Paediatric Basic Life Support

&
Choking Guidelines
1 February 2014
Background
Cardiorespiratory arrest is much less common in children
than in adults and providers who are not specialists in
paediatric practice will manage most cases initially.

There are distinct differences between the arrest of cardiac
origin, seen predominantly in adults, and the asphyxial arrest,
which occurs commonly in children.

Therefore, a separate paediatric algorithm is justified for
healthcare professionals who have a duty to respond to
paediatric emergencies and who are in a position to receive
enhanced training.
2 February 2014
Age Definitions
A newborn is a child just after birth.

A neonate is a child in the first 28 days of
life.

An infant is a child under 1 year.

A child is between 1 year and puberty
3 February 2014
Check for Signs of life =
A Check airway for signs or risk of any
airway obstruction
B Check for normal breathing pattern, if
in any doubt assume they are not
breathing.
C Check pulse, assess general colour,
and perfusion
D Monitor for changes in conscious level
E Can you see any obvious major
injuries that require prompt treatment
4 February 2014
Infant BLS - Initial approach
Ensure safety
Check responsiveness
gently stimulate the infant
ask loudly Are you alright
DO NOT shake an infant
Shout for help
Look for any signs of airway obstruction
and remove (DO NOT PUT FINGER IN
MOUTH)
5 February 2014
Infant Airway
Open airway
head tilt/chin lift neutral position ears in
line with shoulders.
gently tilt head using hand on forehead
simultaneously lift chin with fingertip(s) under
point of chin
TAKE CARE not to push on soft tissues under
the chin

6 February 2014
AIRWAY
7 February 2014
Assessing breathing - Infant
Keep airway open
Look, listen and feel & look for signs of life
you will see abdominal movement if an infant is
breathing
Assess for 10 seconds
If not breathing normally
commence rescue breathing.
If he/she is breathing normally
- Place in the recovery position, check ABCDE, send or
go for help
8 February 2014
Assess Breathing- Infant
9 February 2014
Rescue breaths - infant
Ensure head tilt/chin lift
Carefully remove any obvious airway obstruction
Cover mouth and nasal aperture of infant with
your lips
Blow steadily for 1-1
1
/
2
seconds watching for
chest to rise
Maintain head tilt/chin lift and take mouth away,
watch for chest to fall
Repeat 5 times whether effective or not

10 February 2014
Rescue breathing - Infant
11 February 2014
Use of pocket masks in infants
To ensure an adequate
seal around the mouth
and nose of infants
(and small children)
the pocket mask
should be placed
upside down with
apex over the chin,
and the oxygen
port at the
forehead.
12 February 2014
Circulation - Infant
Look for signs of life
Check for a pulse for 10 seconds
Infant - brachial pulse on the inner aspect of
the upper arm
Infants with a very slow pulse rate (<1 per second or
60per minute)
Watch for any movement, including swallowing or
breathing (other than an occasional gasp i.e.
gagging/coughing)
If there are no other signs of life, you should only
withhold CPR if certain that there is a DEFINITE PULSE

13 February 2014
Chest compression- Infant
Start chest compression 15
compressions
Locate sternum
To avoid compressing the upper abdomen,
locate the xiphisternum by finding the
angle where the lowest ribs join in the
middle. Compress the sternum one
fingers breadth above this.

14 February 2014
Chest compression - Infant
Press vertically downwards with two
fingers on sternum to depress to at least
1/3rd of the depth of the chest
Release pressure
Repeat at a rate of at least 100/min no
more than 120/min.
After 15 compressions give 2 ventilations
Combine ventilations and chest
compression at a ratio of 2:15

15 February 2014
Chest compression - Infant
Infant landmark for
chest compression
A/ Find the angle
where the lowest
ribs meet in the
middle
B/ 1 fingers breadth
above this line
C/ Apply tips of two
fingers
16 February 2014
Compressions - Infant
A
B
C
17 February 2014
Getting help
It is essential to get help as soon as possible when a child
collapses
With two rescuers
one should go for help
one should begin resuscitation 2:15
Lone rescuer
undertake about 1 minute of resuscitation (4 cycles of 2:15)
then go for help (it may be possible to take a small child or infant
with you)
When making the telephone call indicate that it is an infant
and that you require the appropriate arrest team & equipment
18 February 2014
DO NOT STOP
Once basic life support has commenced
do not stop unless the victim shows signs
of regaining consciousness:
Coughing
Opening eyes
Speaking
Moving purposefully
Starts breathing

19 February 2014
Stopping resuscitation
Infant show signs of recovery

Qualified help arrives

You become exhausted
20 February 2014
Recovery position
Principles
should be as close to a true lateral position as possible
mouth should be dependent
stability may require support of pillow or rolled blanket
avoid any pressure on chest so as not to restrict
breathing
should be possible to return to back or side easily and
safely
always pay particular regard to possibility of cervical
injury
good observation and access to airways should be
possible
Can hold the baby in position if preferred (see next
slide)
21 February 2014
Holding in recovery position
22 February 2014
Choking protocol
Choking in infants and children happens
usually when they are conscious.

A rapid response will help prevent a
cardiac arrest.

23 February 2014
Infant Choking
SHOUT FOR HELP, and determine
conscious level
If the child is conscious but has absent or
ineffective cough give back blows
If back blows ineffective give chest thrusts

24 February 2014
Infant Back Blows
Turn the infant head down supporting the
chin.
Place the heel of your hand between the
shoulder blades.
Carry out up to 5 back slaps.
If the obstruction is expelled before the 5
are completed stop at that point and
reassess the airway and breathing.
25 February 2014
Infant Back Slaps
26 February 2014
Infant Chest Thrusts
If the back slaps are unsuccessful move
straight to chest thrusts.
Turn the infant over and support the head
and as with chest compressions place two
fingers on the sternum.
Compress the chest up to 5 times.
These are similar to chest compressions,
but sharper in nature and delivered at a
slower rate

27 February 2014
Infant Chest Thrusts
28 February 2014
Infant Choking 1
After chest thrusts, reassess
consciousness of the infant
If the object has not been expelled and the
victim is still conscious, continue the
sequence of 5 back blows and 5 chest
thrusts reassessing after each cycle
Send for help if still not available, DO NOT
leave the infant at this stage
29 February 2014
Infant Choking 2
If the infant is or becomes unconscious
place them on a firm flat surface, open
mouth and look for visible object
Open the airway and attempt 5 rescue
breaths
After 5 attempts (successful or not)
commence chest compressions
Continue at 2:15 for 1 minute before
summoning help
30 February 2014
Child Basic Life Support
Ensure safety
Check responsiveness
gently stimulate the child by stabilising the head and
shaking
ask loudly Are you alright
DO NOT shake a child with suspected neck injuries
Shout for help
Look for any signs of airway obstruction and
remove (DO NOT DO A BLIND FINGER
SWEEP)
31 February 2014
Airway - Child
Open airway
head tilt/chin lift into the sniffing position
if possible with child in the position found
gently tilt head using hand on forehead
simultaneously lift chin with fingertip(s) under
point of chin
TAKE CARE not to push on soft tissues under
the chin
in case of difficulty gently turn onto back and
open airway

32 February 2014
Assessing breathing - Child
Keep airway open
Look, listen and feel
10 seconds

If not breathing normally
commence rescue breathing

If he/she is breathing normally
- Place in the recovery position, check
ABCDE, send or go for help
33 February 2014
Rescue breathing - child
Ensure head tilt/chin lift
Pinch soft part of nose
Open mouth a little
Place lips round mouth ensuring a good seal
Blow steadily for 1-1
1
/
2
seconds watching for
chest to rise
Maintain head tilt/chin lift and take mouth
away, watch for chest to fall
Repeat 5 times whether effective or not
34 February 2014
Rescue Breathing - Child
35 February 2014

Pocket mask use in Children
Place upside down
(see slide 11)
If it is difficult to get a
seal (air leakage
around the mask) the
face mask can be
placed the same as in
adults.
36 February 2014
Circulation - Child
Check the pulse
For 10 seconds
CHECK THE CAROTID PULSE
Watch for any movement, including
swallowing or breathing (other than an
occasional gasp i.e. coughing/gagging)
If there are no other signs of life, you
should only withhold CPR if certain that
there is a DEFINITE PULSE
37 February 2014
Chest compression
No signs of circulation
Unsure about circulation

Start chest compression
Combine rescue breathing and chest
compression at a ratio of:
2 :15 in a small child
2:15 in a large child
38 February 2014
Chest compression - child
To avoid compressing the upper abdomen, locate the
xiphisternum by finding the angle where the lowest ribs
join in the middle. Place the heel of one hand one
fingers breadth above this.
DO NOT place on or below the xiphisternum
Lift fingers away from chest
Press down on sternum to depress to at least 1/3rd of
the depth of the chest
Release pressure
Repeat at a rate of at least 100/min, no more than
120/min
After 15 compressions repeat 2 ventilations
Continue at a rate of 2:15

39 February 2014
Small Child Chest Compressions
1 fingers breath
above the
xiphisternum
40 February 2014
Getting help
It is essential to get help as soon as possible when a child
collapses
With two rescuers
one should go for help
one should begin resuscitation 2:15
Lone rescuer
undertake about 1 minute of resuscitation (4 cycles 2:15)
go for help (it may be possible to take a small child or infant with you)
When making the telephone call indicate that it is a child and
that you require the appropriate arrest team & equipment.

41 February 2014
Stopping resuscitation
Child show signs of recovery

Qualified help arrives

You become exhausted
42 February 2014
Recovery position
Principles
should be as close to a true lateral position as possible
mouth should be dependent
stability may require support of pillow or rolled blanket
avoid any pressure on chest so as not to restrict breathing
should be possible to return to back or side easily and safely
always pay particular regard to possibility of cervical injury
good observation and access to airways should be possible
43 February 2014
Recovery Position
CHILD
44 February 2014
Child Choking
SHOUT FOR HELP, and determine
conscious level
If cough effective, encourage cough and
monitor
If the child is conscious but has absent or
ineffective cough give back blows
If back blows ineffective give abdominal
thrusts

45 February 2014
Child Back Blows
Turn the Child head down over your knee.
Place the heel of your hand between the
shoulder blades.
Carry out up to 5 back slaps.
If the obstruction is expelled before the 5
are completed stop at that point and
reassess the airway and breathing.
46 February 2014
Child Back Blows
47 February 2014
Child Abdominal Thrusts
Abdominal thrusts should be used only in
children over 1 year old
They can be carried out when the child is
standing, sitting, kneeling or lying.
A maximum of 5 abdominal thrusts should
take place.

48 February 2014
Abdominal Thrusts
If back blows fail - stand behind the child
Lean child forwards
Form a fist with one hand, placing it
between umbilicus and xiphisternum
Grasp it with the other, encircling the patient
Pull sharply inwards and upwards
Repeat up to 5 times, or till obstruction
relived
If child is lying down the manoeuvre can be
done by placing the heal of a hand between
umbilicus and xiphisternum and pushing
down and up towards costal margin
49 February 2014
Child choking 1
After abdominal thrusts, reassess the child
If the object has not been expelled and the
victim is still conscious, continue the
sequence of back blows and abdominal
thrusts, reassessing after a sequence
Send for help if still not available, DO NOT
leave the child at this stage

50 February 2014
Child Choking 2
If the child is or becomes unconscious
place them on a firm flat surface, open
mouth and look for visible object
Open the airway and attempt 5 rescue
breaths
After 5 attempts (successful or not)
commence chest compressions
Continue at 2:15 for 1 minute before
summoning help

51 February 2014
Resource material
Resuscitation Council - Pediatric BLS web
pages
http://www.resus.org.uk/pages/pbls.pdf


52 February 2014
HANDY HINTS infant only
If there are two or more
rescuers, you may use the
encircling technique to give
compressions
-Place both thumbs flat, side by
side, on the lower third of the
sternum
- Spread the rest of both hands,
with the fingers together, to
encircle the lower part of the
infants rib cage with the tips of
the fingers supporting the infants
back
- Press down on the lower
sternum with your two thumbs to
depress it approximately one-
third of the depth
53 February 2014
HANDY HINTS
CHILD CHEST COMPRESSIONS
- When to use two hands!?!
- If you are unable to compress the chest to one-
third depth, you will need to use two hands.

Lone rescuers may use a ratio of 30:2,
particularly if they are having difficulty with the
transition between compression and ventilation

54 February 2014