NHIỄM KHUẨN HUYẾT SỐC NHIỄM KHUẨN TRẺ EM PGS TS BS Phùng Nguyễn Thế Nguyên HSCC- CĐ, BV NHI ĐỒNG Giảng viên cao cấp- ĐH Y DƯỢC TP HCM www.facebook.com/capcuunhidong/ Mục tiêu Trình bày lưu đồ hồi sức nâng cao? Trình bày xử trí đường thở, thở tuần hoàn nâng cao? Cập nhật vấn đề liên quan dùng • Adrenalin • Bicarbonate • calcium Nguyên nhân ngưng tim BV - - 90% of pediatric cardiac arrest is  Asystole, or  Bradycardic PEA Defibrillation seldom needed PEA-Pulseless electrical activity - Unpalpable pulse in the presence of organized cardiac electrical activity - Referred to as electromechanical dissociation (EMD) - Raizes: 68% of monitored in-hospital deaths and 10% of all in-hospital deaths - Survival: 10-20% - Điện tim bình thường tạo nên mạch Compression? PEA Tension pneumothorax Atropine All of the following are true regarding Atropine It increases SA and AV conduction through muscuranic antagonism At low doses, it has central and peripheral parasympathomimetic actions which may lead to paradoxic vagotonic effects It does not cause fixed and dilated pupils during cardiac arrest Atropine  0.02 mg/kg IV or IO  0,04 mg/kg qua NKQ  Minimum dose: No  Maximum single dose: • Child: 0.5 mg • Adolescent: 1mg Calcium  In infants, cardiac contractility depends on extracellular calcium influx since intracellular calcium is deficient  Hypocalcemia can present with cardiogenic shock!  There is no role for the empiric use of calcium  Indications for use:  Correct documented hypocalcemia  Antagonise hyperkalemia and hypermag  CCB toxicity Dose: CaCl2 10% (100 mg/ml) 20 mg/Kg IV Sodium Bicarbonate All of the following are true NaHCO3 inactivates catecholamines NaHCO3 leads to increased CO2 production and worsening acidosis No evidence shows an improvement in outcome when NaCO3 in administration during resuscitation from cardiac arrest pH +0,14 PaCO2 + mEq/l HCO3 + mmHg Ca 2+ -0,08 mmol/l During severe acidosis (pH less than 7.2) - The heart is more susceptible to V-fib and other arrhythmias - Myocardial contractility is suppressed, hypotension occurs, hepatic blood flow is reduced, and oxygen delivery to tissue is impaired BUT… Bicarbonate Compromise CPR by reducing systemic vascular resistance Create extracellular alkalosis that will shift the oxyhemoglobin saturation curve and inhibit oxygen release Produce hypernatremia and therefore hypersmolarity Produces excess CO2, which freely diffuses into myocardial and cerebral cells and may paradoxically contribute to intracellular acidosis Exacerbate central venuous acidosis and may inactivate simultaneously administered catecholamines Acidosis process - - Acidosis  Developing minutes  Significant acidosis 18 minutes  Regain normal ventilation and circulation quickly, acidosis generally resolves within 60 minutes Two studies cited in the 2010 Guidelines demonstrated increased ROSC, hospital admission and survival to hospital discharge associated with the use of bicarbonate - The majority of studies showed no benefit or found no relationship with poor outcomes Benefit of Sodium bicarbonate - Overdosed from  Tricyclic antidepressants  Diphenhydramine  Aspirin  Verapamil  Cocaine - Hyperkalemia - Hypermagiesia Dose of NaHCO3 NaHCO3 (1 mEq/ml) mEq/kg IV/ 10 phút CARDIAC ARREST – SHOCKABLE RHYTHM Amiodarone -Lidocaine Consider….! Thank you!