Bks

Copyright 2007 Seattle/King County EMS

The infant is lying still and has poor muscle tone.
He is irritable if touched, and his cry is weak. There
are no abnormal airway sounds, retractions, or
flaring. He is pale and mottled. The respiratory rate
is 30 breaths/min, heart rate is 180 beats/min, and
blood pressure is 50 mm Hg/palp. Air movement is
normal and breath sounds are clear to auscultation.
The skin feels cool and capillary refill time is 4
seconds. The brachial pulse is weak. His abdomen
is distended.
A young mother presents to the ED with a 6-
month-old boy who has had vomiting for 24 hours.

What are the key
signs of illness in
this infant?

General assessment
Initial assessment
Management actions
Severity assessment
Secondary assessment (focused history,
detailed physical exami-nation, pulse oximetry,
and specialized assessment procedures)
Further interventions
Reassessment
Transport
Documentation

What is a general assessment?
Formerly referred to as a first
impression,

a quick look to establish whether
there are significant life-threatening
problems that require immediate
interventions.

The initial assessment is a hands-on
examination of the ABCDEs (airway,
breathing, circulation, disability,
exposure).

It builds on information you gathered
during your general assessment.

Initial Assessment
The first stage of which is quick
screening (triage) to identify

those who need emergency treatment
those who are at special risk and should be
given priority
Or.... those who are non-urgent cases
Not SICK
SICK

Stable
potential unstable.
UnStable
Level 1 Resuscitative
Level 2 Emergent
Level 3 Urgent
Level 4 Less urgent
Level 5 Non-urgent

Why treat
children
differently?
ANAK BUKAN DEWASA KECIL
The key differences to consider in
children are:
1. Weight
2. Anatomical size and shape
3. Physiological cardiovascular,
respiratory, immune function
4. Psychological intellectual ability
and emotional response

Anatomical Differences
A childs anatomy differs in four significant
ways from an adults. They are:
Smaller airways
Less blood volume
Bigger heads
Vulnerable internal organs
Anatomical Differences, cont'd
Large tongue in relation to
a small oropharynx
Diameter of the trachea is
smaller
Trachea is not rigid and
will collapse easily
Back of the head is
rounder and requires
careful positioning to keep
airway open

smaller airway
Relatively smaller blood
volume

Approximately 70 cc of
blood for every 1kg (2 lbs)
of body weight

A 10 kg child has about
700cc of bloodabout the
volume of a medium sized
soda cup
smaller airway
less blood volume
Head size is proportionally
larger
Prominent occiput and a
relatively straight cervical
spine
Neck and associated
support structures arent
well developed
Infants and small children
are prone to falling
because they are top
heavy
less blood volume
bigger heads
smaller airway
Internal organs are not
well protected
Soft bones and cartilage
and lack of fat in the rib
cage make internal organs
susceptible to significant
internal injuries
Injury can occur with very
little mechanism or
obvious signs
bigger heads
internal organs
less blood volume
smaller airway
Infants less than 6 months old
are obligate nasal breathers.
As the narrow nasal passages
are easily obstructed by
mucous secretions

In 3- to 8-year-olds,
adenotonsillar hypertrophy may
be a problem. This not only
tends to cause obstruction, but
also causes difficulty when the
nasal route is used to pass
pharyngeal, gastric or tracheal
tubes.
The anatomy of
the airway itself
changes with age,
and consequently
different problems
affect different
age groups

The body surface area (BSA) to
weight ratio decreases with
increasing age.

Small children, with a high ratio,
lose heat more rapidly and
consequently are relatively more
prone to hypothermia.

At birth the head accounts for
19% of BSA; this falls to 9% by
the age of 15 years

The infant has a relatively
greater metabolic rate and
oxygen consumption. This is
one reason for an increased
respiratory rate.
However, the tidal volume
remains relatively constant in
relation to body weight (57
ml/kg) through to adulthood

Respiratory rate by age at rest
Age(Years) Respiratory rate/ MENIT
< 1 30 -40
1 - 2 25 -35
2 - 5 25 - 30
5 -12 20 - 25
>12 15 -20
Absolute size and relative body
proportions change with age.

Observations on children must be
related to their age.

Therapy in children must be related
to their age and weight.

The special psychological needs of
children must be considered.
Development Considerations
Infant: 1 to 12 months
Toddler: 1 to 3 years
Preschool Age: 3 to 5 years
School Age: 6 to 12 years
Adolescent: 12 to 15 years

PEMERIKSAAN
SULIT DILAKUKAN
KOMINIKASI SULIT
CENDRUNG KETAKUTAN
PENILAIAN KEGAWATAN
SULIT DILAKUKAN
You must recognize the SICK child within the
first minute of contact.
Much of the information you need to make a
decision can be obtained without touching
the patient.
PEDIATRIC ASSESSMENT TRIANGLE)
CIRCULATION

a rapid way to determine
physiologic stability
Pediatric Assessment Triangle
There are three elements that you need to
assess in a pediatric patient in order to
determine SICK or NOT SICK:
Appearance
Work of breathing
Circulation to the skin
These three clinical indicators reflect the
overall status of a childs cardiovascular,
respiratory and neurologic systems.
PAT, continued
Alertness
Distractibility
Consolability
Eye contact
Speech/cry
Spontaneous motor
activity
Color
airway
PAT, continued
Abnormal position
Abnormal breath sounds
Retractions
Nasal flaring
airway
work of breathing
PAT, continued
Color
Temperature
Capillary refill time
Pulse quality
airway
work of breathing
circulation
PAT,
Alertness
Distractibility
Consolability
Eye contact
Speech/cry
Spontaneous motor
activity
Color
airway
appearance
Muscle tone
Conciousnes
PAT,
Alertness
Distractibility
Consolability
Eye contact
Speech/cry
Spontaneous motor
activity
Color
airway

appearance
T I L C S
Element YANG DINILAI
TONE
Extremities movement
move spontaneously or not
Interactivity Alertness: Is the child alert and
attentive to surroundings
Consolability
restless/ AGITATION Does comforting by
the caregiver alleviate agitation and crying?
Look/Gaze
Do the childs eyes follow your movement and maintain
eye contact with objects or people, or is there a vacant
gaze?
Speech/Cry
Are vocalizations strong, or are they weak, muffled, or
hoarse?
A Child is Alert
V Child responds to Verbal stimulus
P Child responds to Painful stimulus
U Child is Unresponsive to any
stimulus

The AVPU
method

Visable Movement/Respiratory Effort
REFLEKSI GANGGUAN OKSIGENASI, VENTILASI
Abnormal airway sounds
Abnormal positioning
Retractions
Nasal flaring
PAT,
Abnormal
Increased excessive (nasal
flaring, retractions or
abdominal muscle use) or
decreased absent
respiratory effort
or noisy breathing.

work of breathing
PAT,
Normal:
Breathing appears
regular without
excessive respiratory muscle
effort or
audible respiratory sounds

work of breathing
Element
Explanation
Abnormal
airway sounds
Altered speech, stridor, wheezing
or grunting
Abnormal
positioning
Head bobbing, SNIFFING,
TRIPOTING,
Retractions
Supraclavicular, intercostal or
substernal retractions of the chest
wall
Flaring
Nasal Flaring
Characteristics of Work of Breathing
PAT,
Color
Temperature
Capillary refill time
Pulse quality
circulation
Inadequate perfusion of
vital organs leads to
compensatory
vasoconstriction in non-
essential anatomic areas,
especially the skin.

Therefore circulation to
skin reflects overall
adequacy of perfusion
Characteristic of
CIRCULATION TO SKIN
ELEMENT
Explanation
Pallor

White skin coloration from
lack of peripheral blood
Mottling

Patchy skin discoloration, with
patches of cyanosis, due to
vascular instability or
Cyanosis

Bluish discoloration of skin
and mucus
SIRKULASI KULIT
N
+
0
+ / 0
0
0
N
N
N
0
N/0
DISTRESS PERNAFSAN
GAGAL NAFAS
SYOK
GANGGUAN METABOLIK
GANGGUAN PRIMER SSP
Normal
Appearance
Increased
Work of Breathing
MEANS RESPIRATORY DISTRESS
Normal Circulation
MEANS RESPIRATORY FAILURE
Increased or
Decreased Work
of Breathing
Abnormal
Appearance
Normal circulation
Abnormal
Appearance
Poor Circulation to Skin

MEANS SHOCK
Poor Circulation to
Skin

Normal
Appearance
MEANS OBSERVE
Pediatric Primary Survey
After completing the Triangle, begin a more
complete pediatric primary survey.
A Airway
B Breathing
C Circulation
D Disability
E Exposure
Penilaian fisik
Evaluation of Respiratory
Performance
Respiratory Rate and Regularity
Level of Consciousness
Color of the Skin and Mucous
Membranes
Respiratory Mechanics
Head Bobbing
Nasal Flaring
Retractions
Grunting
Stridor
Wheezing or Prolonged Exhalation

LAJU/ FREKUENSI PERNAFASAN
RETRAKSI
STRIDOR INSPIRASI / EKSPIRASI
GRUNTING
PENGGUNAAN OTOT BANTU NAFAS
NAFAS CUPING HIDUNG
Gangguan pernafasan berat
Depresi SSP
Penyakit neuro muskular
Tidak bisa
dinilai pada
USAHA NAFAS/ KINERJA PERNAFASAN
BREATHING
FREKUENSI NAFAS
USIA (TAHUN) FREKUENSI/ MENIT
< 1 30 -40
2-5 20 - 30
5-12 15 - 20
>12 12 - 16
DIPENGARUHI DEMAM, NYERI, EMOSI/ TAKUT
FREK > 60 POTENSIAL GAGAL NAFAS
retraksi, kesadaran
World Health Organization criteria for the
diagnosis of tachypnoea
Age months Respiratory frequency
Breaths/min-1

< 2 month > 60
212 > 50
> 12

> 40

Respirations
Abnormal respirations are a common
sign of illness or injury.
Count respirations for 30 seconds.
In children less than 3 years, count the
rise and fall of the abdomen.
Note effort of breathing.
Listen for noises.
INTERPRETATION of BREATH SOUNDS
Sound Cause
Stridor Upper airway obstruction
Wheezing Lower airway obstruction
Expiratory
grunting
Inadequate oxygenation
Inspiratory
crackles
Fluid/mucus/blood in the
Absent breath
sounds despite
increased work of
breathing
Complete airway obstruction
(upper or lower airway)
Pleural fluid, consolidation,
or pneumothorax
STATUS KARDIO VASKULAR
EFEK PADA ORGAN LAIN
STATUS MENTAL
CIRCULATION

STATUS KARDIO VASKULAR
FREKUENSI DENYUT TAKIKARDI:TANDA HIPOKSIA,
PERFUSI BURUK ( demam, sakit,
takut
BRADIKARDI: HIPOKSIA, ISKEMIA
ISI DAN TEKANAN
(VOLUME NADI)
CAPILLARY REFIL NORMAL < 2 DETIK
TEKANAN DARAH
PRODUKSI URIN
HIPOTENSI : PRETERMINAL
1 2 cc/ kgBB/jam
Skin Signs
Feel for
temperature
and moisture.

Estimate
capillary refill.
FREKUENSI JANTUNG
TEKANAN SISTOLIK MINIMAL
70 + { 2 x umur (tahun) }
USIA FREKUENSI
< 3 bulan 85 - 200
3 bln 2 thn 100 - 190
3 10 tahun 60 -140
Pulse
In infants, feel over the brachial or femoral area.
In older children, use the carotid artery.

Count for at least 1 minute.
Note strength of the pulse.
STATUS NEUROLOGIK
A
ALERT
V
RESPONS TO VOICE
P
RESPONS TO PAIN
U
UN RESPONSIVE
A V P U
CARA CEPAT MENILAI KESADARAN
SKALA KOMA GLASGOW < 4 tahun
AKTIFITAS RESPONS NILAI
Buka mata Spontan
Karena suara
Karena nyeri
Tidak ada
4
3
2
1
Motorik Menurut perintah/spontan
Lokalisasi nyeri
Menarik karena nyeri
Fleksi karena nyeri
Ekstensi karena nyeri
Tidak ada
6
5
4
3
2
1
Lisan ( Verbal) Terorientasi,tersenyum
Menangis berhubungan
Menangis tdak konsistent
iritabel
Tidak ada
5
4
3
2
1
SKALA KOMA GLASGOW 4 15 tahun
AKTIFITAS RESPONS NILAI
Buka mata Spontan
Karena suara
Karena nyeri
Tidak ada
4
3
2
1
Motorik Menurut perintah
Lokalisasi nyeri
Menarik karena nyeri
Fleksi karena nyeri
Ekstensi karena nyeri
Tidak ada
6
5
4
3
2
1
Lisan ( Verbal) Terorientasi
Kacau/ bingung
Kata-kata tidak tepat
Suara tidak khas
Tidak ada
5
4
3
2
1
TINDAKAN LANJUT
MENERUSKAN RESUSITASI
PEMERIKSAAN /PEMANTAUAN
LEBIH LANJUT
MERUJUK
A young mother presents to the ED with a 6-
month-old boy who has had constant vomiting for
24 hours.

The infant is lying still and has poor muscle tone.
He is irritable if touched, and his cry is weak. There
are no abnormal airway sounds, retractions, or
flaring. He is pale and mottled. The respiratory rate
is 30 breaths/min, heart rate is 180 beats/min, and
blood pressure is 50 mm Hg/palp. Air movement is
normal and breath sounds are clear to
auscultation. The skin feels cool and capillary refill
time is 4 seconds. The brachial pulse is weak. His
abdomen is distended.
Respiratory Emergencies
Respiratory distress is a state where a child is
able to maintain adequate oxygenation of the
blood, but only by increasing his or her work
of breathing.

Respiratory failure occurs when a child
cannot compensate for inadequate
oxygenation and the circulatory and
respiratory systems begin to collapse.

Seizures
Seizures may be caused by:
Infection
Head trauma
Epilepsy
Electrolyte imbalance
Hypoglycemia
Toxic ingestion or exposure
Birth injury

Trauma
Use appearance, work of breathing and
circulation to the skin in your assessment.

Mechanism of injury may also play a
factor when deciding whether the child is
SICK or NOT SICK.
Drowning
The most important factors in drowning
are the duration and severity of hypoxia.

Restoring the ABCs is vital.

Hypothermia can occur in cold water
settings.
Burns
Check for possible involvement of the
airway.

Make a quick estimate of the burned
body surface area.

Take care to avoid further contamination
of burn injuries by wearing gloves and
carefully dressing the wounds.
82
Basic Life Support
Slide 83
S A F E approach
Shout for help
Aprroach with care
Free from danger
Evaluate ABC
Basic Life Support
Check for DANGER, stop and look
Check RESPONSE, verbal and tactile but
do not shake and shout
If conscious, assess carefully, patient may
still need urgent medical review

Continue to assess and manage
Airway
Breathing
Circulation

Slide 86
D
R
A
B
C
Slide 87
Basic Life Support Flowchart
Check for DANGER
Check for RESPONSE
CONSCIOUS
Make comfortable
Observe ABC
UNCONSCIOUS
Alert assistance
Clear airway
Apply head tilt and jaw support
Check for breathing
NOT BREATHING
2 rescue breaths
Check for pulse
Look for signs of life
BREATHING
Lateral position
Observe ABC
INADEQUATE PULSE
No signs of life
Commence CPR
Slide 88
Basic Life Support
Airway

Breathing

Circulation
Is The patient
able to
speak or cry ?

Airway Assessment
Slide 91
Observe for secretions and clear (suction)
Do not attempt a blind finger sweep
Open the airway
chin lift / jaw thrust
neutral position in infants
sniffing position in children

Slide 95
Airway Opening Manoeuvres
Chin lift/head tilt
Infants
Neutral head position
with chin lift
Smaller children
Sniffing position
with chin lift
Slide 96
Chin lift/head tilt

Older children/adults
Backward head tilt
with pistol grip
Slide 99
Jaw thrust
Jaw thrust
Use when concerned re
cervical spine injury
May also facilitate
bag and mask
ventilation
Slide 101
Foreign Body
Mild airway
obstruction
Effective Cough
Assess Severity
Severe airway
obstruction
Ineffective Cough
Unconscious
Call for
help
Commence
CPR
Conscious
Call for help
Give up to 5 back
blows
If not effective
Give up to 5 chest
thrusts
Encourage
coughing
Continue to check
victim until recovery
or deterioration
Call for help
Slide 102
Foreign Body
Assess Severity
Effective Cough
Mild airway
obstruction
Encourage coughing
Continue to check
victim until recovery or
deterioration
Call for help
Slide 103
Foreign Body
If there is an effective cough (mild
obstruction):
Encourage coughing
Continue to check victim until recovery or
deterioration
Call for help
Do not attempt any manoeuvres to remove
unless this is very easily done

Slide 104
Foreign Body
Assess Severity
Severe airway
obstruction
Ineffective Cough
Unconscious Conscious
Call for help
Commence CPR
Call for help
Give up to 5 back blows
If not effective
Give up to 5 chest
thrusts
Slide 105
Foreign Body
If there is an ineffective cough (severe
obstruction):
Unconscious
call for help, commence CPR
Conscious
call for help
give up to 5 back blows firm blows
between the shoulder blades using the heel
of the hand
Slide 106
Back blows infant

Back blows small child
Slide 107
Foreign Body
If 5 back blows unsuccessful:
Chest thrusts
identify same compression point as for CPR
give up to 5 chest thrusts
similar to compressions but sharper and delivered at a slower
rate
check to see if each thrust has relieved the airway obstruction
Infant
place in a head down supine position across rescuers thigh
Child/ older child / adult
may be placed in sitting or standing position
Note: this is not the same as a Heimlich manouvere this
manouvere is on the chest
Airway Adjuncts
Slide 109
Oropharyngeal Airways

Use: to keep the airway open in an unconscious patient
and to facilitate bag and mask ventilation
Use with caution
If airway is able to be maintained
with head positioning and jaw
support dont use an
oropharyngeal airway
Use of oropharyngeal airways:
size is imperative measure
from centre of teeth/mouth to
angle of the jaw layed across
the face
In the infant and small child
insert the concave side over
the tongue under direct vision.
This avoids damage to the
palate

Slide 110
Oropharyngeal Airways

Potential problems:
Trauma
Obstruction
Illicit a gag reflex
causing aspiration
Laryngospasm
Vagal response
Nasopharyngeal Airway
Slide 114
Basic Life Support
Airway

Breathing

Circulation
Evaluation of
Respiratory
Performance
Slide 116
Look, Listen & Feel
10 seconds
Breathing assessment
Respiratory Rate and
Regularity
Level of Consciousness
Color of the Skin and Mucous
Membranes

The Need for Oxygen
0 1 minute: cardiac irritability
0 4 minutes: brain damage not likely
4 6 minutes: brain damage possible
6 10 minutes: brain damage very likely
> 10 minutes: irreversible brain damage
Within few minutes of
non-breathing, the
patient will suffer
irreversible damage.
The etiology of CPA in
pediatric is asphyxial
rather than
cardiogenic.
Oxygen therapy is the
most important and
initial treatments of
the sick child.

Initial assesment of the sick
child
Breathin
g
No
efective
breathin
g
Airway
Maintain
able
Un
maintain
able
Bag
mask
ventil
ation
NIPP
V
Intub
ation
s
oxyge
n
Airway
adjunc
t
Simple mask
partial rebreathing mask
low flow
nasal cannula.
simple oxygen mask.
high flow:

nonrebreathing masks.
Venturi masks.
oxygen hoods
oxygen tents.
aspirationfsh.swf
Slide 130
Breathing
If breathing is absent or inadequate:
Give 2 rescue breaths allowing about 1
second per inspiration
Sufficient breath to achieve gentle rise
and fall of chest, this means
puffs for an infant
breaths for a child
full breaths for an older
child/adult
Slide 131
Bag and Mask
Correct mask size: cover mouth and nose only
Holding the mask: C-grip
C
Slide 132
Bag and Mask
a few technicalities...
Mask size
Bridge of nose to cleft of chin and sufficiently wide to cover
mouth
If too big you may get an air leak and also potential damage
especially with pressure applied to the eyes
Self inflating bag
Connect to oxygen 10L/Min
Once reservoir bag full, delivering 95-100% oxygen
Pressure release valve prevents too high pressure
Self-inflating, so can be used to deliver room air
Slide 133
Self Inflating Bag Sizes

Child (500ml) 2.5 25kg

Preterm
Infant
(240ml)
<2.5kg
Adult
(1600ml)
>25kg
Slide 134
Checking Self Inflating Bags
Check that the self inflating bag compresses and
reinflates quickly and air is felt from patient outlet
Check the one way valve opens when self inflating
bag is compressed
Occlude patient outlet with hand and compress bag,
listen for the pressure release value to release
Take off oxygen reservoir bag and place over the
patient outlet. Inflate the reservoir bag checking for
holes
Bag mask ventilation

Bag to Mask Ventilation
Slide 138
Cricoid pressure:
Place two fingers on the level of the cricoid cartilage and apply
pressure (gently!)
Closes the oesophagus and straightens trachea
Dont release pressure until instructed or if the
patient actively vomits
Monitor the Effectiveness of
Ventilation
Monitor the Effectiveness of
Ventilation
Visible chest rise with each breath.
Oxygen saturation.
Heart rate.
Blood pressure.
Distal air entry.
Patient response.
Copyright 2000 American Heart Association
Circulation 2000;102:253I--290I-
Bag-mask
ventilation
for child
victim
Contraindicated if
gag-reflex is intact

Higher success rate

Does NOT protect
from aspiration

Difficult to maintain
during transport
Slide 147
Basic Life Support
Airway

Breathing

Circulation
Color of skin and capillary
refill
Strength of peripheral
and central pulses
Skin temperature
Obtain vascular access
(set IV lines)
Initiate volume
replacement
Perform chest
compressions
Defibrillate or provide
synchronized cardioversion
Initiate drug therapy
PULSE Check
Take no more than 10
seconds
Cardiac output in infancy and childhood largely
depends on heart rate.
No scientific data has identified an absolute heart
rate at which chest compressions should be
initiated;
the recommendation to provide cardiac
compression for a heart rate <60 bpm with
signs of poor perfusion
Slide 151
Pulse Check
the smallprint
Do not check the pulse for longer than 10 seconds
If the patient shows no sign of life and a pulse cannot be
palpated in 10 seconds presume it to be absent!
Brachial is recommended in the infant as carotid pulse is
difficult to find and extension of the neck may compromise
the airway
Carotid pulse locate thyroid cartilage and feel to side, dont
feel too high due to the risk of inadvertently massaging the
carotid sinus, inducing bradycardia and hypotension

Locating and palpating carotid artery pulse
( > 1 year)
Locating and palpating brachial pulse
( < 1 year)
152
Slide 153
Look for signs of life

No signs of life =
unconscious
unresponsive
not moving
not breathing normally
No signs of life commence external cardiac
compressions

Slide 154
Circulation
Assess for pulse and
signs of life

If no pulse,
inadequate pulse or no
signs of life

commence ECC
CPR of the pediatric patient
155
PIJAT JANTUNG LUAR
If no pulse palpated,
begin
chest compression
157
Slide 158

Patient should be on a hard
surface eg. cardiac board
Rhythmic action, equal time for
compression and relaxation
Aim for a rate of 100
compressions per minute
Slide 159
CPR Ratio
CIRCULATION
Hand Position
Depth of
Compression
INFANT
1/3 depth of chest
OLDER
CHILD

30 compressions: 2 breaths
5 cycles / 2 min

SMALL
CHILD
Lower half of sternum
Ratio and Rate
1 rescuer
The ratio describes the number of
compressions in relation to breaths,
the rate is the number of
compressions/breaths given per
minute.
Ratio and Rate
2 rescuers
15: 2
5 cycles/min
30: 2
5 cycles/2 min
Slide 160
CPR Infant
Infant
Locate the lower half of the sternum
Two fingers one operator CPR
Two thumbs / two fingers if two operators
Ratio
Lone health care provider/ lay rescuer
30 compressions : 2 breaths (5 cycles per 2 minute)
Two health care providers
15 compressions : 2 breaths (5 cycles per 1
minute)
Aim for a rate of 100 compressions per
minute
Slide 161
CPR Infant
Finger/Thumb
position:
lower 1/2 of the sternum

Compression depth:
1/3 of the depth of the chest
Slide 162
CPR Ratio
CIRCULATION
Hand Position
Depth of
Compression
INFANT
1/3 depth of chest
OLDER
CHILD

5 cycles / 2 min

SMALL
CHILD
Ratio and Rate
1 rescuer
Ratio and Rate
2 rescuers
15: 2
5 cycles/min
30: 2
5 cycles/2 min
Slide 163
CPR Small Child
Child: Up to 8 years
Use the heel of one hand
Locate lower half of sternum
Ratio
Lone health care provider/ lay rescuer
Two health care providers
Aim for a rate of 100 compressions per minute

Slide 164
CPR Ratio
CIRCULATION
Hand Position
Depth of
Compression
INFANT
1/3 depth of chest
OLDER
CHILD

5 cycles / 2 min

SMALL
CHILD
Ratio and Rate
1 rescuer
Ratio and Rate
2 rescuers
15: 2
5 cycles/min
30: 2
5 cycles/2 min
Slide 165
CPR Older Child/Adult
Older child/adult i.e.>9years
Use two hands
Locate lower half of sternum
Ratio:
Lone health care provider/ lay rescuer or
two health care providers
30 compressions : 2 breaths (5 cycles per 2
minute)
Aim for a rate of 100 compressions per minute
Pressure is exerted through the heel of the hand,
with arm/s straight, using body weight as the
compression force
Slide 166
CPR
(Small and older child)
Compression depth: 1/3 of chest
CPR older child/ adult
1/3
CPR small child
Slide 167
CPR
ARC recommend minimum interruptions of
ECC and CPR should not be interrupted to
check for signs of life
Ineffective CPR:
too gentle
too slow
incorrect hand position
too many interruptions
Locating finger position for chest compressions in
infant (< 1 year)
Imagine a line drawn between the nipples
Place 2 fingers on sternum 1 fingers width below line.
Depress - 1 in.
At least 100 per min
1 breath to every 5 compressions
168
Locating hand position for chest compressions in
child (> 1 year)
Use 2-3 fingers to locate lower margin of rib cage.
Follow rib margin to base of sternum (xiphoid process)
Over 8 yr
Place other hand on top of hand on sternum
Depress 1 - 2 in
80-100 per min
2 breaths to every 15 compressions
169
1 ~ 8 yr
Use heel of one hand
Depress 1 1 in
100 per min
One-rescuer
1 breath to every 5 compressions
Two-rescuer
2 breaths to every 15 compressions
170
Brachial pulse check in infant
Carotid pulse check in child
One-hand chest compression
technique in child
After each compression
allow the chest to recoil
fully
because complete chest
reexpansion improves
blood flow into the heart

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Copyright 2007 Seattle/King County EMS

Copyright 2007 Seattle/King County EMS

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