4. Basic Life Support in the Collapsed Infant and Child 2020.pdf

Paediatric

1. Basic Life Support in the
Collapsed Infant and Child
ETAT+ Sierra Leone 2020

2. Learning Objectives
At the end of the session you will be able to:

Identify the importance of
anticipating and preventing collapse
responding quickly to collapse

Use the structured approach to the collapsed
child (in cardiac or respiratory arrest)

3. Emergency care in hospital
What is the most important factor in success?

4. Being prepared
Staff
who is in the team
how are they alerted

Setting for delivering support
special area
at the bedside

Equipment
responsibility for provision and maintenance

Knowledge
training
guidelines
orientation and awareness

5. Emergency care in hospital
What is the most important factor in
saving lives?

PREVENTION
Early recognition of severe illness
Preventive action

6. Most common causes of collapse in children
Respiratory failure
e.g. Pneumonia
Circulatory failure (shock)
Severe anaemia
Dehydration
Septic shock
Heart failure

7. The collapsed child - a structured approach
 SSSS
Safety
Stimulate the child – if they are not obviously responsive
Shout for help
Setting
 A Airway
 B Breathing
 C Circulation

8. Resuscitation - Airway
Is the airway
Clear
Obstructed
At risk
Look in the mouth
vomit/secretions
Position the airway
neutral in infant < 1yr
sniffing in child ≥ 1 yr

9. If there is an Airway problem – fix it immediately!
Suction

Airway opening manoeuvres
Position (neutral/sniffing)
Chin lift
Jaw thrust (if two people)

Airway adjuncts
Oropharyngeal
Nasopharyngeal

10. Resuscitation – check for Breathing
After positioning
Look
Chest movement
Listen
Stridor
Secretions
Noises of breathing
Feel
Air movement on your
cheek

11. Resuscitation – Airway and Breathing
Open + clear the Airway
Look + listen + feel for Breathing
Check adequacy of breathing and
need for oxygen
BREATHING
ABSENT/
INADEQUATE
BREATHING
5 breaths with bag-valve-mask (BVM)

12. Effective bag and mask ventilation

13. Resuscitation – Breathing
ABSENT/INADEQUATE BREATHING
5 breaths with bag-valve-mask
Select appropriate mask & ensure good seal
1 second inspiration,1 second expiration
Look at chest movement
Attach oxygen to BVM as soon as possible
The chest must rise well at least twice
Open + clear the Airway
Look + listen + feel for Breathing

14. If chest wall does not rise at least twice
•Reposition the head
•Review position and seal of the mask
•Consider 2-person technique
•Consider passing a nasogastric tube and
aspirate if too much air in stomach after lots
of bag valve mask ventilation

15. Resuscitation - Circulation
5 breaths with bag-valve-mask
Re-assess airway & breathing while check large pulse
Continue BVM breaths with oxygen
20 breaths/min for 2 min
Then reassess ABC
Heart rate ≥ 60/min, not breathing
Heart
rate very
slow
< 60/min
Help is
needed

16. Resuscitation - Circulation
5 breaths with bag-valve-mask
Re-assess airway & breathing while check large pulse
Heart rate very slow < 60/min, no breathing
15 chest compressions (100-120/min) to
2 breaths
Aim for 6–7 cycles of 15:2 per minute
Every 2 minutes, check for pulse or signs of life

17. Chest compressions
Lower 1/3 of sternum (avoid xiphisternum)
In the midline
Compress the chest by 1/3 of its depth
Equal time for compression & relaxation
Firm, flat surface

18. Chest compressions
•Infant <1 year
•Two finger method for
one rescuer
•Hand encircling
technique for two
rescuers
•Child >1 year
•Two handed technique
•Heel of lower hand on
lower sternum
•Second hand on top of first
•Elbows straight
•Shoulders over hands

19. Adrenaline
•Only use if enough skilled help to gain IV/IO access
and give adrenaline
•Ventilation and chest compression must be
continued throughout

•Dose 0.1ml/kg (10mcg/kg)
•Concentration 1:10,000
•Dilute adrenaline 1ml with 9mls of NS
•Give adrenaline immediately and after every other
cycle (every 3-4 minutes)

20. When to stop?
•Patient shows signs of life
•Does not show signs of life and the team agrees it is time
to stop (20 minutes)

•Document
•Date
•Time
•Who present
•How many cycles
•Which drugs given
•Outcome
•Plan

21. Questions?

22. Summary
Your facility must prepare for sick children and
plan ahead

When you suspect a child has collapsed, you
must act quickly

But you must act in a systematic fashion
Airway assessment and support
Breathing assessment and support
Circulation assessment and support

23. Thank you so much for
your attention!