Paediatric bls

Paediatric bls

1. PAEDIATRIC BASIC LIFE SUPPORT By : Dr. Praman Kushwah Dr. Nilofer Mujawar (Prof. & Head, Dept of P aediatrics ) Dr. Ashish Vaidya (Lecturer Dept. o f Paediatrics)

2. INTRODUCTION Children are much more than ‘ Little Adults ’. They need to be cared for DIFFERENTLY in an emergency. A child is defined as the age of 1 to the onset of PUBERTY . For infants and children up to the age of 17 years , you MUST OBTAIN CONSENT from the child’s parent or legal guardian

3. CHAIN OF SURVIVAL Prevention of ARREST Early high quality bystander CPR Rapid activation of EMERGENCY response system Effective ADVANCED life support Integrated post cardiac arrest CARE

4. Check for s afety Check for r esponse s hout for Help Check for p ulse Give c pr Check a irway Check b reathing Simultaneously

5. Safety

6. SAFETY Check for Your Safety Avoid danger to – You Others Casualty Make the area safer or remove yourself and casualty to an area of safety. If an area is too dangerous stand back and call emergency services

7. response

8. response Response may vary according to age of child Rubbing on the palms of the hands or soles of an infant’s feet may elicit a response Can also use the COWS Method. C an you hear me? O pen your eyes. W hat is your name? S queeze my hand

9. Shout for help Help can be ANYONE nearby . ACTIVATE Emergency response system A nd GET an Automated External Defibrillator .

10. circulation

11. Cpr chest compression & ventilation

12. Cpr - assessment Most important step is recognising need for CPR. CPR should be commenced immediately in children if; Unresponsive Not breathing normally Not moving, signs of life . Lay rescuers should begin CPR, based upon the above information. Checking for a pulse is not required or recommended. For Health care personnel , the carotid or Femoral pulse are typically the easiest to assess. If pulse not identified within <10 seconds CPR should commence

13. HIGH QUALITY Cpr S tart COMPRESSION within 10 seconds of recognition of arrest P USH HARD ,PUSH FAST : Rate at least 100/min Depth at least 5 cm in child and 4 cm for infants Complete chest R ecoil Minimize I nterruptions Give effective B reathing Avoid excessive v entilation Cycle : 5 cycles of [30:2] in approximately 2 minutes. Recheck for signs of life at the end of cycle Ratio : 30 compression to 2 ventilation for 1 rescuer : 15 compression to 2 ventilation for 2 rescuer

14. Cpr : Where to do it Compressions are done in the midline on the lower half of the sternum or the ‘centre of the chest How to do it Infants (< 1yo) Use 2 fingers over the centre of the chest. Compress to 1/3 depth of chest wall (~4cm). Child (1-8yrs) Use heel of 1 hand, or alternatively 2 hands, with one positioned on top of the other. Compress 1/3 depth of chest wall (~5cm) in the centre of the chest . Greater than 8yrs = same as adult

15. airway - clearance - maneuvers

16. Airway clearance Clearing the airway Turn child on one side. Clearing visible foreign material from mouth and nostrils. If suction is available use suction to clear material. Back Blows Chest Thrust Placing the child in the recovery position, if they are breathing, and post airway clearance can be useful.

17. Airway maneuvers Airway manoeuvres and appropriate positioning in children can differ from adults, dependant upon size. Infants (<1yr) should have their head in the horizontal or neutral position Head tilt/Chin lift Tilt head backwards (not neck) Support jaw at the point of the chin Jaw Thrust Good if neck injury is suspected Difficulty with obtaining adequate airway with Head tilt/chin lift.

18. breathing

19. breathing Look, Listen & Feel is now omitted If not breathing, and the casualty has a patent airway, rescue breathing should be commenced. 1 breath after every 3 seconds In clinical situations use a face mask to deliver breaths. Seal mask against face using index finger and thumb Deliver air over 1 second to make chest rise.

20. In Infant Key difference : L ocation of pulse check – Brachial Artery Technique of Delivering compression Two finger for singel rescuer Two thumb for two rescuer C ompression depth - approximately 4 cms Compression ventilation rate & ratio are same

21. automated electronic defibrillator (AED)

22. Using an AED (automated electronic defibrillator) If a Defibrillator (Automated External Defibrillator – AED) is available, apply and follow voice prompts . CPR continues until the AED is present , all the pads are in place and the AED is on. AEDs accurately identify heart rhythms as either ‘ shockable ’ or ‘non- shockable ’. Remember when shocking the casualty to get everyone to stand well back. Do not touch them!

23. algorithm

24. Chocking child Infant and child Conscious Five back blows Five abdominal thurst Unconscious Rescue breathing

25. Take home message Shift from ABC to CAB High quality CPR Use of AED

26. References & acknowledgements Information American Heart Association

27. Thank you