Cardiac Arrest in Children - aetiology

There are two types of cardiac arrest in adults, and children.

Primary Cardiorespiratory Arrest: due to an underlying cardiac arrhythmia (eg VF or VT) is more frequent in adults. The onset is often acute and unpredictable. Immediate defibrillation is needed.

Secondary Cardiorespiratory Arrest is more common in children and is because the body can't deal with the underlying injury or illness.
The pre-terminal rhythm in children is often bradycardia which leads to asystole or PEA - non shockable rhythms.

The outcome from cardiorespiratory arrest in children is poor, especially if there is a prolonged duration. Compared to adults, children are physiologically different but like adults, early recognition of the seriously ill child can prevent sudden death.

Some conditions are more likely to affect children than adults, and more likely to cause their arrest:
Croup: remember a narrower tracheal tube than would normally be expected may be required.
Epiglottitis: you must keep the child calm until the airway is secure.
Bronchiolitis
Coma
Seizures
Anaphylaxis: give adrenaline as quickly as possible

Drowning, electrocution and hypothermia can also affect children, and cause cardio-respiratory arrest. In an arrest situation, the standard CPR algorithms should be followed.

Survival rates remain poor, with survival rates of 0 - 38% quoted in the literature.

Paediatric Quizes

We're doing well, and racing through the PMPs here...
It's time for a Life in the Fastlane quiz...what do you think?

http://lifeinthefastlane.com/2013/01/paediatric-quiz-022/


We've also found a different quiz on epiglottitis. For more information, have a look at twitter. There's loads of information.

Here's another question to get you thinking:

https://www.facebook.com/EMWeapon/posts/607184405958750 


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An Epiglottitis Case...

Like all things, this case is theoretical but you can always trust Life in the Fast Lane to have information on anything and everything!

A sick two year old with stridor - what would you do?



Above frame taken from: http://lifeinthefastlane.com/2010/06/intubation-of-a-toddler-with-airway-obstruction/

If you thought that sounded easy...have a look at this page from EP monthly - all about intubating a patient with epiglottitis.

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Epiglottitis

Epiglottitis isn't something that we see a lot of. There's nothing (yet) about it on Enlighten me, and e-learning modules on it are scarce. That is probably because it's not very common. But when we do see it, it is life threatening.

There is a great picture here of what a larynx is supposed to look like in epiglottitis. This would explain the symptoms, and why we worry about it.

Epiglottitis is caused by Haemophilus influenza B type. 15% of HIB cases present with epiglottitis. The "green book" has excellent information on immunisation, and tells you everything you'd ever want to know about HIB.



The above frame was taken from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147953/Green-Book-Chapter-16.pdf

If you'd actually like to learn about epiglottitis, there is an American tutorial here.

Apnoea, stridor and airway and obstruction

For more blog posts and information on PMP2, click here. 

The college syllabus is well defined:

These are tricky subject areas to find information on, and very rare in practice.
For the allergic causes of airway obstruction, visit the anaphylaxis page.

For more airway posts, click here.

 

For more epiglottitis posts, click here. 

 

For more choking posts, please click here.

For more surgical airway posts, please click here. 

For more tonsillectomy posts, please click here.