Pediatric BLS

Purposees of guidelines

• Infant BLS : < 1 years

• Child BLS : > 1 years – puberty (breast develop in female , axillary in male)

• Adult BLS : > puberty

Topic reviewed in 2015

• C-A-B sequence

• New algorithms for 1 rescuer and multiple rescuer pediatric HCP

• Upper limit 6 cm for chest compression depth

• Chest compression rate 100 – 120 /min

• Confirm compression and ventilation are needed for pediatric BLS

High-quality CPR

• Ensuring chest compressions of adequate rate

• Ensuring chest compressions of adequate depth

• Allowing full chest recoil between compression

• Minimizing interruptions in chest compression

• Avoid excessive ventilation

BLS sequence for lay rescuer

• Safety of rescuer and victim• Assess need for CPR• Check for response : gently tap victim and ask loundly• Check for breathing

– Regular breathing -> recovery position– Not breath/grasping -> start CPR

• Start chest compression• Open the airway and give ventilations

– Head tilt –chin lift maneuver in injured/non-injured victim– Mouth to mouth and nose ->mouth to mouth -> mouth to nose

• Coordinate chest compression and breathing– Chest compression 30:2 breath

• Activated emergency response system – 2 resucer : 1 CPR , 1 activated emergency response system– 1 rescuer : CPR first -> activated emergency response system

BLS sequence for HCP

• Assess the need for CPR• Pulse check (10 sec)• Inadequate breathing with pulse -> give rescue

breaths at rate 12 – 20 breaths/min (3-5 sec/breath) + reassure pulse every 2 min

• Bradycardia with poor perfusion– HR < 60 bpm -> start CPR

• Chest compression – 1 rescuer : 2 finger chest compression– 2 rescuer : 2 thumb

• Ventilation– head tilt –chin life– Spine injury -> jaw thrust

• Co-ordinate chest compression and ventilation (minimal interruptions)– Non-advanced airway

• 1 rescuer -> 30 : 2• 2 rescuer -> 15 :2

– Advanced airway : • Chest compression : 100 – 120 compression / 2 min• Ventilation : 8 – 10 breath / min = 6-8 sec/breath

BLS sequence for HCP

• Defibrillation : VF/pulseless VT ->manual defibrillation 2 J/kg -> 4 J/kg

• Defibrillation sequence using an AED• Breathing adjunts

– Barrier devices– Bag-mask ventilation(HCP)– Precaution : avoid excessive ventilation– 2-person Bag-mask ventilation– Gastric inflation and cricoid pressure– Oxygen : minimal FiO2 to keep O2sat 94%– O2 mask : non rebreathing mask with oxygen inflow 15 L/min– Nasal cannular : suitable for child with spontaneous breathing

BLS sequence for HCP

• Foreign-body airway bstruction

– Most common cause

• Infants : liquid

• Children : ballon , small objects and food

– S&S : sudden onset of respiratory distress with coughing , gagging , stridor or wheezing

– Relief of FBAO

• Infant : 5 back blow , 5 chest thrust

• Child : Heimlich maneuver

BLS sequence for HCP

• Trauma

– Anticipate airway obstruction

– Stop all external bleeding with direct pressure

– Suspect spine injury -> minimize motion of the cervical spine and movement of the head and neck

BLS sequence for HCP

BLS – single rescuer

Multiple rescuer