Pediatric emergency medicine trisk 0192 0192
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advanced care. Once in the ED, resuscitation is best accomplished with an
effective leader who organizes and directs a skilled team. The American College
of Surgeons divides trauma resuscitation into the primary and secondary surveys
(see Chapter 7 A General Approach to the Ill or Injured Child ). The application
of this technique to medical resuscitation allows for rapid, thorough assessment of
the patient in an orderly manner. The primary survey includes the assessment of
airway, breathing, circulation, and disability (ABCDs) to identify the life threat.
The secondary survey is a head-to-toe examination to determine the etiology of
the arrest, and includes diagnostic studies, subspecialty consultation and transfer
to definitive care (see Chapter 7 A General Approach to the Ill or Injured Child ).
The ABCDs are reassessed frequently throughout the resuscitation.
Careful management of airway and breathing is extremely important in
children as the cause of the arrest is most often related to respiratory failure.
Luckily, the child’s myocardium is relatively resilient to hypoxemia, thus rapid
correction of hypoxemia may be all that is necessary to restore circulation. Bagvalve-mask (BVM) ventilation is an effective way to rapidly reverse hypoxemia.
In the prehospital setting, BVM alone, without subsequent intubation, has been
shown to improve outcomes for patients with respiratory arrest in urban settings.
For those patients who do not respond to airway and breathing management
alone, this usually predicts a need for multiple drug interventions.
Vascular access is a major challenge in severely ill pediatric patients.
Peripheral intravenous (IV) access may be difficult to establish quickly. The
intraosseous (IO) route, recommended by PALS for patients in cardiac arrest
route offers a safe, effective method to obtain access rapidly. Central lines are
useful for longer-term access and require advanced skills and often take more
time to place.
