Paediatric BLS

Question 1

Define an infant

Answer 1

<1 year old

Question 2

define a child

Answer 2

1 year to 18 years

Question 3

What is the chain of arrival?

Answer 3

A concept that emphasises 4 key interventions that, if optimised, maximise the chance of survival:

1) Early recognition and call for help

2) Early CPR

3) Early defibrillation

4) Early advanced cardiac life support

Question 4

What is the most common cause of cardiorespiratory arrest in children & infants?

Answer 4

Decompensated respiratory arrest (or circulatory failure causing hypoxia).

Question 5

Steps of paediatric BLS:

Answer 5

1) Ensure personal safety.

2) Checking for a response –> In a child gently shake the patient’s shoulders or in an infant gently stimulate their chest and shout loudly ‘Can you hear me’?’.

3) Call for help

4) Position the patient on their back and open the airway (check for obstruction) e.g. head tilt chin lift or jaw thrust

5) Assess for signs of life: breathing, pulse check

Question 6

How to assess breathing in paediatric BLS?

Answer 6

1) Look, listen and feel to assess if the patient is breathing for 10 seconds.

2) Expose the patient’s chest if possible:
- Look at the chest for rising and falling
- Listen for any evidence of breath sounds
- Feel for air blowing against your cheek

Question 7

How to check the pulse in an infant?

Answer 7

Check for femoral pulses

Question 8

How to check the pulse in a child?

Answer 8

In a child, check for carotid pulses

Question 9

In a child, what pulse rate is treated the same as no pulse?

Answer 9

<60 bpm

Question 10

If there are no signs of life, what are the next steps?

Answer 10

1) Call resus team (2222)

2) 5 initial rescue breaths

3) Perform chest compressions

4) Ventilating the patient

5) Defibrillation using an AED

Question 11

If the child isn’t breathing, how many initial rescue breaths should be delivered?

Answer 11

5

If there is immediate access to a bag valve mask (for example, in a hospital), this should be used. If not, a pocket mask might be more useful in an older child.

If there is no immediate access to medical equipment, provide manual rescue breaths

Question 12

Positioning of head when giving rescue breaths?

Answer 12

For an infant:

1) Place an infant’s head in the neutral position (avoid over-extension)

2) Take a breath, cover the mouth and nose of the infant with your mouth and blow steadily for 1 second (ensuring a good seal by looking for chest rise).

For a child:

1) Place a child’s head in the ‘sniffing position’

2) Take a breath, cover the mouth of the child with your mouth and pinch the nose. Blow steadily for 1 second (ensuring a good seal by looking for chest rise).

Question 13

If no signs of life are present after rescue breaths, what is the next step?

Answer 13

Perform chest compressions

Question 14

What is the rate of chest compressions to ventilations in paeds?

Answer 14

15 chest compressions followed by 2 ventilations

(15:2)

Question 15

Rate of chest compressions in paeds BLS?

Answer 15

100-120 bpm

Question 16

Depth of chest compressions in paeds?

Answer 16

Depress 1/3 of the anterior-posterior dimension of the chest.

In an infant, this is roughly 4cm and in a child is roughly 5cm.

Question 17

Chest compression technique for infant vs small child vs large child?

Answer 17

Infant –> two finger technique or encircling technique

Small child –> heel of hand

Large child –> as per adult BLS

Question 18

When should you continue resuscitation until?

Answer 18

One of 3 things happen:

1) There are signs of life

2) The arrival of further qualified help

3) You become exhausted