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Pediatric Basic Life Support
The following is the sequence that should
be followed by health care professionals
with a duty to respond to pediatric
emergencies:
1 ensure the safety of rescuer and
child.
2 check the child's responsiveness :
. gently stimulate the child and ask
loudly, are you all right ?
. don’t shake infant, or children with
suspected cervical spine injuries
3 A if the child responds by
answering or moving:
. Leave the child in position in which
you find him
. Check his condition and get
help if needed
. Reassess him regularly.
3 B if the child does not respond:
. Shout for help
. open the child airway by tilting the
head and lifting the chin
If you suspect that there may have
been an injury to the neck, try to open
the airway by chin tilt alone. If this is
unsuccessful, add head tilt a small
amount until the airway is open.
4 keeping the airway open, look, listen,
and feel for normal breathing by putting
your face close to the child face and
looking along the chest:
. look for chest movements.
. listen at the child nose and mouth for
breath sounds.
. feel for air movement on your cheek
5 A If the child breath normally:
. turn the child on his side into the recovery
position
. check for continued breathing.
5 B If the child is not breathing or is making
gasps:
. Carefully remove any obvious airway
obstruction.
.Give 5 initial rescue breaths.
. While performing the rescue breaths note
any gag or cough response to your action. These
responses, or their absence, will form part of your
assessment of a signs of a circulation.
Rescue breaths:
. ensure head tilt and chin lift .
.pinch the soft part of his nose closed with the index finger
and thumb of your hand on his forehead
.open his mouth a little ,but maintain the chin upwards .
.take a breath and place your lips around his mouth
,making sure that you have a good seal
.Blow steadily into his mouth over about1-1.5 sec
watching for chest rise.
.maintaining head tilt and lift and chin lift take your mouth
away from the victim and watch for his chest to fall as air
comes out .
.take another breath and repeat this sequence 5 times .
Identify effectiveness by seeing that the child's chest has
risen and fallen in a similar fashion to the movement
produced by a normal breath
If you have difficulty achieving an effective
breath .the airway may be obstructed
.open the child's mouth and remove any
visible obstruction. do not perform a blind
finger sweep
.Ensure that there is adequate head tilt
and chin lift but also that the neck is not
over extended
.if head tilt and chin lift has not opened
the airway try the jaw thrust method
.make up to 5 attempts to achieve
effective breaths .if still. unsuccessful,
move on to chest compression
6 check for signs of a circulation
(signs of life):
Take no more than 10 seconds to:
. look for signs of a circulation. These
include any movement, coughing, or
normal breathing.
. check the pulse ; no more than 10 sec. :
. in a child over than one year – feel for
the carotid pulse in the neck
. in an infant – feel for the brachial pulse
on the inner aspect of the upper arm
7 A if there are signs of circulation:
. continue rescue breaths until the child
start breath effectively on his own.
. turn the child onto his side if he remains
unconscious.
. re-assess the child frequently.
7 B if there are no signs of
circulation:
Or _ no pulse,
Or _ a slow pulse ( less than 60/min.)
Or _ you are not sure:
. start chest compression.
. combine rescue breaths and chest
compression.
For all children, compress the lower third of
sternum:
. to avoid compressing the upper abdomen,
locate the xiphisternum by finding the angle where
the lowest ribs join the midline. Compress the
sternum one finger breadth above this.
. compression should be sufficient to depress
the sternum by approximately one-third of the
depth of the chest.
. release the pressure, then repeat at a rate of
about 100/min.
. after 15 compression, tilt the head, lift the
chin, and give two effective breaths.
. continue compressions and breaths in a ratio
of 15:2
Chest compression in infants:
. place both thumbs flat, side by side,
on the lower third of the sternum, with the
tips pointing towards the infant head.
. spread the rest of both hands, with the
finger together, to encircle the lower part of
the rib cage.
. press down on the lower sternum with
your two thumbs to depress it
approximately one-third of the depth of the
infant chest.
Chest compression in children over 1 year:
. place the heal of one hand over the lower
third of the sternum.
.lift the fingers to ensure that pressure is not
applied over the child ribs.
. position yourself vertically above the victim
chest and, with your arm straight, compress the
sternum to depress it by approximately one-third
of the depth of the chest.
. in larger children, this may be achieved most
easily by using both hands with the fingers
interlocked.
8
continue resuscitation until:
. the child show the signs of life
(spontaneous respiration, pulse,
movement).
. Further qualified help arrives.
. you become exhausted.
When to call for assistance
It is vital for rescuers to get help as quickly as possible when a
child collapses:
. when more than one rescuer is available, one start
resuscitation while another goes for assistance
. if only one rescuer is present, undertake resuscitation for
about 1 minute before going for assistance. To minimize
interruptions in CPR, it may be possible to carry an infant or
small children whilst summoning help.
. the only exception to performing 1 min. of CPR before
going for help is in the case of a child with a witnessed, sudden
collapse when the rescuer is alone. In this case cardiac arrest is
likely to be an arrhythmia and the child may need defibrillation.
Seek help immediately if there is no one to go for you.
Pediatric advanced life support:
Sequence of actions
1 establish basic life support.
2 oxygenate, ventilate, and start chest
compression:
. provide positive-pressure ventilation with highconcentration inspired oxygen.
. provide ventilation initially by bag and mask.
Ensure a patent airway by using an airway maneuver.
. use a compression rate of 100/min.
. as soon as is feasible, an experienced operator
should intubate the child.
. once the child has been intubated and
compressions are uninterrupted, use
ventilation rate of approximately 10/min
3 attach a defibrillator or monitor:
. assess and monitor the cardiac
rhythm.
. if using a defibrillator, place one
defibrillator pad or paddle on the
chest wall just below the right clavicle,
and one in the left axillary line.
. pads or paddles of children
should be 8-12 cm in size, and 4.5 cm
for infant. In infants and small children
it may be best to apply the pads to the
front and back of the chest.
. place monitoring electrodes in the
conventional chest positions.
4 assess rhythm and check for signs
of circulation (signs of life):
. child—feel for the carotid pulse in
the neck.
. infant—feel for the brachial pulse
on the inner aspect of the upper arm.
. take no more than 10 seconds for
the pulse check.
. assess the rhythm on the monitor:
- non-shockable (asystole or
pulseless electrical activity) OR
- shockable (vf/vt).
5 A non shockable ( asystole or pulseless
electrical activity):
This is the most common inchildren.
. perform continous CPR:
- continue to ventilate with high-concentration
oxygen.
- if ventilation with bag-mask give 15 chest
compression to 2 ventilations for all ages
- if the patient is intubated, chest compression
can be continuous as long as this does not
interfere with satisfactory ventilation.
- use chest compression rate of 100/min .
- once the child has been intubated and
compressions are uninterrupted, use ventilation
rate of approximately 10/min.
Note: once there is return of spontaneous
circulation (ROSC) the ventilation rate should
be 12-20/min. measure exhaled CO2 to
ensure tracheal tube placement.
. give adrenaline:
- if venous or intraosseous (IO) access
has been established, give adrenaline 10
micrograms/kg (0.1 ml/kg of 1 in 10000
solution)
- if circulatory access is not present, and
cannot be quickly obtained, but the patient
has a tracheal tube in place, consider giving
adrenaline 100 microgram/kg via the tracheal
tube ( 1 ml/kg of 1 in 10,000 solusion) this the
least satisfactory route
. continue CPR.
. repeat the cycle:
- give adrenaline every 3-5 min
(i.e every other loop)
- once the airway is protected by
tracheal intubation, provide ventilation
at a rate of 10/min and compression
at 100/min
- when circulation is restored,
ventilate the child at a rate of 12-20
breath/min to achieve a normal pCO2
, and monitor exhaled CO2
. consider and correct reversible causes:
- hypoxia
- hypovolaemia
- hyper/hypokalaemia (electrolyte
disturbances)
- hypothermia
- tension pneumothorax
- thromboembolism
- tamponade
- toxic/therapeutic
. consider the use of other medications
such as alkalising agents.
5 B shockable (vf/vt)
This is less common in paediatric practice
but likely when there has been a witnessed
and sudden collapse, it is commoner in the
intensive care unit and cardiac ward.
. defibrillate the heart:
- give 1 shock of 4 j/kg if using a manual
defibrillator
- if using an automated external
defibrillator ( AED ) for a child of 1-8 years,
deliver a pediatric attenuated adult shock
energy.
- if using an AED for a child over 8 years,
use the adult shock energy
. resume CPR:
- without reassessing the rhythm or
feeling for a pulse, resume CPR
immediately, starting chest compression.
. continue CPR for 2 min.
. pause briefly to check the monitor:
- if still VF/VT, give a second shock.
. resume CPR immediately after the
second shock.
. consider and correct the reversible
causes (as above).
. continue CPR for 2 min.
. Pause briefly to check the monitor:
- if still VF/VT:
. give adrenaline followed immediately
by a (3rd) shock.
. resume CPR immediately and
continue for 2 min.
. Pause briefly to check the monitor:
- if still VF/VT :
. give an intravenous bolus of
amiodarone 5 mg/kg and an immediate
further (4th) shock.
. continue giving shock every 2 min
. give adrenaline immediately before
every other shock (i.e every 3-5 min) until
return of spontaneous circulation (ROSC)
Note: after each 2 min of uninterrupted CPR,
pause briefly to assess the rhythm.
. if still VF/VT:
- continue CPR with the shockable (VF/VT)
sequence.
. if asystole:
- continue CPR and swich to the non-shockable
(asystole or pulseless electrical activity) sequence
as above
. if organized electrical activity is seen, check
for a pulse:
- if there is ROSC, continue post-resuscitation
care.
- if there is no pulse, and there are no other
signs of a circulation, give adrenaline 10
microgram/kg and continue CPR as for the non
shockable sequence as above.