PALS 2 (before epc)

High Performance Teams in CPR

  • One of the key measures for a high-performance team during cardiac emergencies is achieving specific performance metrics, particularly focusing on high chest compression fraction (CCF).

Chest Compression Fraction (CCF)

  • CCF Definition: The amount of time spent doing high-quality chest compressions during a cardiac arrest event.

    • Achieving a high CCF is crucial for improving survival rates.

    • Elimination of pauses is necessary to maintain high CCF during CPR.

  • Research Findings:

    • The Resuscitation Outcomes Consortium (ROCK) trials indicated that a 10% increase in CCF correlates to an 11% increase in survival rates.

Key Strategies to Increase CCF

  • Maximizing Time on Chest: Each 10% increase in hands-on chest compression time theoretically results in an 11% increase in survival.

    • Limiting Recharge Time: Strategies to minimize interruptions in compressions include:

    • Use of Advanced Airway: Facilitates uninterrupted compressions by allowing one rescuer to manage airway while others perform chest compressions.

    • Having More Rescuers: More personnel can assist in reducing fatigue and interruptions.

    • Communication: Effective coordination amongst rescuers during CPR and use of devices (e.g., Lucas device) improves efficiency.

  • Location for CPR: One critical point emphasized is working the code where the patient is found rather than moving them, as transfers to the ambulance can significantly decrease compression time, thus impacting survival chances.

Identifying and Reducing Pauses in CPR

  • Common Pausing Events:

    • Intubation

    • Rhythm analysis

    • Pulse checks

    • Compressor switches and defibrillation

Best Practices

  • Measurement of CPR metrics is essential to identify and address areas of pause in practice settings. "You cannot improve what you do not measure" is a significant philosophy highlighted in the discussion.

Effective Use of Equipment

  • Usage of Bag-Valve Masks (BVM) and Oropharyngeal Airway (OPA) is crucial during CPR sessions for efficient ventilation.

    • Each moment without compressions should be minimized.

    • Hovering over the chest to prepare for immediate resumption of compressions can help maintain efficiency.

Team Dynamics in High-Performance CPR

  • Clear Roles and Responsibilities: Team leaders must immediately establish roles.

    • Examples of roles can include medic focused on airway management, another on compressions, etc.

  • Communication Styles:

    • Closed Loop Communication: Essential for ensuring that messages are received and tasks completed.

    • Respectful Communication: Professional interactions maintain morale and focus during high-stress situations.

Cycling and Switching Compressors

  • CPR should ideally be performed in cycles lasting no more than 2 minutes (about 5 cycles per 10 minutes), depending on the patient's reaction and team readiness.

  • Fatigued compressions need to be replaced quickly without waiting for scheduled cycle ends to maintain high performance.

Techniques for Performing CPR

  • Best practices dictate using real-time feedback devices or metronomes to establish proper rhythm for compressions.

Pediatric Emergency Protocols

  • Pediatric Assessment Triangle (PAT): An assessment tool to quickly evaluate child patients’ appearance, work of breathing, and circulation.

    • The appearance includes gauging consciousness.

    • Work of breathing checks for effort and audible signs of distress.

    • Circulation checks for skin temperature, color, and pulse.

  • Primary Assessment Components: (ABCDs)

    • Airway: Always check if it's open and patent.

    • Breathing: Monitor respiratory status and distress signs like nasal flaring or retractions.

    • Circulation: Assess heart rate, pulse, capillary refill time.

    • Disability: Involves assessing the level of consciousness and pupil reaction.

  • Conclusively ensure that exposure (body warmth and skin condition) is monitored at all times.

Managing Choking Situations in Pediatrics

  • Techniques differ significantly based on the age of child regarding the severity and response to choking.

    • Use of back blows for infants, followed by chest thrusts, is essential for relieving airway obstruction.

Critical Skills for Child Emergencies

  • Assessments should happen frequently with attention to changes in status, always applying the evaluate, identify, intervene sequence effectively.

Conclusion

  • Performance in CPR involves not only the technical execution of compressions and ventilation but also the coordination, communication, and practice of a high-performance team to achieve the best outcomes for the patient. Continuous learning and understanding of pediatric care nuances contribute to improved survival rates in critical situations.