BASIC LIFE SUPPORT

Pediatric Basic Life Support

 The provision of CPR with no devices or with mask bag ventilation or barrier devices until
Advanced Life Support (ALS) can be provided.
 Includes infants from birth to 1 year of age and children from 1 to 8 years of age.

Pediatric Cardiopulmonary Arrest

 Characterized by unresponsiveness or lack of breathing (with only an occasional gasp).

 Most often end result of apnea or respiratory failure leading to bradycardia and pulseless
electrical activity or asystole

Factors affecting development of airway obstruction and Respiratory Failure in infant and
Child

 Infants and children have limited oxygen reserve

 The ribs and the sternum normally contribute to maintenance of lung volume
 In the infant and child, the subglottic airways are smaller and more compliant and the
supporting cartilage less developed than in the adult
 The infant tongue is proportionately large in relation to the size of the oropharynx.

BASIC CARDIOPULMONARY LIFE SUPPORT

1. Check and ensure that the scene is safe

2. Check for responsiveness
3. Call for medical help
4. Check for normal breathing and check brachial pulse
5. If the casualty is pulseless or you are unsure, perform CPR
6. Draw an imaginary line from nipple to sternum and place your middle and ring finger next to
your index finger. Lift your index finger and perform 30 COMPRESSIONS (1 1001 1002
1003…)
7. Perform a gentle head tilt – chin lift. Place your mouth over the infant’s mouth and nose and give
2 breaths, just enough for the chest to rise. (If the chest does not rise after first ventilation,
reposition the head and re-attempt to ventilate).
8. If the casualty is still not breathing, continue chest compression until AED or paramedics arrive.
9. When AED arrived, infants below 1 year old is recommended to use pediatric pad on the chest
and the other one on the back between shoulder blades.
10. If the casualty resumes normal breathing carry or place him/her on lateral position and wait for
paramedics to arrive.
 CARDIAC MONITORING

 Non-invasive procedure that displays the electrical activity of the heart; these electrical impulses
are picked by the electrodes and are transported and then recorded in the ECG.

PURPOSES:

 Provide a continuous graphic picture of cardiac electrical activity.

 Monitor oxygen saturation of the arterial blood.
 Help in diagnosis of life-threatening problems, as cardiac dysrhythmias.

INDICATIONS

 Patients with suppressed respiratory system by a drug overdose or anesthesia

 Monitor the pattern of a child’s heart rhythm pre- and post-surgery
 Monitor abnormal heart rhythms.
 Monitor the effect of cardiac medications have on a child’s heart rhythm.

Types of Monitoring Lead System

 All cardiac monitors use lead system to record the electrical activity generated by cardiac tissue.
 Cardiac monitory systems currently on the market vary from three- electrode telemetry devices to
three, four, and five electrode hard-wire systems.

Procedure

PROCEDURE

1. Assessment

 Assess the patient need for cardiac monitoring.

2. Preparation

A. Environment

 Bedside monitor
  Machine cables
 Three electrodes
 Sponge with alcohol
 KY gel
 Scissors

B. Patients Skin

 Shaving (for adolescent)

 Disinfectant with alcohol or soap
 Keep the skin dry

3. Implementation
Initiating ECG monitoring

 Explains the purpose of ECG monitoring to the patients and family

 Applies the electrodes to the appropriate location and attaches the correct cables to each
electrode.
 Note: Electrodes are to be changed every 24 hrs and selects an appropriate lead in which to
monitor the patient.
 Checks cables and lead wires for fraying broken wires or discoloration.
 Plug lead wires into patient’s cable
 Plug the patient’s cable into monitor
 Turn on the monitor
 Adjust the monitor
 Speed (25mm/sec)
 Sets the appropriate alarm limits based on the initial rate/ rhythm and ensures alarms are set to
ON position.
- Note: Pediatrics; alarms are set that are appropriate for the age or as ordered by the physician

Post Care
A. Patient
 Reassure the patient
B. Environment
 Discard the used items
C. Nurse
 Record ECG strips from the monitor
 Evaluate the ECG pattern continually for dysrhythmia
 Wash hands

Ongoing care
 I. Checks the alarm limit settings at the start of every shift and continues to adjust the alarm as rhe
patient’s rhythm and condition warrant.
II. Reviews every shift the monitoring trends and alarms
III. Reassess the patient for signs of hemodynamic compromise with any significant changes in cardiac
rate or rhythm (i.e., BP, oxygen saturation, RR, or myocardial ischemia).
IV. Reports to the physician
 Life threatening cardiac arrythmias and initiates appropriate actions.
 New or unexpected changes in cardiac rate, rhythm or clinical status.
V. Documentation
 Record the patient’s ECG
 Record any dysrhythmia and treatment
SPECIAL CONSIDERATIONS

1. Make sure all electrical equipment and outlets are grounded.

2. Ensure that the patients are clean and dry
3. Avoid opening the electrode packages until just before using
4. Avoid placing the electrodes on bony prominences, hair locations, areas where defibrillator pads
will be placed, or areas for chest compression.
5. If the patient’s skin is very oily, scaly, or diaphoretic, rub the electrode site with a dry gauze pad
before applying the electrode.
6. Have the patient breathe normally during the procedure.
7. Assess skin integrity, and reposition the electrodes every 48 hours.
 ELECTROCARDIOGRAM PLACEMENT

Electrocardiogram
 Record cardiac electrical current by means of metal electrodes placed on the surface of the body.
Note: Patients should be treated according to their symptoms, not merely their ECG.
 A series waves and deflections recording the heart’s electrical activity form a certain “view”.

The 12- Lead ECG

 Paints a complete picture of a heart’s electrical activity by recording information through 12
DIFFERENT PERSPECTIVES.
 These 12 views are collected by placing electrodes or small, sticky patches on the chest
(precordial), wrist and ankles.

CLINICAL PURPOSE
 To detect heart problems or blockages in the coronary arteries.
 To draw a graph of electrical impulses moving through the heart.
 To record heart rate and regularity of heart beats.
 To diagnose a possible heart attack or other heart disorders.

CHEST LEADS PLACEMENT

 To measure the heart’s electrical activity accurately, proper electrode placement is crucial.
 In a 12-lead ECG, there are 12 leads calculated using 10 electrodes.

V1 – 4th ICS Right sternal boarder

V2 – 4th ICS Left sternal boarder
V3 – Midway between V2 and V4
V4 – 5th ICS Left MCL
V5 – 5th ICS Anterior Axillary line
V6 – 5th ICS Left Mid Axillary line

LIMB LEADS PLACEMENT

R- Right Arm
L- Left arm
F- Foot (left leg)
N- Neutral (Right foot)

12 Lead groups
 A lead is a glimpse of the electrical activity of the heart from a particular angle. Put simply, a lead
is like a perspective

 Lead I
 Lead II
 Lead III
 Augmented Vector Right (aVR)
 Augmented Vector Left (aVL)
 Augmented vector foor (aVF)
ANESTHESIA

 Comes from the Greek word Anesthesis meaning “negative sensation”

 Produces muscle relaxation, block transmission of pain, nerve impulses and suppress
reflexes
 Decreases temporarily the memory of retrieval and recall
 Is a way to control pain during a surgery or procedure using medicine called anesthetics. It can
help control your breathing, blood pressure, blood flow, and heart rate and rhythm.

What are the risks and complications of anesthesia?

- Heart problems
- Pneumonia
- Sore throat
- Over vomiting
-
With high doses of local anesthesia, the anesthetic can go into the rest of the body and can affect your
heart and brain.

Some health problems, such as heart or lung disease, increase your chances of problems from anesthesia.
Taking certain medicines, smoking, drinking alcohol, and using illegal drugs can also increase your
chance of problems.

1. General Anesthesia
- Places the entire body including the brain, into a state of unconsciousness (sleep) during which
the patient has no awareness and feels nothing, and will remember nothing of the surgical experience.
- This is commonly induced either via inhalation or injection thru IV
- Inhalation type uses gas or vapor formulations and it is delivered via face masks
- Intravenous type is either incorporated in the intravenous solution or bolus (undiluted)
MAC (Monitored Anesthesia Care)
- Is the intravenous administration of mild sedatives to help a patient relax and relieve anxiety
during minor procedures that do not require general anesthesia.
- Provide comfort & safety during diagnostic/ therapeutic procedures: biopsies, colonoscopies.
- Can range from only monitoring to monitoring with sedation can progress to GA and to resuscitation.

REGIONAL ANESTHESIA
- Is the injection of a local anesthetic around major nerves or the spinal cord to block pain from a
large region of the body, such as a limb.
- Numbing effects can last 8 to 12 hours.

EPIDURAL & SPINAL ANESTHESIA

- Can be used for most surgeries below the belly button.
- An IV must first be inserted to patient since they need to be properly hydrated.
- Local anesthetic is used to numb the area where the needle is inserted.
- Patients may be placed under general anesthesia or mild sedative.

EPIDURAL ANESTHESIA
- Administered in the lower back/lumbar region using a special needle that is inserted between the
vertebrae of the spinal column into the epidural space around the spine.
- Procedure usually takes 10 to 25 minutes.

SPINAL ANESTHESIA
- Administered in the lower back/lumbar region using a special needle that is inserted between the
vertebrae of the spinal column into the dural membrane, which covers the spine and nerve roots.
- Entire process usually takes anywhere from 5 to 20 minutes

LOCAL ANESTHESIA
- Medicine given to temporarily stop the sense of pain in a particular area of the body.
- Patient is conscious during a local anesthetic.
- Administered via injection of anesthetic agents to tissues within and around the operative site.
- Indicated for minor surgeries:
Examples: excisions, suturing of superficial lacerations, and insertion of any material.

Types of Local Anesthesia

Topical administration
- Involves application of cream, lotion, ointment or drop of local anesthetic to traumatized skin to
relieve pain.
- Directly applied to the skin and mucous membrane, open skin surfaces, wounds and burns.
Examples: lidocaine ointment/ spray, benzocaine, EMLA
Infiltration
- Involves injecting anesthetic directly into the tissues to be treated. It brings the anesthetic into
contact with the nerve endings in the area and prevents them from transmitting nerve impulses to the
brain.

Axillary Nerve Block

- Injected around the nerve that passes through the axilla from the shoulder to the arm to numb the
feeling in your arm and hand.
- Used for surgery of the elbow, forearm, wrist or hand.

Interscalene Nerve Block

- Injected around the nerve block in the neck used to numb the shoulder and arm.
- Used for surgery of the shoulder and upper arm.

Femoral Nerve Block

- Injected around the nerve block in the upper thigh/ groin area to numb the leg from the knee to hip
- Used for surgery of the anterior thigh, hip or knee.

Ankle block
- Injected around the ankle to block the five nerve branches that supply sensation to the foot.
- Used for surgery of the ankle, foot, or toes.

Bier Block
- Injected intravenously to numb a limb, typically the arm, and then a tourniquet is applied to prevent
the anesthetic from leaving the area.
- Used for surgeries of hand or arm that last less than an hour.

a. Patient related factors

1. Nutritional status of the client
2. Respiratory, cardio, hepatic, and renal status
3. Extreme age (too young- under 8 years old and too old-more that 65 years old);
4. Circulatory status;
 5. Allergies;
6. Chronic use of alcohol, cigarette, and other substances
7. On medication maintenance

b. Procedure-related factors
1. Types of Anesthesia to be used
2. Urgency of the procedure
3. Length of the procedure
4. Involvement of more body parts

Common Complications

1. Cardiac problems (myocardial infarction)

2. Respiratory problems (pneumonia, apnea, and pulmonary embolism)
3. Renal problems (renal insufficiency and failure)
4. Neurological problems (temporary-permanent cognitive dysfunction)
5. Development of some allergies
6. Death
NEBULIZATION
- The process of dispersing a liquid (medication) into microscopic particles and delivering into the
lungs as the patient inhales through a nebulizer.
- Medication administration via inhalation

Nebulization Therapy
- is to liquefy and remove retained secretions from the respiratory tract.

Indications of Nebulization Therapy

 To relieve respiratory insufficiency due to bronchospasm
 To liquefy and remove retained thick secretion from the lower respiratory tract
 Chest tightness
 Respiratory congestions
 Pneumonia
 Atelectasis
 Asthma
 To reduce inflammatory and allergic responses in the upper respiratory tract

Contraindications:
 Unstable and increased blood pressure
 Individuals with cardiac irritability (may result to dysrhythmias)
 Increased pulses
 Unconscious patients (inhalation may be done via mask but the therapeutic effect may be
significantly low)

Assessments before the procedure:

 Patient’s respiratory status
 History of the episode of respiratory distress
 Patient’s ability to use the nebulizer
 Medications the client is currently taking
 Patient’s knowledge regarding the use of nebulizer

Nebulizer
- A device that uses a small compressor to convert a liquid into a mist so it can be inhaled directly
into the lungs.
Types of Nebulizers

1. Pneumatic Jet Nebulizers – uses compressed gas to make an aerosol

2. Ultrasonic Nebulizers – makes an aerosol through high-frequency vibrations; the particles are
larger than a jet nebulizer (particles are larger than the jet nebulizer).
3. Mesh Nebulizers – liquid passes through a very fine mesh to form the aerosol (puts out the
smallest particles and most expensive)
 TACOMETER

Labor (childbirth)
- is the process of full-term fetus/ baby leaving the uterus (womb). In labor when there is regular
contractions, it will cause the cervix to change.
- Contractions are when the muscles of your uterus get tight and then relax
- Your cervix is the opening to the uterus that sits at the top of the vagina
- When labor starts, your cervix dilates (opens up)

Contractions (True labor)

 Usually very painful, can be difficult to talk during one
 Have a pattern and contractions will become closer together with time
 Associated with dilation of the cervix
 Will continue despite changes in your body positioning

Braxton Hicks (False labor)

o Typically, not as painful and you are able to talk
o No specific pattern, and do not get closer together with time
o The cervix does not dilate with false labor
o May stop if you shift body positions or go to the bathroom

Contraction in Pregnancy
- A contraction is when the muscles of the uterus tighten up like a fist and the relax
- Contractions help push your baby out
- In true labor, contractions last about 30 to 70 seconds and come about 5 to 10 minutes apart.

Duration of Labor
Duration: beginning to end of contraction
Interval: end to beginning of the next contraction
Intensity: strength of contraction
Frequency: beginning to beginning of the next contractions

Normal Duration
Primipara – 14 hrs less than or equal to 20 hrs
Multipara – 8 hrs less than or equal to 14 hrs
Baby Bath

Child rearing practices during the first year vary from country to country. The amount of bathing that is
done is also inconsistent across cultures. Unless contraindicated, most infants and children can be bathed
in a basin at the bedside or on the bed, or in a standard bath tub located on the unit which is often
conveniently adapted for pediatric use.

Objectives
 To keep the baby’s skin clean
 To refresh the baby
 To stimulate the circulation
 To prevent any skin infection
 To closely observe the body for evidence of any abnormalities and to note infant’ growth and
development.
 To induce sleep

First bath of the newborn should be done until 24 hours after birth- or waiting at least 6 hours if a
full day isn’t possible for cultural reasons.

Assessment of the skin before bath

 Colour  Temperature
 Moisture  Texture
  Turgur  Lesions
 Vascularity  Erythema
 Edema  Infection
 Pruritis  Inflammation
 Rashes  Hirutism

Types of baths
 Lap Bath
 Sponge bath
 Tub bath