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2005 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) of Pediatric and Neonatal Patients: Pediatric Advanced Life Support

Key Words: cardiopulmonary resuscitation

Abbreviations: LMA—laryngeal mask airway • RSI—rapid sequence intubation • ID—internal diameter • IV—intravenous • ECG—electrocardiographic • IO—intraosseous • AV—atrioventricular • VF—ventricular fibrillation • VT—ventricular tachycardia • AED—automated external defibrillator • PEA—pulseless electrical activity • PALS—pediatric advanced life support • SVT—supraventricular tachycardia

The first 300 words of the full text of this article appear below.

In contrast to adults, sudden cardiac arrest in children is uncommon, and cardiac arrest does not usually result from a primary cardiac cause.¹ More often it is the terminal event of progressive respiratory failure or shock, also called an asphyxial arrest.

	RESPIRATORY FAILURE

 
Respiratory failure is characterized by inadequate ventilation or oxygenation. Anticipate respiratory failure and possible respiratory arrest if you see any of the following:

• An increased respiratory rate, particularly with signs of distress (eg, increased effort, nasal flaring, retractions, or grunting)
  
• An inadequate respiratory rate, effort, or chest excursion (eg, diminished breath sounds, gasping, and cyanosis), especially if mental status is depressed
  

	SHOCK

 
Shock results from inadequate blood flow and oxygen delivery to meet tissue metabolic demands. Shock progresses over a continuum of severity, from a compensated to a decompensated state. Attempts to compensate include tachycardia and increased systemic vascular resistance (vasoconstriction) in an effort to maintain cardiac output and blood pressure. Although decompensation can occur rapidly, it is usually preceded by a period of inadequate end-organ perfusion.

Signs of compensated shock include

• Tachycardia
  
• Cool extremities
  
• Prolonged capillary refill (despite warm ambient temperature)
  
• Weak peripheral pulses compared with central pulses
  
• Normal blood pressure
  

As compensatory mechanisms fail, signs of inadequate end-organ perfusion develop. In addition to the above, these signs include

• Depressed mental status
  
• Decreased urine output
  
• Metabolic acidosis
  
• Tachypnea
  
• Weak central pulses
  

Signs of decompensated shock include the signs listed above plus hypotension. In the absence of blood pressure measurement, decompensated shock is indicated by the nondetectable distal pulses with weak central pulses in an infant or child with other signs and symptoms consistent with inadequate tissue oxygen delivery.

The most common cause of shock is hypovolemia, one form of which is hemorrhagic shock. Distributive and cardiogenic shock are seen less often.

Learn to integrate the signs of shock because . . . [Full Text of this Article]

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