Paediatric CPR – algorithm including
newborn life support
Martina Kosinová
První pomoc – přednáška (aVLPO011, aZLPO011p)1
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Learning objectives
̶ Student will learn the individual steps of the BLS algorithm in a
child.
̶ Student will learn how to open the child's airways.
̶ Student will learn the correct technique of performing chest
compressions in a child.
První pomoc – přednáška (aVLPO011, aZLPO011p)
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Guidelines 2015
Neonate
̶ NLS – Nenatal life support (Resuscitation and support of transition of infants at birth)
Infant → 18 years
̶ PBLS – Paediatric Basic Life Support
První pomoc – přednáška (aVLPO011, aZLPO011p)
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Basic algorithm
No signs
of life?
Not
reacting?
Safety both
of child
and rescuer
Verbal
and tactile
stimulation
Shout
for help
Open the
airway
Not breathing
normally?
5 rescue breaths
15 compression:
2 breaths
S
Safety
S
Stimulate
S
Shout
for help
A
Airway
B
Breathing
C
Circulation
AED
První pomoc – přednáška (aVLPO011, aZLPO011p)
5 První pomoc – přednáška (aVLPO011, aZLPO011p)
S
Safety
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Response to a stimulation
̶ Verbal stimulation
̶ Tactile stimulation
Doesn‘t answer, cry or move?
První pomoc – přednáška (aVLPO011, aZLPO011p)
S
Stimulate
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Shout for help + AED
̶ a lone rescuer: immediately start CPR (in the very high likelihood
of a primary shockable rhythm, if directly accessible, he or she can
rapidly collect and apply an AED
̶ More than one rescuer: 2nd rescuer immediately call for help
and then collect and apply an AED (if feasible).
̶ Infant and children below 8 years: paediatric attenuator
První pomoc – přednáška (aVLPO011, aZLPO011p)
S
Shout
for help
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Breathing normally?
̶ Turn the child carefully on his back
̶ Open the child’s airway by tilting the head and lifting the chin
̶ Neutral head position (infant)
̶ Place your hand on his forehead and gently tilt his head back
(Do not push on the soft tissues under the chin as this may
obstruct the airway. This is especially important in infants.)
První pomoc – přednáška (aVLPO011, aZLPO011p)
A
Airway
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Is the victim breathing normally?
̶ Keeping the airway open
̶ Look
̶ Listen
̶ Feel
…for normal breathing
Not breathing normally?
10 s
První pomoc – přednáška (aVLPO011, aZLPO011p)
B
Breathing
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If breathing is not normal
or absent:
̶ Carefully remove any obvious airway obstruction.
̶ Give five initial rescue breaths → usually respiration ethiology
of cardiac arrest
̶ Call EMS!
První pomoc – přednáška (aVLPO011, aZLPO011p)
B
Breathing
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5 rescue breaths
Infant
• Neutral head position
• Cover the mouth and nose of the infant with your
mouth/ only mouth/ only nose in the older infant.
• Make sure you have a good seal.
• 1s
• Watch for chest to rise up and fall with rescue breath.
• Repeat 5 times
Child over 1 year of age
• Head tilt and chin lift
• Pinch the soft part of the nose and place your lips
around the mouth.
• Make sure you have a good seal.
• 1s
• Watch for chest to rise up and fall with rescue breath.
• Repeat 5 times
For both infants and children, if you have difficulty achieving an effective breath, the airway may be obstructed:
• Open the child’s mouth and remove any visible obstruction.
• Reposition the head. Make up to five attempts to achieve effective breaths.
První pomoc – přednáška (aVLPO011, aZLPO011p)
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I.K. Maconochie et al. / Resuscitation 95 (2015) 223–248
První pomoc – přednáška (aVLPO011, aZLPO011p)
Infant Child over 1 year of age
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Look for signs of life
Movement
Coughing
Normal breathing
První pomoc – přednáška (aVLPO011, aZLPO011p)
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No signs of life
̶ In BLS do not check the pulse!
̶ Unconscious child, not breathing normally = start chest
compressions
̶ In all children continue with 15 : 2 ratio
(compression : ventilations) till the ambulance come
První pomoc – přednáška (aVLPO011, aZLPO011p)
C
Circulation
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Chest compressions
Infant
• Lower half of the sternum
• Depress the sternum by at least one third of the
anterior–posterior diameter of the chest (4 cm)
• Preferred encircling technique with two thumbs
(alternative technique for the lone rescuer: tips of
two fingers)
• Rate: 100-120/min
• 15:2
Child over 1 year of age
• Lower half of the sternum
• Depress the sternum by at least one third of the
anterior–posterior diameter of the chest (5 cm)
• Place the heel of one hand on the sternum, lift
the fingers, your arms strait, place yourself above
the victim’s chest
• Rate: 100-120/min
• 15:2
První pomoc – přednáška (aVLPO011, aZLPO011p)
C
Circulation
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Chest compressions
I.K. Maconochie et al. / Resuscitation 95 (2015) 223–248
První pomoc – přednáška (aVLPO011, aZLPO011p)
Infant Child over 1 year of age
C
Circulation
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A lone rescuer
Call for ambulace
More than one rescuer
̶ With mobile phone - call help
first (and activate the speaker
function) immediately after the
initial rescue breath
̶ If no phone is readily available perform 1
min of CPR before leaving the child.
̶ one start the CPR, second call
the ambulance immediatelly
and then collect and apply an
AED
První pomoc – přednáška (aVLPO011, aZLPO011p)
První pomoc – přednáška (aVLPO011, aZLPO011p)18
Do not interrupt resuscitation until
̶ The child shows signs of life.
̶ Ambulance arrive and také
over the CPR
̶ You become exhausted
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Paediatric CPR Newborn Life Support
První pomoc – přednáška (aVLPO011, aZLPO011p)
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Newborn Life Support
̶ Algorithm for resuscitation and support of transition of infants at birth
̶ Facilitation of the fetal-to-neonatal transition (The absorption of lung fluid, the aeration
of the lungs, the initiation of air breathing, and cessation of the placental circulation)
̶ 6-10 % of newborns require some help in transition in first minutes after the birth
̶ 85% of babies born at term initiated spontaneous respirations within 10 to 30 s of birth
̶ An additional 10% responded during drying and stimulation
̶ 3% initiated respirations following positive pressure ventilation
̶ Only 0.1% received chest compressions and/or adrenaline
První pomoc – přednáška (aVLPO011, aZLPO011p)
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Basics from NLS
Temperature
Possition
Open
the airway
Stimulation
První pomoc – přednáška (aVLPO011, aZLPO011p)
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Basic algorithm
No signs
of life?
Not
reacting?
Safety both
of child
and rescuer
Verbal
and tactile
stimulation
Shout
for help
Open the
airway
Not breathing
normally?
5 rescue breaths
15 compression:
2 breaths
S
Safety
S
Stimulate
S
Shout
for help
A
Airway
B
Breathing
C
Circulation
AED
První pomoc – přednáška (aVLPO011, aZLPO011p)
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Learning outcomes
̶ Student is able to describe the technique of performing rescue
breaths in children of all ages.
̶ Student is able to name the individual steps of the BLS algorithm
in a child.
̶ Student is able to describe the differences in the CPR of a child
and an adult.
První pomoc – přednáška (aVLPO011, aZLPO011p)
Lékařská fakulta Masarykovy univerzity
2021