Tuesday , June 19 2018
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Resuscitation CPR

Resuscitation Of A Child

Purpose

Prolonged Hypoxemia due to inadequate oxygenation, ventilation and circulation and cardiac arrest/resuscitation.

Scope

Cardiac arrest and prolonged hypoxic children.

Definition-Resuscitation

Cardio pulmonary resuscitation is a basic emergency procedure for life support, consisting of artificial respiration and manual external cardiac compressions.

Applicable Areas

NICU

Responsibility

Staff Nurse, Auxillary Nurse Midwife, NICU Registrar, Head Nurse and Consultants.

Procedure

  • Keep the following equipments ready –
  • Ambu bag with face mask and oxygen connection.
  • Intubation tray containing small size endotracheal tube, laryngoscope with appropriate size blade, stellate, Dynaplast and lubrication jelly.
  • Crash Cart.
  • Ventilator with ventilator tubing.
  • Keep central suction ready with sterile suction catheter.
  • Two 100 ml Normal Saline for suction.
  • Radiant warmer, stethoscope.
  • Emergency drug like Inj. Adrenaline, Inj. Atropine, Inj. Soda-bi-carbonate.
  • Disinfectant for hand rubs.
  • Kidney tray.
  • Assess child for airway, breathing and circulation.
  • Establish airway by lifting the child’s chin or jaw should be displaced forward to maintain airway patency.
  • The neck should be extended slightly.
  • If airway is not patent intubation provides airway patency.
  • If respiratory arrest has occurred, ventilation must be provided using bag and mask with 100% oxygen.
  • A nasogastric tube should be introduced to relieve abdominal distension due to bag and mask ventilation.
  • The child should be well oxygenated before intubation.
  • Monitor heart rate throughout the procedure.
  • Bag and mask ventilation should be provided if the child becomes cyanotic or bradycardic.
  • Assist for intubation.
  • Once tube is passed, hand ventilation is performed while chest expansion is assessed and breath sounds are auscultated.
  • If clinical examination indicates satisfactory tube position, secure the tube with tape in such a way that the centimeter marking is visible at the child’s lips.
  • Attach Endo Tracheal Tube to mechanical ventilation.
  • Cardiac compression should be provided whenever cardiac arrest occurs.
  • The rescuer must compress the sternum directly over the heart.
  • Chest compressions are performed one finger width below the nipple line in the infant at the rate of 100/min. Compressions performed are finger width above the coastal sternal junction of a child at a rate of 100/min.
  • The child should be placed on a rigid cardiac board during compression.
  • Vascular access should be achieved quickly during CPR.
  • Same resuscitation drugs like adrenaline, atropine may be administered endotracheal.
  • Fluid or Blood products should be administered to the children who are in hypovolemic shock.
  • If spontaneous cardiac activity does not return within 30 minutes of resuscitation, it is reasonable for the team to consider cessation of resuscitation.
  • After the resuscitation, make the child comfortable.
  • Remove all the used articles, wash them and restock the crash cart.
  • Generated Biomedical waste should be segregated as per HIC policy.

Documentation

  • Documents in Nurse’s Observation Sheet whether –
  • Resuscitation was successful.
  • Condition of a Child.
  • Duration of resuscitation.
  • The level of E.T. Tube should be recorded or an adhesive tape be placed at the head end of the bed.
  • The size and the marking of E.T. tube to be placed at the head end of the bed.
  • Observe for any hypothermia, acidosis or other complications.
  • Drugs used and the outcome.