Resuscitation
The following are only general guidelines taken from the APLS manual and need
to be varied according to the condition of the child
Cardiac arrest in children is rarely due to primary cardiac disease, they are
mostly secondary to hypoxia (birth asphyxia, inhalation of foreign body,
bronchiolitis, asthma and pneumothorax) or secondary to neurological
dysfunction (poisoning, convulsions)
The management of a critically ill child requires a systematic, well rehearsed
team approach. Nowhere is a well-functioning team more vital than in the
emergency situation. Success depends on each team member carrying out his or
her own tasks and being aware of the skills of the other team members.The
whole must be under the direction of a team leader. One person should be
responsible for documentation of all the drugs etc given.
Preparation
If warning has been received of the child’s arrival, then preparations can be
made:
 Ensure the appropriate help is available
 Work out the likely drug, fluid and equipment needs
Initial assessment
Airway
Is the child breathing?
If no – an attempt to open the airway should be made using the head tilt/chin lift
manoeuvre (see APLS/EPLS manual)
Breathing
Is the child breathing? (look, listen and feel)
If no – give 5 initial rescue breaths
Circulation
Is there no pulse or pulse < 60 beats per minute or no signs of circulation?
If yes – commence cardiac compressions
Chest compressions should compress the lower third of the sternum
The finger/thumb or hand position for all ages is found by locating the
xiphisternum and placing the finger/thumb or hand one finger breadth above this.
2
Infants:
Infant chest compression can be more effectively achieved using the hand
encircling technique; the infant is held with both the rescuers hands encircling the
chest. The thumbs are placed in the correct position, as above, and compression
carried out. (See APLS manual for diagrams). This only works for 2 rescuers. If
alone, the single rescuer should use the 2 finger approach.
Children:
Place the heel of one hand over the lower third of the sternum one finger breadth
above the xiphisternum. Lift the finger to ensure pressure is not applied over the
child’s ribs. Position yourself vertically above the child’s chest and, with your arm
straight, compress the sternum to depress it by approximately 1/3 rd of the depth
of the chest. For larger children this may be achieved by using both hands with
the fingers interlocked. Again, see APLS manual for diagrams.
Once the correct technique has been chosen and the area for compression
identified, 15 compressions should be given to 2 ventilations
Compression rate is 100/minute for all ages
Intravenous/intraosseus access
Consider intubation
Weight = 2(age years + 4)
The following pages contain the APLS algorithm
3
Stimulate and assess response
Open airway
Check breathing
5 rescue breaths
Check pulse or signs of
circulation
CPR
15 ventilations:2 compressions
Shockable?
VF/VT algorithm
Assess rhythm
4
Non-shockable?
PEA,asystole
Non-Shockable - Asystole and PEA:
Ventilate with high
concentration O2
Continue CPR
Continue CPR
Intubate
IV/IO access
Adrenaline
10mcg/kg
( 0.1mls 1:10,000 solution)
IV or IO
Pause briefly to check
monitor every 2
minutes
4 minutes CPR
Consider and correct reversible causes of cardiac arrest
based on any history of the event and any clues that are
found during the resuscitation – 4Hs and 4Ts
Hypoxia
Tension pneumothorax
Hypovolaemia
Tamponade
Hyperkalaemia
Toxic substances
Hypothermia
Thromboembolic
5
Shockable - VF and pulseless VT.
DC shock 4j/kg
2 minutes CPR
check monitor
Intubate, high flow O2
IV/IO access
DC shock 4j/kg
2 minutes CPR
check monitor
Intubate
IV/IO access
Adrenaline10mcg/kg
then
DC shock 4j/kg
2 minutes CPR
check monitor
Amiodarone 5mg/kg
then
DC shock 4J/kg
2 minutes CPR
check monitor
Consider
4Hs
4Ts
Consider
alkalising
agents
Adrenaline
then
DC shock 4J/kg
2 minutes CPR
check monitor
2 minutes CPR
check monitor
DC shock 4J/kg
ALS Updated March 2009 review 2011
Ref : APLS manual 4th Edition
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