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

2. 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

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

4. 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

5. Pediatric BLS
Algorithm

6. 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

7. 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

8. 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

9. 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

10. 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

12. Recovery position

13. 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

15. 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

16. 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

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

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

19. 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

20. 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

21. 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)

22. 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

23. 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

24. 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

27. Thank you