vacuum) in the chest when allowing chest recoil in order to bring blood back into the heart. Hyperventilation creates positive pressure in the chest ALL the TIME, decreasing venous return and rendering CPR less effective. My personal opinion is that this is the single biggest thing that Healthcare Providers do on a regular basis that contributes to poor outcomes! The patient is getting at best 30 percent of their normal cardiac output during CPR, they do not need extra air in the chest. (They can’t use it!) Just enough to see the chest rise is enough air in the lungs. Hyperventilation is a classic example of too much of a good thing.
6) EARLY DEFIBRILLATION!
Generally, the earlier the defibrillation attempt, the better the chances are of achieving ROSC. CPR buys time by preserving vital organs until a defibrillation attempt, but usually a patient needs defibrillation to recover.
Author: Scott Carpenter
Question: Why 15:2 ratio of compressions to ventilations in child CPR for Healthcare Providers?
The biggest reason why children are 15:2 with 2 rescuer Healthcare Provider CPR is because children are very much more likely to have cardiac arrest secondary to respiratory issues and lack of oxygen. Children and infants generally have very strong hearts that want to beat on their own. If the heart stops, it is usually because it has not been supplied enough oxygen.
An adult heart tends to stop (patient tends to go into pulseless arrest) for truly cardiac reasons, and therefore, a 30:2 ratio remains the preferred ratio for adults. Also, single rescuer CPR in children and infants remains 30:2, because it takes quite a bit of time to switch back and forth between breathing and compressions. Once two rescuers are present, however, this ratio can be changed to 15:2, maximizing oxygenation in children and infants, while still minimizing interruptions in compressions.
Note, however, that the ration of compressions to ventilations in Heartsaver (non-healthcare provider) CPR remains always 30:2 for simplicity sake, and due to the fact that working as a team is not covered in the Heartsaver course.
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