Infant/Child Basic Life Support
Infant/Child Basic Life Support
Aim
• This resource aims to introduce you to Basic Life
Support (BLS) and the appropriate use of the
Recovery Position for infants and children in and
out of hospital. The timetabled practical workshop
will enable supervised practice of all techniques.
• All techniques are taught in accordance with the
Resuscitation Council UK (RCUK) “Standards for
clinical practice and training”(2004) and the latest
(October 2011) Resuscitation guidelines which are
available to download from www.resus.org.uk
Infant/Child Basic Life Support
Learning Outcomes
At the end of this learning experience you should be able to:
1.Describe the ABC of Basic Life Support (BLS).
2.Describe the underlying anatomy and physiology of BLS.
3.Demonstrate effective BLS for all age groups.
4.Identify the differences in technique required when applying
the principles of BLS to different age groups.
5.Demonstrate the Recovery Position.
6.Demonstrate how to relieve a foreign body obstruction in all
age groups.
7. Demonstrate effective use of a pocket mask.
Infant/Child Basic Life Support
Basic Life Support is the series of measures intended
to maintain adequate ventilation and circulation until
expert help arrives. It may be required in the following
situations;
• An unconscious non breathing casualty (respiratory
arrest).
• An unconscious casualty who is not breathing and has
no heart beat (cardio-respiratory arrest).
• A casualty who is breathing and has a heartbeat but is
unconscious and will need to be put into the recovery
position wherever possible.
Infant/Child Basic Life Support
in terms of BLS
• Infants are less than I
year in age
• Children are aged 1-8
In practice the size of the child is more important than the age
Infant/Child Basic Life Support
In order to live we need a regular supply of
glucose and oxygen to all parts of the
body.
The brain in particular becomes severely
damaged if deprived of oxygen for more
than a few minutes (usually 3 to 4).
Infant/Child Basic Life Support
To ensure that the brain and other
organs are supplied with oxygen
three things are essential:
Airway
Clear and open to enable
air containing oxygen
to pass into lungs.
Infant/Child Basic Life Support
Breathing
This process delivers
air into lungs so
oxygen
can enter the blood.
Infant/Child Basic Life Support
Circulation
Requires a pumping
heart and sufficient
blood to carry
oxygen around
the body.
Infant/Child Basic Life Support
Basic Life Support (BLS), is the emergency treatment needed
to overcome failure of one or all of these functions.
Cardio respiratory arrest or cardiac arrest - when breathing
has stopped and the heart is not maintaining an adequate
cardiac output -is most likely to occur in infants and children
as a result of respiratory failure and hypoxia.
The Resuscitation Guidelines are based on this premise.
Basic Life Support buys the casualty time preventing organ
damage resulting from a lack of oxygen but is unlikely to
cause the heart to re-start therefore summoning expert help is
vital
Infant/Child Basic Life Support
Before approaching a casualty always check for:
Danger
• To yourself
• The Casualty
• Bystanders
Infant/Child Basic Life Support
Check RESPONSE
• Tap or flick the sole
of the foot
• Call the child’s name
NEVER SHAKE A BABY
Infant/Child Basic Life Support
and then…….
Call for expert help
Infant/Child Basic Life Support
Anatomy of the airway of infants and
children
• The cartilaginous rings surrounding the airway are softer than
in adults making it more susceptible to occlusion if the head is
incorrectly positioned.
• In infants the occiput is very large tending to push the head
forward and occluding the airway.
• Infants and children have larger tongues relative to their size
increasing the chance of airway obstruction.
• The airway is narrower meaning that any inflammation of the
airway could cause severe distress.
• The airway is “funnel shaped” becoming narrower at the level
of the larynx any foreign body can become lodged here.
Infant/Child Basic Life Support
Open the
Airway
By using the head tilt chin lift
manoeuvre.
The head is maintained in a neutral
position.
Breathing
Check for
•Look at the chest for movement.
•Listen for breath sounds
•Feel for air on your cheek
Infant/Child Basic Life Support
This check should take 10 seconds if the
child is breathing normally and it is safe
to do so, place him in the recovery
position( and summon help from the
ambulance service by calling 999 OR
112 (the later number is valid
throughout Europe) .
Stay with the child and reassess
regularly.
Infant/Child Basic Life Support
ALTERNATIVE METHOD OF OPENING AIRWAY WHEN THERE IS
SUSPECTED NECK (CERVICAL) INJURY
JAW THRUST
Infant/Child Basic Life Support
• Remember the most likely cause of cardiac
arrest in infants in children is hypoxia so in a
non-breathing child give five rescue breaths
first.
Infant/Child Basic Life Support
• In the older child place the mouth over the child’s mouth
creating a seal an pinch the nose.
• For both age groups deliver each breath slowly over 1-1.5
seconds taking a breath yourself between each one
• Check for chest movement
Infant/Child Basic Life Support
• Having given 5 effective rescue breaths check
for Circulation
• Look for signs of life such as coughing
movement or normal breathing.
• It is also recommended to check for the
presence of an effective central pulse.
• In babies either the brachial or femoral pulse
can be used.
• In children the carotid pulse can be used.
Infant/Child Basic Life Support
Brachial site
Femoral site
Infant/Child Basic Life Support
Carotid site
Infant/Child Basic Life Support
Ensure an ambulance has
been called.
• Place two fingers on the
lower third of the
sternum one fingers
breadth below the nipple
line.
• Commence 15 chest
compressions at a speed
of 100 -120 per min
Infant/Child Basic Life Support
Ensure an ambulance has
been called.
• Place the heel of one
hand on the lower third
of the sternum.
• Commence 15 chest
compressions at a speed
of 100 -120 per min.
Infant/Child Basic Life Support
Alternative approach for compressions in infants
When there are two rescuers
present ;
• Place both thumbs on the
lower third of the sternum
one fingers breadth below
the nipple line.
• The hands should encircle
the infants chest and
support his back.
• Commence
15
chest
compressions at a speed of
100 -120 per min.
Infant/Child Basic Life Support
•
Defibrillation
Defibrillation is a rare event in paediatric
cardiac arrests
In an out of hospital situation a
defibrillator will either come with the
ambulance or may be available in
supermarkets trains stations etc.
In hospital this will be part of the cardiac
arrest or “crash” trolley.
Defibrillators should only be used by
those trained in their use
The outcome of paediatric cardiac arrest is poor (Kitamuara et al 2010)
The child’s best chance of survival is recognition of the signs of deterioration
in the sick child.
The Airway Breathing Circulation Disability Exposure mnemonic gives priority
to the key management steps in the assessment and treatment of sick children.
It should be used in all children and SAVES LIVES
Infant/Child Basic Life Support
• If following the assessment the child is discovered to be breathing
normally but not fully conscious he should be placed in the
recovery position.
• The rationale for this is to maintain a safe airway by maintaining the
head tilt chin lift and prevent inhalation of any blood or vomit
which may threaten the patency of the airway.
• Whilst the recovery position is the safest position for an
unconscious casualty NEVER try to move someone if you think they
might have other injuries which may be made worse by moving. In
this situation maintain the airway and wait for expert help to arrive.
• See how to place a child in the recovery position here
http://www.youtube.com/watch?v=mMnzn8T_3Q8
Infant/Child Basic Life Support
• The sequence of actions you should take in hospital are
the same and should be commenced as soon as possible;
• The ONLY differences are;
• You should call the emergency response team (Crash
Team) on the specially designated number stating that it
is a paediatric arrest. A safety alert issued by National
Patient Safety Agency (NPSA 2004) required NHS
hospitals to standardise this number to 2222, but always
check.
• When performing rescue breathing always use a pocket
mask, or, if you know how to use it, a bag valve mask
(RC/UK 2003).
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Infant/Child Basic Life Support
Pocket Mask
Infant/Child Basic Life Support
Bag Valve Mask
Infant/Child Basic Life Support
• If a solid or liquid object enters the airway the child will
immediately react with vigorous coughing.
• If the object completely obstructs the airway (Foreign
Body Airway Obstruction FBAO) normal movement of
air is prevented and asphyxia and hypoxia will rapidly
develop.
• Airway obstruction can also be caused by infection and
inflammation resulting in oedema or an allergic
response. In this instance emergency medical care
must be sought.
• The two causes of airway obstruction are managed
differently.
Infant/Child Basic Life Support
Recognition of FBAO
• The event may be witnessed
• If not witnessed clues could be a history of
eating or playing with small items or toys
immediately before the episode.
• The airway obstruction develops suddenly
without any other signs of illness or infection.
Infant/Child Basic Life Support
Infant/Child Basic Life Support
Back
Blows
Infant
Child
Infant/Child Basic Life Support
Chest Thrust Infant
Infant/Child Basic Life Support
Abdominal Thrust Child
Infant/Child Basic Life Support
If the child becomes unconscious:
•
•
•
•
Place on a firm flat surface
Send for help if still not available
Open the mouth and look for any obvious object
If seen make one attempt to remove with a single finger
sweep
DO NOT ATTEMPT MULTIPLE OR BLIND FINGER SWEEPS
• Open the airway attempt five rescue breaths
• Commence CPR at a ratio of 15:2
• Re-check the airway with each set of rescue breaths and
remove if seen as above.
Infant/Child Basic Life Support
• Now attempt the Multiple choice questions.
References and Resources
•Resuscitation Guidelines 2010 Resuscitation Council (UK).
•Safer Handling during Resuscitation Resuscitation Council (UK) 2009.
• Standards for clinical practice and training (2008) A Joint Statement from The
Royal College of Anaesthetists, The Royal College of Physicians of London, The
Intensive Care Society, The Resuscitation Council (UK)
•Teaching- Bag -Valve Mask RC(UK) Statement June 2003.
All the above available from Resuscitation Council UK Website: www.resus.org.uk
• Kitamura T. Iwami T. Kawamura T. et al “Conventional and chest compression
only cardiopulmonary resuscitation by bystanders for children who have outof-hospital cardiac arrests: a prospective, nationwide ,population based cohort
study” Lancet 2010; 375: 1347-54