The following points should be considered while attending to a child with suspected cardiorespiratory arrest.
- The American heart association advocates ‘phone first’ approach to irresponsive adult, which is designed to bring defibrillation facility as quickly as possible. In pediatric age group, 1 minute of BLS to be done before leaving the unresponsive child to activate Emergency Medical Services (EMS) (‘Phone fast’ approach)If 2 rescuers are present CPR and activation of emergency system are done simultaneously. If alone and cause of emergency known, you can provide targeted response. When cause of emergency is not known for infants and children < 8 yr—provide CPR first and then phone fast, because respiratory cause of arrest is more common.Children > 8 yrs – phone first and then provide CPR because cardiac cause of arrest more common (Exception—submersion, trauma, drug overdose).
- Ensure safety of rescuer and victim. Follow universal precautions.
- Stimulate—stimulate gently and avoid shaking the victim or moving if trauma is suspected.
- Tongue is the most common cause of airway obstruction in an unconscious child.
- Maneuvers to open airway are designed to lift the tongue away from back of pharynx; head tilt-chin lift or jaw thrust, maneuvers.
- When head and neck injury is suspected, use jaw thrust during bag—mask ventilation.
- When FBAO is suspected in unresponsive child use the tongue —jaw lift
- 2–5 rescue breaths can be given to ensure that at least 2 effective ventilations are provided.
- Volume of each rescue breath should be sufficient to rise the chest visibly. If air enters freely and chest rises the airway is clear.
- Cricoid pressure will decrease gastric inflation in unconscious or unresponsive child during bag and mask ventilation.
- If there is no chest rise even after repositioning and reopening airway, treat the victim for presumed FBAO.
- Resuscitation bags used for ventilation of full-term newborns, infants and children should have a minimum volume of 450–500 ml. Regardless of the size of the resuscitator used, the rescuer should use only the force and tidal volume necessary to cause the chest to rise.
- Avoid excessive tidal volume in small airway obstruction (Causes air trapping, baro trauma and reduced cardiac output) and head injury.
- Use bracheal pulse in infant and carotid pulse in child for pulse check.
- Pulse check should take no more than 10 seconds.
- Profound bradycardia with poor perfusion is an indication for chest compression.
- In newborn chest should be compressed to one third its depth. For the infant or child depth of compression is one third to one half of the depth of chest.
- Compress lower half of sternum. Avoid compressing the xiphoid process.
- Chest compressions should produce palpable pulses in a central artery.
- The compression (downward) and relaxation (upward) time during each compression cycle should be approximately equal. Do not lift fingers from sternum during a cycle or in between cycles.