الفهرس 
Acknowledgements
Anatomy of air way systemOnly 14 pages are availabe for public view
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Abstract
The present study is aprospective study on patients admitted in intermediate care units and intensive care unit at assiut university children hospital aim to assess the quality of care and management of children with cardiorespiratory arrest according to the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) (2015) of Pediatric Patients between 1st of March 2017 to February 2018. The study included 86 cases that comprised all children from 1 month to age of 18 years, include all seriously ill children admitted with or develop cardiorespiratory arrest and undergo CPR; children with traumatic cause of cardiorespiratory arrest were excluded, all cases were subjected to witnessed cardiopulmonary resuscitation, some of cases were subjected to full examinations, Laboratory data (CBC, KFT, RBS, coagulation profile), the patients were 51 males and 35 females. They were divided into five groups: Infant (1m-1y) 45.3%, toddler (1y-3y) 27.9%, preschooler (3y-5y) 14%, schooler age (6y-12y) 5.8% and adolescents (12y-18y) 7%. Most of patients (75.6%) were from rural areas, and mostly in intermediate care unites (68.6%).Twenty eight patients were with chronic disease (32.6%) and 58 patients with acute disease, most of patient (35 cases) presented with chest disease (40.7%) while 20 patient presented with gastroenteritis (23.3%).18 patient with cardiac disease (20.9%). 8 patient with septicemia and 5 patient with central nervous system affection. Pre arrest assessment of studied cases done through warning score, it was done in 27 cases (31.3%) in intensive care unit precardiac arrest most of cases had alow score rang (0-35), while none of cases had maximum score 74. most of these cases exhibit return of spontaneous circulation(92.5%) regardless the score. Most of cases (80 cases) were with non-shock able rhythm (93%) and 6 cases with shock able rhythm (6.9%). cardiac compression in most of cases was one third of anteroposterior diameter of the chest (62.8%) ,while less than one third of anteroposterior diameter of the chest (37.2%) with chest recoil in 28 cases (32.5%),and no chest recoil in 60 cases (69.7%),cardiac compression interruptions in 34 cases (39.5%) , with compression rate in most patients range from 100 to 120 ,cardiac compression with rotation in 22 cases (25.6%) and without rotation in 64 cases (74.4%).. CA patients with a response time of ≤5 minutes had a higher rate of ROSC (70%), the patients with a duration of CPR 15 minutes had a better outcome of ROSC(86%) patients ventilated with ambo bag mask ventilation (59 case) were higher than those with ambo bag and endotracheal tube ventilation (27 case). the frequency of ventilation in all studied case was 10-12 breath/minute, airway opening through head tilt chin lift position and compression-ventilation ratio 15 compression to 2 ventilation in all cases 55 cases resuscitated using adrenalin with dose of 0.01mg/kg (61.9%) and 31 cases (36.1%) resuscitated using adrenalin in adose of 0.1mg/kg in a cycle of cardiopulmonary resuscitation most of drug given through intravenous route. also it was observed that most of cases (80 case) receive atropine pre intubation with dose 0.1mg/kg. 6 cases that undergone defibrilation (6,9%) with doses rang from 2J/kg not exceed 10J/kg , amiadaron used in 6,9% of cases post cardio version, with fluid bolus used in 60 cases (69.7%) and 49 cases(56.9%) put on introp. Patient exhibit ROSC were 60 cases, most of cases had bilateral pupil reaction (55%),thirty six cases were with seizure (60%), according to motor system abnormalities found that most of cases were with hypotonia(53%) and hyporeflexia(56%),regarding conscious level 28 cases were unresponsive (46,6%) ,while 32 cases were responding to painful stimuli (53,3%). In comparison between different relevant factors groups Factors affecting outcome following cardiopulmonary resuscitation. It show that of 86 patients 60cases (75%) exhibit ROSC, non cardiac etiology, non shockable rhythms, response time ≤5 minutes, duration of CPR 15 minutes, or total adrenaline doses ≤5 mg group had higher ROSC.