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European Resuscitation Council
Summary
Causes of cardiorespiratory arrest
BLS sequence in paediatrics
AED in children
Foreign body airway obstruction relieve
BLS
Recognition of a person in cardiac or
respiratory arrest
Delivery of oxygen to vital organs by CPR
Without the use of adjuncts
Paediatric cardiorespiratory arrest
Secondary to hypoxia, acidosis,
inappropriate perfusion
Terminal Rhythm: Bradycardia, Pulseless
Electrical Activity → Asystole
Out-of-hospital arrest is « hypoxic and
hypercapnic with respiratory arrest
preceding asystolic cardiac arrest»
Comparison with adult arrest
Ventricular Fibrillation in children is more
rare than in adult
6-9% to 15-24% (SIDS excl) of cardiac arrest
Secondary to metabolic anomaly : 4H/4T
Hypothermia
Hypoxia
Hyper/hypokalaemia
Hypovolaemia
Tamponade
Toxics - drugs
Thrombo-embolism
Tension-pneumothorax
Activation of the EMS system
In child less than 8 years
All: Drowning, Trauma, Poisonning
Single rescuer summons help (EMS)
after one minute of BLS
“call fast”
Activation of the EMS system
In child older than 8 years
All: Witnessed sudden collapse,
Known cardiopathy
Single rescuer summons help (EMS)
immediately to provide rapid access
to AED
“call first”
Safety
Ensure rescuer’s safety first
Then ensure victim’s safety (even
trauma)
Use barrier devices (infectious diseases)
Look for clues of what has caused the
emergency
Stimulate
Establish responsiveness
Never shake a child
Tactile stimulation
• Maintaining C-spine (stabilise forehead)
• Shake arm or tug hair
Verbal stimulation
• Child’s name
• “Wake up”
• “Are you alright”
Shout for assistance
Single rescuer: shouts for help while
remaining with the child and starts CPR
Multiple rescuers: one rescuer provides
BLS while one rescuer activates EMS
system
Airway
To open the airway, lift the tongue that occludes
the AW by
Head tilt-chin lift
Neutral position
More head extension
Airway
To open the airway, lift the tongue that occludes
the AW by
Jaw thrust
Checking the airway
Look into the mouth
Ensure no foreign body is present
Remove with ONE gentle finger sweep
Avoid blind finger sweep
(further impaction, soft tissue damage)
Breathing
Check breathing: Look, Listen, Feel
For up to10 seconds
If the child
Is breathing spontaneously and effectively
Maintain AW
Summon help
Place in recovery
position
Has no detectable,
spontaneous, effective
breathing
Deliver rescue breaths
Rescue Breaths
Deliver up to 5 breaths to ensure 2
effective
Slow breath : 1 to 1.5 second each
Minimise gastric distension
Optimise oxygen delivered
Deep rescuer’s breath between each rescue breath
Optimise amount of oxygen
Minimise amount of expired CO2
Rescue Breaths
Mouth-to-mouth and nose technique
Rescue Breaths
Mouth-to-mouth technique
Circulation
Assess for signs of circulation
For up to 10 seconds
Pulse
Brachial or femoral pulse in infant
Carotid pulse in child
Signs of life
Cough
Movement
Normal breathing (no gasp)
If signs of circulation are
Found
Reassess breathing
Give rescue breaths
(20 cpm)
Reassess
Absent or pulse is very
slow + poor perfusion
Deliver external chest
compression
Depress 1/3 to ½ of A/P Ø
thorax
Rate : 100/min (actual 60-80
min)
Ratio : 5 compressions for
1 rescue breath
Circulation
ECC in Infant
Two-fingers technique
Two-thumbs technique
Circulation
ECC in Child < 8 years
Circulation
ECC in Child > 8 years
Ratio 15:2
Reassess
ECC produces a palpable central pulse
Reassess briefly after one minute and
summon help
Continue CPR non-stop
Activate EMS System
Take the child with you to continue CPR
Informations
Detailed location, phone number
Type of accident, number and age of
victims
Severity and urgency (ALS)
Confirm reception of message
Duration of CPR
ROSC and spontaneous respiration
Qualified team arrives
Rescuer exhausted
Automated External Defibrillator
(AED)
Evaluates the victim’s ECG
Determines if a “shockable”
rhythm is present
Charges the “appropriate” dose
When activated by operator,
delivers a shock
Provides synthesised voice
prompts to assist the operator
AED in children?
Class Indeterminate recommendation in children < 8 years
Recommended (Class IIb) for children older than
8 years in the pre-hospital setting (ILCOR 2000)
Most arrests in young children are of respiratory origin
In this class of age arrests rhythms are mainly
asystole and PEA
VF may occur in up to 25% of cardiac arrest when
SIDS are excluded
Prompt defibrillation is the definitive treatment for VF
and pulseless VT
CPR remains the most important step of Paeds-BLS
Recommendation (Circulation 2003; July)
ILCOR consensus statement for AED in children
May be used for children 1-8 years of age with no
signs of circulation
Should deliver a child dose
Arrhythmia detection algorithm with high specificity
for paediatric shockable rhythms (i.e not recommend shock
delivery for non-shockable rhythms)
Insufficient evidence to support recommendation for
or against the use of AEDs in children < 1 year of age
For single rescuer, 1 minute of CPR before any other
action (i.e. activating EMS or AED attachment)
Defibrillation is recommended for documented
VF/pulseless VT. (Class I)
FBAO in conscious victim
Assess Airway
5 Chest
Thrusts
INFANT
5 Back
Blows
Assess Airway
Assess
breathing
adequacy
If conscious
level
deteriorated
Unconscious
FBAO
Algorithm
CHILD
5 Back
Blows
5 Abdominal
Thrusts
FBAO in unresponsive child
Unconscious Victim
Attempt
5 Rescue
Breaths
Open
Airway
5 Back
Blows
Check
mouth
5 Chest
Thrusts
Unable to
achieve chest
movements on 5
attempts of
breaths
Attempt
5 Rescue
Breaths
Open
Airway
5 Back
Blows
Check
mouth
5 Chest
thrusts
5
Abdominal
Thrusts
Recovery position
To avoid the back-fall of the tongue in the
pharynx and hence obstruction of AW
To avoid risk of aspiration of vomit,
secretions…
Recovery position
Principles
As near a true lateral position as possible
Patent airway maintained
Child easily observed and monitored
Child stable cannot roll over
Free drainage of vomit/secretion
No pressure on chest (impeding breathing)
Can be turn easily on their back for BLS
Conclusions
We discuss about…
• Results of BLS
• Sequence of Paeds-BLS
• Use of AED in children
• FBAO