Pediatric Basic Life Support Emergency pediatric – PICU division Pediatric Department Medical Faculty, University of Sumatera Utara H. Adam Malik Hospital

Pediatric Basic Life Support (BLS) should be part of Community efforts, include : Prevention Basic cardiopulmonary resuscitation (CPR) Access to EMS system (Emergency Medical Services) Pediatric Advanced Life Support (PALS) Pediatric Chain of Survival

Pediatric Chain of Survival Prevention Basic CPR Prompt access to EMS system Prompt PALS Pediatric Basic Life Support

Prevention Major causes of death in infants & children Respiratory failure Sudden Infant Death Syndrome (SIDS) prone sleeping position, sleeping on soft surface, second-hand smoke Sepsis Neurologic disease Injuries motor vehicle, bicycle, drowning, burn, firearm

Pediatric BLS Algorithm

Guidelines delineate a series of skills as a sequence of distinct steps, but they are often performed simultaneously (eg. starting CPR & activating the EMS system) Always make sure that the area is safe for you And victim

Check for Response (box 1) Responsive Check injuries Leave the child to phone EMS Return quickly and recheck condition frequently Allow the child to remain in position that is most comfortable

Unresponsive Position the victim supine (face-up) position on flat, hard surface (sturdy table, floor, ground) suspected trauma : minimize turning or twisting of the head and neck

Open the airway (box 3) A lay rescuer : head tilt-chin lift maneuver for both injured and noninjured A health care provider : head tilt-chin lift maneuver without evidence head or neck trauma; jaw thrust without head tilt,if suspect a cervical spine injury Use head tilt-chin lift maneuver if jaw thrust does not open the airway

Check breathing (box 3) No more than 10 seconds Look : rhytmic chest & abdominal movement Listen : exhaled breath sounds at nose & mouth Feel : exhaled air on your cheek Periodic gasping also called agonal gasp, is not breathing If the child is breathing & no evidence of trauma  recovery position

Recovery position

Give rescue breaths (box 4) Maintain an open airway and give 2 breaths Infant : mouth-to-mouth-and-nose technique Child : mouth-to-mouth technique Make sure that the breaths are effective (i.e the chest rises) If the chest does not rise, reposition the head, make a better seal, and try again

Pulse Check (for health care providers) (box 5) Try to palpate a pulse (brachial in an infant and carotid or femoral in a child) Take no more than 10 seconds If despite oxygenation & ventilation, the pulse is ‹ 60 beats/minute (bpm), and there are sign of poor perfusion (ie.pallor, cyanosis)  begin chest compression Pulse ≥ 60 bpm but not breathing, provide rescue breathing 12 to 20, without chest compression

Chest Compression (box 6) Infant : compress the sternum with 2 fingers, placed just below intermammary line or 2 thumb-encircling hands technique (2 rescuers) Child : the heel of 1 hand or with 2 hands on lower half sternum but not over xiphoid or ribs Good compressions : - “push hard” : 1/3 to 1/2 to AP chest-diameter - “push fast” : ± 100 compressions/minute - Release completely to allow chest to fully recoil - Minimize interruptions in chest compressions

Two-finger chest compression technique in infant (1 rescuer)

Two thumb-encircling hand chest compression in infant (2 rescuer)

Coordinate Chest Compressions and Breathing (box 6) 1 rescuer = compressions : ventilations = 30 : 2 2 rescuer = compressions : ventilations = 15 : 2 Do not ventilate & compress the chest simultaneously with either mouth-to-mouth or bag mask ventilation The compressing rescuer should deliver 100 compressions per minute continuously without pauses ventilation

Activate the EMS System and Get the AED (box 7) Lone rescuers : perform CPR for 5 cycles (about 2 minutes) before activating EMS, then start CPR again with as few interruptions of chest compressions as possible ›1 rescuer : 1 rescuer begin CPR as soon as infant or child unresponsive, 1 rescuer should activate the EMS system and get an AED

Defibrillation (box 8) AED’s can be safely and effectively used in children 1 to 8 years of age VF and pulseless VT are referred to as “ shockable rhythms” because they respond to electrical shock (defibrillation)

Foreign-Body Airway Obstruction > 90% of deaths from FBAO in children <5 years Sign of FBAO - sudden onset of respiratory distress with coughing, gagging, stridor, or wheezing - Characteristics that distinguish FBAO from other causes (eg.croup) sudden onset in a proper setting & the absence of antecedent fever or respiratory symptoms

FBAO may cause mild or severe airway obstrusction - can cough & make some sounds - do not interfere - Allow the victim to clear the airway by coughing while you observe for signs of severe FBAO Severe : - cannot cough or make any sound - child : perform subdiaphragmatic abdominal thrust (Heimlich maneuver) untill the object expelled or the victim become unresponsive - Infant : deliver 5 back blows (slaps) followed by 5 chest thrust

Unresponsive Perform CPR but should look into the mouth before giving breaths Foreign body (+)  remove it Should attempt to remove an object only if they can see it in the pharynx

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