Pediatric emergency medicine trisk 0213 0213

more likely to have received rates between 85 and 100 and the average depth of compression 2.4 mm deeper than nonsurvivors Though a rescuer may not feel fatigued, chest compression quality deteriorates within the first minutes of chest compressions, leading to the current recommendation of switching providers every minutes However, frequent changes in providers cause an interruption in compressions and new compressors may be more likely to lean during the first compressions Some providers may maintain high-quality compressions beyond the recommended 2-minute limit Using a real-time CPR feedback system may provide objective information regarding when to change compressors In Bobrow’s study of adults with an OHCA, chest compression rate, depth, ventilation rate, and preshock pause were all improved when audiovisual feedback was used in combination with rescuer retraining Most importantly, feedback and training improved survival by 30% INTRAVENOUS ACCESS The site used for vascular access depends on the patient’s condition and the provider’s experience The most common sites used in the ill pediatric patient include peripheral venous access, IO access, and central venous access via the femoral vein In the arrested patient, IO access is indicated and can be accomplished quickly (30 to 60 seconds) and provides a route for all drugs and fluids needed during resuscitation The onset of action of drugs administered via this route is comparable to that of drugs administered into the central circulation Adenosine, which is rapidly metabolized once administered, may not work when given via the IO Manual pressure, a push–pull fluid delivery system, or use of a pressure bag is necessary when giving fluids to restore the vascular volume in order to overcome the resistance of the marrow venous plexus The preferred site in children is the medial surface of the tibia to cm below the tibial tuberosity Alternative sites include the anterior surface of the distal femur, proximal medial malleolus, and the anterior iliac spine ( Fig 9.12 ) There are several types of rigid, styletted needles commercially available for this procedure in infants and children There are also semiautomated IO devices available for use in children The bone injection gun (BIG) is a spring-loaded device that can be used in adolescents/adults and can effectively penetrate the thicker bony cortex The EZIO (Vidacare, San Antonio, TX), a battery-powered handheld drill, is available for use in both children and adults Further research is needed to evaluate efficacy of the semiautomated IO placement devices as compared to manual IO needles Contraindications to IO placement include recently fractured bone, osteogenesis