PEDIATRIC BASIC LIFE SUPPORT

PRESENTED BY : LOUIS VAN RENSBURG (ALS PARAMEDIC)

ABC OR CAB?2010 AHA for CPR recommend a CAB sequence

Chest compression

Airway

Breathing

Ventilation

Critical thinking: WHY?

CAB GUIDELINESHow do we classify age groups according to PALS ?

• Infant BSL guidelines apply to infants < approximately one year of age.

• Child BSL guidelines apply to children > 1 year until puberty (breast development in girls and axillary hair in males)

• Adult BSL for puberty and above.

CHEST COMPRESSIONCompression Ventilation Ratio: 15:2 30:2 When would you use which ratio?

Rate of 100 compression per minutePush hard: sufficient force to depress at least one third the anterior-

posterior diameter of the chest.

1 ½ inches in infants (4 cm) 2 inches in children (5 cm)

Allow chest recoil after each compression to allow the heart to refill with blood

(NB Hands off time)

CHEST COMPRESSIONCompression TechniqueChildren: One or two hands may be used , as long as compressions is done

effectively. Infant: 2 fingers in the centre of the infants chest or Two Thumb encircling

technique. (Which of the above to you think is preferred? )

VENTILATION / COMPRESSIONOne rescuer: 30 :2 Two rescuer: 15:2

After initial 30 compression, open airway using a head tilt-chin lift and give 2 breaths.

Note: if you use mouth to mouth, pinch off the nose.

Continue for approximately 2 minutes (about 5 cycles) before calling for ERS and AED.(Do you agree with the above statement)

CABS SEQUENCEAssess need for CPRIf health care provider take 10 seconds to check for pulse (No Longer) Brachial in infant:

Carotid or femoral in a child:

“ARE YOU OKAY?”

INADEQUATE BREATHING WITH PULSEIf pulse > 60 per minutes but there is inadequate breathing

give rescue breathing at a rate of about 12 to 20 breathes per minute.

Reassess pulse about every 2 minutes Carotid or femoral for child Brachial for infant

UNRESPONSIVE AND NOT BREATHINGIf the child is unresponsive and not breathing (or only gasping)

begin CPR.Start with high-quality chest compression. (30 chest

compressions or 15 chest Compressions)After one cycle 2 minutes check for pulses/re-asses

SEE PBLS ALGORITHM ON NEXT SLIDE

PAEDIATRIC BASIC LIFE SUPPORT ALGORITHM

BRADYCARDIA WITH POOR PERFUSIONIf pulse is less than 60 per minutes and there are signs of poor perfusion Pallor Mottling Cyanosis

despite support of oxygenation and ventilation – start CHEST COMPRESSION

DEFIBRILLATION“Children with sudden witnessed collapse (eg, a child

collapsing during an athletic event) are likely to VF or pulseless VT and need immediate CPR and rapid CPR and rapid defibrillation. “defibrillation. “

VF and pulseless VT are referred to as “shockable rhythms” because they respond to electric shocks.

VT – ventricular tachycardiaVF – ventricular fibrillation

VT – VENTRICULAR TACHYCARDIA

VT may be pulseless or with a pulse? (Difference in management?)

VF – VENTRICULAR FIBRILLATION

Coarse vs Fine (Be carefull fine may present similar to assytole)

DEFIBRILLATION DOSINGThe recommended first energy dose for defibrillation is 2 J/kg.If second dose is required, it should be doubled to 4 J/kg.AED with pediatric attenuator is preferred for children < 8

years of age.

WEIGHT = (AGE * 2 ) + 8

DEFIBRILLATION SEQUENCETurn AED onFollow the AED promptsEnd CPR cycle (for analysis and shock)Resume chest compressions immediately after the shock. Minimize interruptions in chest compressions.

State CLEAR when giving the shock and have visual / verbal communication with any other rescue personal

ASPHYXIAL CARDIAC ARRESTCardiac arrest caused by asphyxiation (lack of oxygen in

blood)

• Carbon dioxide accumulates in the lungs while oxygen in the lungs is depleted resulting in cardiac arrest.

• Causes: drowning, choking, airway obstruction, sepsis, shock. (Anything else.)

ASPHYXIAL CARDIAC ARRESTVentilations over Compressions:

“One large pediatric study demonstrated that CPR with chest compression and mouth-to-mouth rescue breathing is more effective than compression alone when the arrest was from a noncardiac etiology.”

“Ventilations are more important during resuscitation from asphysia-induced arrest, than during resuscitation from VF or pulseless VT.”

FOREIGN-BODY AIRWAY OBSTRUCTIONChoking and Asphyxiation as a result of it:

90% of childhood deaths from foreign body aspiration occur in children < 5 years of age; 65% are infants. (Who’s infants according PBLS guidelines)

Most common causes of foreign-body airway obstruction:• Balloons• Small objects (Toys)• Foods (hot dogs, round candies, nuts and grapes)

FBAO WHAT TO DO NEXT?If FBAO is mild, do not interfere. Allow the victim to clear the airway by coughing.If the FBAO is severe (victim unable to make a sound) you must

act the relieve the obstruction.

FBAOIf FBAO is mild, do not interfere. Allow the victim to clear the airway by coughing.If the FBAO is severe (victim unable to make a sound) you must

act the relieve the obstruction.• Responsive Pt:

• Ask to cough, and don’t interfere with their own actions to remove object (unless pt becomes unconscious. )

• Child: If pt unable to help himself assist by doing upwards abdominal thrusts.

• Infant: 5 back slaps, and 5 chest thrusts. • Unresponsive Pt:

• Being CPR regimen and every two minutes re-asses , see if you cant see FBAO

FBAO – UNRESPONSIVE • Start Chest Compression

• After 30 chest compressions open airway (NB look for object = FBAO)

• If you see a foreign body remove it

• DO NOT perform a blind finger sweep

• Give 2 breaths

• Followed by 30 chest compressions