Paediatric

Basic Life SupportEDUCATION & TRAINING DIVISION

SRI LANKA COLLEGE OF PAEDIATRICIANS

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Basic life supportObjectives

To understand the structured approach to basic life support

To learn the sequence of basic life support

To describe the skills to be acquired

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Basic Life SupportObjectives

Anybody who knows how to do it

Anywhere

Immediately

No Equipment

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3

Basic Life SupportObjectives

To restore the circulation of oxygenated blood after a sudden pulmonary and/or Cardiac arrest

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Infant / Child

Newborn

Infant – one month to one year

Child – one year to “puberty”

If you think it’s a child, it’s a child

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Basic life supportPriorities

Airway

Breathing

Circulation

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Basic life supportDRS approach

Dangers !

Scene safety 11-Dec-19

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Basic Life Support

Dangers – Your Personal Protection

• Gloves

• Masks

• Goggles

• Aprons

• Boots

• Pocket mask

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Basic life supportDRS approach

Check for responsiveness

Stabilize the head

Shake from the shoulder

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Basic life supportDRS approach

Call for help

Anybody to help me please !

Call 1990 11-Dec-19

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Basic life supportHead Tilt & Chin lift

One hand on the forehead

Finger tips of the other hand on the chin

Don’t touch the soft tissue 11-Dec-19

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Basic life supportHead Tilt & Chin lift

1 year – sniffing position

Head slightly extended position

< 1 year – Neutral position

Ears parallel to the floor

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Basic life supportCheck for airway opening

Look – for chest expansion

Listen for Breath sounds

Feel for Breaths 11-Dec-19

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Basic life supportAirway – jaw thrust

< 1 year – Neutral > 1 year – sniffing position

Life the angle of the jaw 90 degrees up

without changing the position of the patient

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Basic life supportCheck for airway opening

Look – for chest expansion

Listen for Breath sounds

Feel for Breaths 11-Dec-19

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Basic life support

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Normal Breathing – Yes Start on High Flow oxygen through NRBM

Basic life supportNormal Breathing – NO

Start on Exhaled Air Resuscitation Breaths

Mouth to Mouth Breathing

Two rescue breaths 11-Dec-19

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Basic life supportNormal Breathing – NO Resuscitation breaths

Above one year Pinch the nose Take a normal breath Place lips over the mouth Blow until chest rise Take about 1 second Allow chest to fall Repeat

2 Rescue Breaths

The use of protective

devices is recommended 11-Dec-19

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Basic life supportNormal Breathing – NO Resuscitation breaths

Under one year Cover both nose and mouth with your lips Take a normal breath Blow until chest rise Take about 1 second Allow chest to fall Repeat

2 Rescue Breaths

The use of protective devices is recommended11-Dec-19

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Basic life supportCirculation

Check pulse for 10 seconds

Above 1 year carotid

Under 1 year Brachial / Femoral

How long – maximum 10 seconds

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Basic life supportNo pulse – check for signs of life

• No breathing

• No coughing

• No movements

• No gagging

• Pale and mottled skin

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Basic Life Support Chest Compressions : Ventilation

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Basic life supportInfant chest compressions

Two fingers method

Hand encircling method

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Basic life supportChest compressions over 1 year

One hand or two hands

Use palm only

Fingers free

Elbows straight 11-Dec-19

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Basic Life Support

Chest Compressions : Ventilation

• 15:2 for all children

• Compression rate in all ages:

100 per minute

• Six cycles per minute

• Continue for one minute

Push hard ; Push fast

Depth 1/3 of chest diameter

Equal compression : Relaxation

Elbows straight

Make sure helper is arriving

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Ensure helper is arriving

equipment

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Basic Life Support + AED

• Continue chest compressions

• Insert an oral airway

• Attach the pads

• Start AED

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Some AEDs will automatically

switch themselves on when

the lid is opened

Follows voice

prompts 11-Dec-19

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Basic Life Support + AED

Continue Chest Compressions

Attach Pads To Casualty’s Bare Chest

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AED

• Analyzing rhythm

• Stop CPR

• Stay away

• Shock indicated

• Charging

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SHOCK INDICATED

DEFIBRILLATION

Stand clear

Deliver shock

(press shock button)

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SHOCK DELIVERED

Continue compressions : ventilation 15 : 2 for 2 minutes Follow the Instructions

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Continue BLS For 2 Minutes

Analysing Rhythm

Do Not Touch Victim

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Asystole

check leads are attached

PEA (EMD)

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NO SHOCK ADVISED

FOLLOW AED INSTRUCTIONS

Start CPR if no pulse felt

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If no pulse felt

Start CPR and continue CPR for 2 minutes

Asystole

check leads are attached

PEA (EMD)

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At the end of 2 minutes

Check pulse & Breathing

Pulse & Breathing Present

Stop CPR

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If Victim Starts To Breathe Normally Place in Recovery Position

• It ensures the tongue is held in forward position

• It reduces the chance of inhalation of any expelled gastric

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AED > 8 years

(Automated External Defibrillator)

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“

”Basic Life Support in Adults

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Compression rate : 100 per minute

30 compressions : 2 Breaths

Continue for one minute

Push hard ; Push fastDepth 4 – 5 cm Equal compression : RelaxationElbows straight

Switch CPR provider every 2 min cycle to avoid fatigue11-Dec-19

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Go on combining

30 chest compressions with 2 rescue breaths

Only stop when:

Professional help takes over

You are exhausted

The victim starts breathing normally

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Reversible causes

CORRECT REVERSIBLE CAUSES

•Hypoxaemia

Hypovolaemia

Hypo/hyperthermia

Hypo/hyperkalaemia & other

metabolic disorders

Tamponade

Tension pneumothorax

Toxins / Poisons / Drugs

Thrombus - pulmonary / coronary

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Post resuscitation care

The goal is to restore:

Normal cerebral function

Stable cardiac rhythm

Adequate organ perfusion

Quality of life11-Dec-19

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Airway and breathing

• Ensure a clear airway,• Oral airway • Adequate oxygenation • Ventilation

• Pulse oximetry: • Aim for SpO2 94 – 98%

• Capnography:• Aim for normocapnia• Avoid hyperventilation

• Insert gastric tube

• Secure airway for transfer

• Consider immediate extubation

• if patient breathing and conscious level

improves quickly after ROSC

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Circulation

• Pulse and blood pressure

• Peripheral perfusion e.g. capillary refill time

• Right ventricular failure

• Distended neck veins

• Left ventricular failure

• Pulmonary oedema

• ECG monitor and 12-lead ECG11-Dec-19

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Disability – Neurological assessment:

Glasgow Coma Scale score

Pupils

Limb tone and movement

Posture

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Further assessment

History

• Health before the cardiac arrest

• Time delay before resuscitation

• Duration of resuscitation

• Cause of the cardiac arrest

• Family history11-Dec-19

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Further assessment

Monitoring

• Vital signs

• ECG

• Pulse oximetry

• Blood pressure

• Capnography

• Urine output

• Temperature

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Transfer of the patient

• Discuss with admitting team

• Cannulae, tubes secured

• Suction

• Oxygen supply

• Monitoring

• Documentation

• Reassess before leaving

• Talk to family

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The choking child

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The choking childManagement

Finger sweep

Inspection under direct vision√

Back blows / chest thrusts √

Heimlich manouvre11-Dec-19

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The choking childThe choking infant

Back Blows Chest compressions

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Choking forein body airway obstruction in adults

Severe airway obstruction – conscious (unable to speak, to breathe,

to cough)

5 back blows

5 abdominal thrust

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Choking forein body airway obstruction

Severe airway obstruction – unconscious

Start CPR(even if the puls is present)

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BLS Summary

• DRS initial approach

• Airway opening manoeuvres

• Normal breathing?

• CPR

• Assess rhythm

• ALS Protocol

• Post-resuscitation care

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