PEDIATRIC BASIC

LIFE SUPPORT

Department of Child Health

Faculty of Medicine Padjadjaran University
Hasan Sadikin General Hospital Bandung
 2010

2005
2015
IHCA and OHCA chain of survival
 CPR
sequences
Continue 2010
recommendation
C-A-B instead
A-B-C
 Specific techniques are required

 Varied according to the size of the child

 Rescuer can support the vital respiratory

and circulatory functions of a collapsed
child with no equipment
Safety of Rescuer and Victim

 Always make sure that the area is safe for

you and the victim

 Move a victim only to ensure the victim’s

safety
ASSESMENT AND TREATMENT

 The SAFE approach

Shout for help
Approach with care
Free from danger
Evaluate ABC
Overall Sequence of Basic Life Support in
Pediatric Cardiopulmonary Arrest
1. Check for response
2. Shout for help
3. Position the victim
4. Open the airway
5. Check breathing and give rescue breath
6. Check pulse and give chest compression
Major Changes Pediatric Basic Life Support
(AHA,2010)
• Change in CPR sequence (A-B-C  C-A-B)
• Modification of recommendations regarding
adequate depth of chest compression
• Removal look, listen, and feel for breathing
from the sequences
• Use of AED
 Issues in 2015 pediatric BLS
 Pediatric BLS Healthcare Provider Cardiac
Arrest Algorithms for a single rescuer and
for 2 or more rescuers
 The sequence of compressions, airway,
breathing (C-A-B) versus airway, breathing,
compression (A-B-C)
 Chest compression rate and depth
 Compression-only (Hands-Only) CPR
Key Actions in Pediatric BLS

1. Verify scene safety

2. Determine unresponsiveness,
get help, and activate
emergency medical services
(EMS)
3. Initiate cardiopulmonary
resuscitation (CPR)
Algorithms
 For 1 and 2 person healthcare provider
CPR have been separated to better guide
rescuers through the initial stage of
resuscitation
 Cellular telephones can allow a single
rescuer to activate the emergency
response system while beginning CPR
 Continue to emphasize for obtaining an
AED quickly
Pediatric Basic
Life Support
Update 2015
Algorithm
for single
rescuer
Chest Compression Depth
 2010 - 2015 To achieve effective chest
compression at least 1/3 of the anteroposterior diameter
of the chest  4cm (1,5 inches) in most infant and 5cm
(2 inches) in most children

 2005 Push with sufficient force to depress the chest

1/3-1/2 anteroposterior diameter of the chest

 Why Evidence from radiologic studies  compressin

to ½ anteroposterior diameter may not be achievable
Look, listen and feel
 2010 Look, listen, feel was removed from the
sequence for assessment of breathing after opening the
airway

 2005 Look, listen, feel was used to assess breathing

after the airway was opened

 Why With the new chest compression first sequence,

CPR is performed if the child or infant is unresponsive
and not breathing (gasping) and begins with
compression
Check for Response

 Simple assessment of responsiveness

 Asking and gently shaking by the shoulders,
“Are you okay?”
 Call the child’s name if you know it
 In case associated with trauma, the neck and
spine should be immobilised
 Placing on hand firmly on the forehead, while
one of the child’s arm is shaken gently
Shout for help and start CPR

 If the child is unresponsive and is not

moving

 Shout for help and start CPR.

Position the Victim

 If the victim is unresponsive, make sure

that the victim is in a supine (face-up)
position on a flat, hard surface such as a
sturdy table, the floor, or the ground

 If you must turn the victim, minimize turning

or twisting of the head and neck
Open the Airway
unresponsive airway has been blocked
by tongue falling back to obstruct the
pharynx

HEAD TILT / CHIN LIFT MANEUVER

Head Tilt–Chin Lift Maneuver

 If the victim is unresponsive and trauma is not

suspected
 open the child’s airway by tilting the head back and
lifting the chin
 Place one hand on the child’s forehead and gently tilt
the head back.
 At the same time place the fingertips of your other hand
on the bony part of the child’s lower jaw, near the point
of the chin, and lift the chin to open the airway.
 Do not push on the soft tissues under the chin as this
may block the airway.
HEAD TILT AND CHIN LIFT IN INFANT
HEAD TILT AND CHIN LIFT IN CHILDREN
If head tilt / chin lift not posibble
/ contraindicated

JAW TRUST MANEUVER

Jaw-Thrust Maneuver
 If head or neck injury is suspected
 use only the jaw-thrust method of opening the
airway
 Place 2 or 3 fingers under each side of the lower
jaw at its angle, and lift the jaw upward and outward
 Your elbows may rest on the surface on which the
victim is lying
 If a second rescuer is present, that rescuer should
immobilize the cervical spine
Jaw thrust for child victim
Spine immobilization with airway opening
in child with potential head and neck trauma
Foreign body airway obstruction
 Cross finger maneuver to check any obstruction
 Finger sweep to remove any foreign subject
found in the victim’s mouth

WARNING
 Do not use the finger sweep technique if the casualty is
conscious
 The finger sweep can trigger a conscious casualty's "gag
reflex" and cause him to vomit.
 A. Cross finger
E. Finger Sweep

E
 Relief of FBAO

 FBAO  cause mild or severe airway obstruction.

 When the airway obstruction is mild  the child can cough
and make some sounds.
 When the airway obstruction is severe  the victim cannot
cough or make any sound.

● If FBAO is mild  do not interfere

Allow the victim to clear the airway by coughing while you
observe for signs of severe FBAO.
● If the FBAO is severe  the victim is unable to make a sound
Foreign body airway obstruction

 If can’t seen, remove by performing:

back blow or chest thrust x 5 (infant)
Heimlich or abdominal thrust X 5 (children)
Infant back blows to relieve
complete FBAO
Infant chest thrust to relieve
complete FBAO
Heimlich Maneuver
Abdominal thrusts performed
for supine, unresponsive child
Check Breathing
 While maintaining an open airway, take no more
than 10 seconds to check whether the victim is
breathing
 Look for rhythmic chest and abdominal movement,
 Listen or exhaled breath sounds at the nose and
mouth
 feel for exhaled air on your cheek.
 Periodic gasping,also called agonal gasps, is not
breathing
Look, Listen and Feel
Breathing

 If airways opening technique not result in

resumption of adequate breathing within 10
seconds exhaled air resuscitation

Up to five initial rescue breaths should be given

to achieve two effective breaths
Breathing
 The rescuer breathes in and seals around
the victim’s mouth and nose
 If the mouth alone is used then the nose
should be pinched closed using the thumb
and index finger
 Slow exhalation : 1 – 1.5 seconds
 Should take a breath between resque
breaths
Mouth-to-mouth-and-nose breathing
for small infant victim
Mouth-to-mouth breathing for
child victim
General guidance for exhaled
air resusitation:

 The chest should be seen to rise

 Slow breath at the lowest pressure reduce
gastric distension
Pulse Check (Circulation)

Palpate a pulse:

 brachial in an infant
 carotid or femoral in a child
 Take no more than 10 seconds
Brachial pulse check in infant
Carotid pulse check in child
Circulation

Start chest compression if:

- No pulse or not sure

- Slow pulse (< 60 bpm) with sign of poor
perfusion (pallor, cyanosis)
characteristics of good
compressions:
 “Push hard”: push with sufficient force to depress
the chest approximately one third to one half the
anteriorposterior diameter of the chest.
 “Push fast”: push at a rate of 100 compressions
perminute.
 Release completely to allow the chest to fully recoil.
 Minimize interruptions in chest compressions
 Avoid exessive ventilation
INFANT

 Area compression : line between nipples

and compressing over the sternum one
finger breadth below this line

 Two finger technique

 Hand-encircling (two thumb) technique
Two-finger chest compression
technique in infant
Two thumb–encircling hands
chest compression technique in infant
In a child:

 should compress the lower half of the

sternum with the heel of 1 hand or with 2
hands (as used for adult victims)

 but should not press on the xiphoid or the

ribs.
One-hand chest compression
technique in child
Two-hand chest compression
technique in child
CARDIOPULMONARY RESUSCITATION

 For 1-rescuer should perform chest

compression-ventilation ratio (30:2)

 For 2-rescuers should perform chest

compressions while the other maintains the
airway and performs ventilations at a ratio
of 15:2 with as short a pause in
compressions as possible
After 5 cycles (about 2 minutes).
 Evaluate :
Pulse
Breath
Consciousness
Color
Pupil
If no pulse or
pulse less than 60 bpm
Continue CPR
 If the pulse is > 60 bpm but there is no spontaneous
breathing or inadequate breathing
 give rescue breaths at a rate
 12 to 20 breaths per minute
(1 breath every 3–5 seconds)
until spontaneous breathing resumes
 Give each breath over 1 second.
 Each breath should cause visible chest rise.