Download - Reanimacion pediatrica anestesia, guias 2014
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Modulo Anestesia en Pediatria
Reanimación Cardiovascular Pedíatrica
Presenta: MC. Rafael Eduardo Herrera Elizalde R1ACoordinador: Dra. Ariadna Espinoza de la Garza MBA
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Objetivos
Descripción del soporte vital básico y avanzado en el paciente pediátrico
Particular enfoque en el perioperatorio.
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Paro Cardiaco…
Situación Clínica presente desde el momento en que el corazón deja de latir (no flujo)
Pasando por una situación de “bajo Flujo” durante RCP
Hasta la recuperación de la circulación espontanea
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Mínimas Interrupciones, Calidad, Frecuencia…
Weisfeldt and Becker (3 Fases)
Eléctrica - ATP (3 a 4 minutos)
Circulatoria – Depleción ATP
AESP – Asistole (compresiones restauran ATP)
Metabólica > 8 a 10 minutos
Protección Celular
ABC pasa a CAB
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Cadena de Supervivencia
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Soporte Vital y la Anestesiología
Pioneros en este rubro
Familiarizados con el manejo de la vía aérea
Familiarizados con los fármacos utilizados para la reanimación
ALS - PALS (Fuera de Quirofano)
Agregaremos: ETCO2, Línea Arterial, AVC (valorar efectividad de RCP),desfibrilación, RCP a tórax abierto, soporte vital extracorpóreo.
Donald H. Shaffner, MD,Eugenie S. Heitmiller, MD, and Jayant K. Deshpande, MD; Pediatric Perioperative Life Support; A and A 2013;117:960–79
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Preparación Pre-resucitación
Riesgo de Paro Cardiaco Intraoperatorio en Paciente pediátrico es inversamente proporcional a la edad, mayor riesgo en menores de 1 mes.
ASA directamente proporcional Pediatric Anesthesia 2010 14: 412–416
Donald H. Shaffner, MD,Eugenie S. Heitmiller, MD, and Jayant K. Deshpande, MD; Pediatric Perioperative Life Support; A and A 2013;117:960–79
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Causas de Paro Cardiopulmonar en Paciente Pediátrico
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Paro Cardiaco Intrahospitalario
40%
14%
24%
22%
Asistolia FV/TV
AESP No reportado ETIOLOGÍA
Asfixia: 67%
Isquemia: 61%
Arritmia: 10%
PRONÓSTICOROSC 66%33% sobrevive al alta65% buen resultado neurológico
Dianne L. Atkins, Et. Al; Epidemiology and Outcomes From Out-of-Hospital Cardiac Arrest in Children: The Resuscitation Outcomes Consortium Epistry -Cardiac Arrest Circulation. 2009;119:1484-1491
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Paro Cardiaco Extrahospitalario
71%
15%
4%10%
Asistolia AESP FV/TV No determinado PRONÓSTICO
ROSC 30%, >20 min: 25%
9.6% sobrevive al alta
30% buen resultado neurológico
Dianne L. Atkins, Et. Al; Epidemiology and Outcomes From Out-of-Hospital Cardiac Arrest in Children: The Resuscitation Outcomes Consortium Epistry -Cardiac Arrest Circulation. 2009;119:1484-1491
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Donald H. Shaffner, MD,Eugenie S. Heitmiller, MD, and Jayant K. Deshpande, MD; Pediatric Perioperative Life Support; A and A 2013;117:960–79
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Donald H. Shaffner, MD,Eugenie S. Heitmiller, MD, and Jayant K. Deshpande, MD; Pediatric Perioperative Life Support; A and A 2013;117:960–79
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Cuando el paro cardiaco se presenta…
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AHA y PALS
Falla Respiratoria
Obstrucción de la Vía Aérea (superior o inferior)
Enfermedad Parenquimatosa
Mal control de la ventilación
Falla Cardiovascular
Choque
Hipovolémico
Distributivo
Cardiogénico
Obstructivo
Paro Cardiaco Súbito
Donald H. Shaffner, MD,Eugenie S. Heitmiller, MD, and Jayant K. Deshpande, MD; Pediatric Perioperative Life Support; A and A 2013;117:960–79
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AHA y PALS para Anestesiólogo
Falla Respiratoria
1. Obstrucción Vía Aérea Superior
2. Obstrucción de Vía Aérea Inferior
3. Enfermedad Parenquimatosa
4. Alteraciones Ventilatorias
Falla Cardiovascular
4 componentes
1. Ritmo
2. Pre-Carga
3. Contractilidad
4. Pos-Carga
Donald H. Shaffner, MD,Eugenie S. Heitmiller, MD, and Jayant K. Deshpande, MD; Pediatric Perioperative Life Support; A and A 2013;117:960–79
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Donald H. Shaffner, MD,Eugenie S. Heitmiller, MD, and Jayant K. Deshpande, MD; Pediatric Perioperative Life Support; A and A 2013;117:960–79
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COMPRESIONES TORÁCICAS
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Índice Cardiaco hasta de 3 lts/min/m2
Donald H. Shaffner, MD,Eugenie S. Heitmiller, MD, and Jayant K. Deshpande, MD; Pediatric Perioperative Life Support; A and A 2013;117:960–79
GCHCO3
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Rol del acceso Venoso Central y la Linea
Arterial
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Rol de la PVC… Acceso Venoso Central
SvO2 mayor de 72% - 100% retorno a circulación espontanea
SvO2 menor de 30% - 0%
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Linea Arterial
Esto basado en si ya dispones de ella.
Presion Arterial Diastolica mayor a 40 mmHg un predictor de la restauracion de la circulacionespontanea
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Donald H. Shaffner, MD,Eugenie S. Heitmiller, MD, and Jayant K. Deshpande, MD; Pediatric Perioperative Life Support; A and A 2013;117:960–79
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Donald H. Shaffner, MD,Eugenie S. Heitmiller, MD, and Jayant K. Deshpande, MD; Pediatric Perioperative Life Support; A and A 2013;117:960–79
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¿¿RCP EN PACIENTE PRONO???
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GRACIAS!!!