1. Paediatric Basic Life Support
EPLS
Paediatric Basic Life Support
European Resuscitation Council

2. Summary Causes of cardiorespiratory arrest BLS sequence in paediatrics
AED in children
Foreign body airway obstruction relieve

3. BLS Recognition of a person in cardiac or respiratory arrest
Delivery of oxygen to vital organs by CPR
Without the use of adjuncts

4. Paediatric cardiorespiratory arrest
Secondary to hypoxia, acidosis, inappropriate perfusion
Terminal Rhythm: Bradycardia, Pulseless Electrical Activity → Asystole
Out-of-hospital arrest is « hypoxic and hypercapnic with respiratory arrest preceding asystolic cardiac arrest»

5. Comparison with adult arrest
Ventricular Fibrillation in children is more rare than in adult
6-9% to 15-24% (SIDS excl) of cardiac arrest
Secondary to metabolic anomaly : 4H/4T
Hypothermia Tamponade
Hypoxia Toxics - drugs
Hyper/hypokalaemia Thrombo-embolism
Hypovolaemia Tension-pneumothorax

6. Activation of the EMS system
In child less than 8 years
All: Drowning, Trauma, Poisonning
Single rescuer summons help (EMS)
after one minute of BLS
“call fast”

7. Activation of the EMS system
In child older than 8 years
All: Witnessed sudden collapse,
Known cardiopathy
Single rescuer summons help (EMS)
immediately to provide rapid access to AED
“call first”

8. Safety Ensure rescuer’s safety first
Then ensure victim’s safety (even trauma)
Use barrier devices (infectious diseases)
Look for clues of what has caused the emergency

9. Establish responsiveness
Stimulate
Establish responsiveness
Never shake a child
Tactile stimulation
Maintaining C-spine (stabilise forehead)
Shake arm or tug hair
Verbal stimulation
Child’s name
“Wake up”
“Are you alright”

10. Shout for assistance
Single rescuer: shouts for help while remaining with the child and starts CPR
Multiple rescuers: one rescuer provides BLS while one rescuer activates EMS system

11. To open the airway, lift the tongue that occludes the AW by
Head tilt-chin lift
Neutral position
More head extension

12. To open the airway, lift the tongue that occludes the AW by
Jaw thrust

13. Checking the airway Look into the mouth
Ensure no foreign body is present
Remove with ONE gentle finger sweep
Avoid blind finger sweep
(further impaction, soft tissue damage)

14. Check breathing: Look, Listen, Feel
For up to10 seconds

15. If the child Is breathing spontane- ously and effectively Maintain AW
Summon help
Place in recovery position
Has no detectable,
spontaneous, effective
breathing
Deliver rescue breaths

16. Deliver up to 5 breaths to ensure 2 effective
Rescue Breaths
Deliver up to 5 breaths to ensure 2 effective
Slow breath : 1 to 1.5 second each
Minimise gastric distension
Optimise oxygen delivered
Deep rescuer’s breath between each rescue breath
Optimise amount of oxygen
Minimise amount of expired CO2

17. Rescue Breaths
Mouth-to-mouth and nose technique

18. Rescue Breaths
Mouth-to-mouth technique

19. Assess for signs of circulation
For up to 10 seconds
Pulse
Brachial or femoral pulse in infant
Carotid pulse in child
Signs of life
Cough
Movement
Normal breathing (no gasp)

20. If signs of circulation are
Found
Reassess breathing
Give rescue breaths (20 cpm)
Reassess
Absent or pulse is very
slow + poor perfusion
Deliver external chest compression
Depress 1/3 to ½ of A/P Ø thorax
Rate : 100/min (actual min)
Ratio : 5 compressions for
1 rescue breath

21. Circulation
ECC in Infant
Two-fingers technique
Two-thumbs technique

22. Circulation
ECC in Child < 8 years

23. Circulation
ECC in Child > 8 years
Ratio 15:2

24. Reassess ECC produces a palpable central pulse
Reassess briefly after one minute and summon help
Continue CPR non-stop

25. Activate EMS System Take the child with you to continue CPR
Informations
Detailed location, phone number
Type of accident, number and age of victims
Severity and urgency (ALS)
Confirm reception of message

26. Duration of CPR ROSC and spontaneous respiration
Qualified team arrives
Rescuer exhausted

27. Automated External Defibrillator (AED)
Evaluates the victim’s ECG
Determines if a “shockable” rhythm is present
Charges the “appropriate” dose
When activated by operator, delivers a shock
Provides synthesised voice prompts to assist the operator
An automated external defibrillator or DESA is a type of defibrillator which analyzes the patient's rhythm and advises the operator when a shockable rhythm is detected. It is not necessary for the DESA operator to be skilled in rhythm recognition. DESA should only be applied to patients who are unconscious, pulseless and not breathing. 16

28. AED in children?
Class Indeterminate recommendation in children < 8 years
Recommended (Class IIb) for children older than 8 years in the pre-hospital setting (ILCOR 2000)
Most arrests in young children are of respiratory origin
In this class of age arrests rhythms are mainly asystole and PEA
VF may occur in up to 25% of cardiac arrest when SIDS are excluded
Prompt defibrillation is the definitive treatment for VF and pulseless VT
CPR remains the most important step of Paeds-BLS

29. Recommendation (Circulation 2003; July)
ILCOR consensus statement for AED in children
May be used for children 1-8 years of age with no signs of circulation
Should deliver a child dose
Arrhythmia detection algorithm with high specificity for paediatric shockable rhythms (i.e not recommend shock delivery for non-shockable rhythms)
Insufficient evidence to support recommendation for or against the use of AEDs in children < 1 year of age
For single rescuer, 1 minute of CPR before any other action (i.e. activating EMS or AED attachment)
Defibrillation is recommended for documented VF/pulseless VT. (Class I)

30. FBAO in conscious victim
Assess breathing adequacy
If conscious level deteriorated
5 Abdominal Thrusts
5 Back
Blows
Assess Airway
CHILD
Unconscious FBAO
Algorithm
5 Chest
Thrusts
INFANT

31. FBAO in unresponsive child
Unconscious Victim
Unable to achieve chest movements on 5 attempts of breaths
Attempt
5 Rescue Breaths
Open Airway
Attempt
5 Rescue Breaths
Open Airway
5 Back Blows
5 Back Blows
Check mouth
Check mouth
5 Chest Thrusts
5 Chest thrusts
5 Abdominal Thrusts

32. Recovery position
To avoid the back-fall of the tongue in the pharynx and hence obstruction of AW
To avoid risk of aspiration of vomit, secretions…

33. Recovery position Principles
As near a true lateral position as possible
Patent airway maintained
Child easily observed and monitored
Child stable cannot roll over
Free drainage of vomit/secretion
No pressure on chest (impeding breathing)
Can be turn easily on their back for BLS

34. ?

35. Conclusions We discuss about… Results of BLS Sequence of Paeds-BLS
Use of AED in children
FBAO