PAEDIATRIC BASIC LIFE SUPPORT

PAEDIATRIC BASIC LIFE SUPPORT 

By Dr. Chheng Kheng and Dr. Lorntry Patrich 

INTRODUCTION 

Basic Life support (BLS) is a technique that can be employed by a single rescuer to support respiratory and circulatory function of a collapsed child using no equipment. The outcome for children following cardiac arrest is generally poor, therefore early recognition that a child’s condition is deteriorating and provide appropriate management as soon as possible is crucial.

Steps in Pediatric Basic Life Support: DRS ABC :

Dangers?

It is essential that the rescuer does not become a second victim and that the child is removed from continuing danger as quickly as possible.

Responsive?

Checking for response: Are you alright?

• To determine responsiveness gently tap the infant/child’s shoulders, speak to the person by name if      it is known. Ask loudly “are you all right?”

• Note that infants and children who cannot talk yet and older children who are scared are unlikely to    reply meaningfully but may make some sound or open their eyes to the rescuers voice.

• Do not shake infants or children.

Send for help:

Help should be summoned rapidly. If more than one rescuer are available at the scene, sending for help should be done while at least one rescuer need to be with the victim to perform successive life support.

Airway: Opening Airway

When a child is unconscious, all muscles are relaxed. If the infant/child is lying on their back the tongue falls against the back of the throat and obstructs the airway.

To open the airway

    • Lay infant/child flat on the back on a firm surface

    • apply head tilt/chin lift and/or jaw thrust in case of trauma

    • Positioning: neutral position in infant, and sniffing position in children (see pictures)

A blind ‘finger sweep’ technique should not be used as it can damage soft palate, and bleeding from within the mouth which can worsen the situation. Furthermore, foreign bodies may be forced further down the airway; they can become lodged below the vocal cords (vocal folds) and be even more difficult to remove.

Breathing normally?

Once the airway is cleared and open, check for normal breathing for no more than 10 seconds, using the following method.

     • Look: for movement of lower chest or upper abdomen

     • Listen: for escape of air from nose and mouth

     • Feel: for movement of chest and upper abdomen

Note that an occasional gasp or noisy breathing is not considered normal breathing.

Circulation:

If there are no signs of life (unconsciousness, no movement, no normal breathing or coughing), check for a pulse (for no more than 10 seconds). In children the carotid pulse can be palpated. In infants the neck is generally short and fat and the carotid pulse may be difficult to identify. Therefore the brachial pulse or the femoral pulse should be felt.

Start chest compression if:

     • No pulse

     • Slow pulse less than 60 per minute

     • No signs of life

DURATION OF CPR:

Rescuers should minimize interruption of chest compression, and CPR should not be interrupted to check for response or breathing as this is associated with lower survival rates.

If multiple rescuers available, rescuers should be changed at least every 2 minutes to prevent rescuer fatigue and deterioration in chest compression quality.

Rescuers should continue CPR until:

     • The victim responses or starts breathing normally

     • It is impossible to continue (exhaustion, the scene becomes unsafe…)

     • A health professional arrives and takes over the CPR

RESCUE BREATHING WITHOUT CHEST COMPRESSIONS:

In the event it is determined that an infant or child has signs of circulation but do not demonstrate adequate respirations, rescue breathing should continue using the following:

     • Rescue breaths can be delivered at a rate of 20 breaths per minute

     • Each breath should be of sufficient volume to see the chest rise. If the chest does not

         rise, head tilt /chin lift and mask seal should be rechecked

     • Avoid inflating lungs with too much force as there is a risk that air will inflate the

         stomach resulting in regurgitation of stomach contents and aspiration into the lungs;

     • Reassess for a pulse every 10 breaths but spend no more than 10 seconds doing so;

     • Be prepared to commence compressions if a pulse is no longer palpable

     • If the person resumes breathing normally, put him/her in recovery position

CHOKING OR FOREIGN BODY AIRWAY OBSTRUCTION (FBAO)

The diagnosis of foreign body aspiration is clear-cut (the onset of respiratory compromise is

sudden and is associated with coughing, gagging, stridor) and dyspnea is increasing and apnea can

occur.

REFERENCES

1. Advanced Pediatric Life Support: Basic Life Support Section modified April 2011 from

Australian Resuscitation Council and New Zealand Resuscitation Council for use by

trained health professionals.

2. American Heart Association CPR guideline 2010

3. UK Resuscitation Council 2010 Resuscitation Guideline

4. Australian Resuscitation Council 2010 Resuscitation Guideline

Thanks