PEDIATRIC BASIC

LIFE SUPPORT
Yani Dewi Suryani
 GENERAL OBJECTIVE

 After completing skill practice of

cardiopulmonary resuscitation, the
students will be able to perform
cardiopulmonary resuscitation
correctly
 SPECIFIC OBJECTIVE

 At the end of skill practice, the student

will be able to identify the responsiveness
and manage airway, breathing, circulation
in critically ill patients during the initial
hours when critical care expertise may not
be available
 Expected competencies

• Students perform correct evaluation of

patient’s condition.
• Students perform correct
cardiopulmonary resuscitation.
 Methods

 Presentation
 Demonstration
 Coaching
 Self practices
 Laboratory facilities

 Skill laboratory/class room

 Trainers
 Audiovisual aids
 Anatomy model (infant and child mannequin)
 Resuscitation equipment
 Student learning guide
 Trainer guide
 References
 Evaluation

 Skill demonstration
 OSCE
Specific techniques are required
Varied according to the size of the child
Rescuer can support the vital respiratory and
circulatory functions of a collapsed child with
no equipment
 Safety of Rescuer and Victim

• Always make sure that the area is safe for you

and the victim

• Move a victim only to ensure the victim’s

safety
 ASSESMENT AND
TREATMENT

The SAFE approach

Shout for help
Approach with care
Free from danger
Evaluate ABC
 Overall Sequence of Basic Life
Support in Pediatric Cardiopulmonary
Arrest
1. Check for response
2. Shout for help
3. Position the victim
4. Open the airway
5. Check breathing and give rescue breath
6. Check pulse and give chest compression
Check for Response

• Simple assessment of responsiveness

• Asking and gently shaking by the shoulders,
“Are you okay?”
• Call the child’s name if you know it
• In case associated with trauma, the neck and
spine should be immobilised
• Placing on hand firmly on the forehead, while
one of the child’s arm is shaken gently
 Shout for help and start CPR

If the child is unresponsive and is not

moving

Shout for help and start CPR.

 Position the Victim

If the victim is unresponsive, make sure that

the victim is in a supine (face-up) position on
a flat, hard surface such as a sturdy table, the
floor, or the ground

If you must turn the victim, minimize

turning or twisting of the head and neck
 Open the Airway

unresponsive airway has been blocked by

tongue falling back to obstruct the pharynx

HEAD TILT / CHIN LIFT MANUVER

Head Tilt–Chin Lift Maneuver
• If the victim is unresponsive and trauma is not
suspected
• open the child’s airway by tilting the head back and
lifting the chin
• Place one hand on the child’s forehead and gently tilt
the head back.
• At the same time place the fingertips of your other
hand on the bony part of the child’s lower jaw, near
the point of the chin, and lift the chin to open the
airway.
• Do not push on the soft tissues under the chin as this
may block the airway.
HEAD TILT AND CHIN LIFT IN INFANT
HEAD TILT AND CHIN LIFT IN CHILDREN
If head tilt / chin lift not posibble
/ contraindicated

JAW TRUST MANEUVER

 Jaw-Thrust Maneuver
If head or neck injury is suspected
use only the jaw-thrust method of opening
the airway
Place 2 or 3 fingers under each side of the
lower jaw at its angle, and lift the jaw upward
and outward
Your elbows may rest on the surface on
which the victim is lying
If a second rescuer is present, that rescuer
should immobilize the cervical spine
Jaw thrust for child victim
 Spine immobilization with airway opening
in child with potential head and neck trauma
 Foreign body airway obstruction

• Cross finger maneuver to check any obstruction

• Finger sweep to remove any foreign subject
found in the victim’s mouth

WARNING
• Do not use the finger sweep technique if the
casualty is conscious
• The finger sweep can trigger a conscious casualty's
"gag reflex" and cause him to vomit.
 A. Cross finger
E. Finger Sweep

E
 Relief of FBAO

 FBAO  cause mild or severe airway obstruction.

 When the airway obstruction is mild  the child can
cough and make some sounds.
 When the airway obstruction is severe  the victim
cannot cough or make any sound.
● If FBAO is mild  do not interfere
Allow the victim to clear the airway by coughing while you observe for signs
of severe FBAO.
● If the FBAO is severe  the victim is unable to make a sound
 Foreign body airway obstruction

• If can’t seen, remove by performing:

back blow or chest thrust x 5 (infant)
Heimlich or abdominal thrust X 5 (children)
Infant back blows to relieve complete
FBAO
Infant chest thrust to relieve complete
FBAO
Heimlich Maneuver
Abdominal thrusts performed for
supine, unresponsive child
 Check Breathing
While maintaining an open airway, take no
more than 10 seconds to check whether the
victim is breathing
Look for rhythmic chest and abdominal
movement,
Listen or exhaled breath sounds at the nose
and mouth
feel for exhaled air on your cheek.
Periodic gasping,also called agonal gasps, is
not breathing
Look, Listen and Feel
 Breathing

If airways opening technique not result in

resumption of adequate breathing within 10
seconds exhaled air resuscitation

Up to five initial rescue breaths should be given

to achieve two effective breaths
 Breathing

• The rescuer breathes in and seals around the

victim’s mouth and nose
• If the mouth alone is used then the nose
should be pinched closed using the thumb
and index finger
• Slow exhalation : 1 – 1.5 seconds
• Should take a breath between resque breaths
Mouth-to-mouth-and-nose breathing
for small infant victim
Mouth-to-mouth breathing for child
victim
General guidance for exhaled
air resusitation

The chest should be seen to rise

Slow breath at the lowest pressure reduce
gastric distension
Firm, gentle pressure on the cricoid cartilage
may reduce gastric insufflation
 Pulse Check (Circulation)

Palpate a pulse:
brachial in an infant
carotid or femoral in a child
Take no more than 10 seconds
Brachial pulse check in infant
Carotid pulse check in child
 Circulation

Start chest compression if:

- No pulse or not sure
- Slow pulse (< 60 bpm) with sign of poor
perfusion (pallor, cyanosis)
Characteristics of good compressions
(high quality CPR)

• “Push hard”: push with sufficient force to

depress the chest approximately one third to one
half the anteriorposterior diameter of the chest.
• “Push fast”: push at a rate of 100 compressions
perminute.
• Release completely to allow the chest to fully
recoil.
• Minimize interruptions in chest compressions.
 INFANT

Area compression : line between nipples and

compressing over the sternum one finger
breadth below this line
Two finger technique
Hand-encircling (two thumb) technique
Two-finger chest compression
technique in infant
 Two thumb–encircling hands
chest compression technique in infant
 In a child:
should compress the lower half of the
sternum with the heel of 1 hand or with 2
hands (as used for adult victims)

but should not press on the xiphoid or the

ribs
One-hand chest compression
technique in child
Two-hand chest compression
technique in child
 CARDIOPULMONARY
RESUSCITATION

For 1-rescuer should perform chest

compression-ventilation ratio (30:2)

For 2-rescuers should perform chest

compressions while the other maintains the
airway and performs ventilations at a ratio of
15:2 with as short a pause in compressions as
possible
 After 5 cycles (about 2 minutes).

Evaluate :
Pulse
Breath
Consciousness
Color
Pupil
If no pulse or
pulse less than 60 bpm
Continue CPR
• If the pulse is > 60 bpm but there is no
spontaneous breathing or inadequate
breathing
 give rescue breaths at a rate
 12 to 20 breaths per minute
(1 breath every 3–5 seconds)
until spontaneous breathing resumes
Give each breath over 1 second
 Each breath should cause visible chest rise
 Thank you for listening

Any Question ?