BASIC LIFE SUPPORT

• Cardiopulmonary resuscitation (CPR) is a lifesaving procedure when the heart stops

beating during medical emergencies.

• In children the most common causes of cardiac arrest are profound hypoxia due to
respiratory failure or progressive shock.

• Pediatric CPR differs from that in adults because children are anatomically and
physiologically different.

• CPR is performed to restore effective circulation and ventilation.

 Indication for CPR

Cardiac arrest

Imminent arrest
 Indication for CPR

Cardiac arrest Imminent arrest

• unresponsive
• Unresponsive
• not breathing or gasping
• not breathing or gasping
• heart rate < 60/min or less than normal
for age and pulse not felt with signs of
• with no heart beat or pulse
poor perfusion
Recognition of cardiac arrest/ imminent arrest
Pediatric assessment triangle (PAT) for cardiac arrest

Airway = Unstable
Disability = Breathing = Apnoeic
Unresponsive (not breathing or
gasping)

Circulation = No Heart beat

No pulse
 Pediatric assessment triangle (PAT) for imminent arrest

Airway = Unstable
Breathing = Apnoeic (not breathing
Disability = or gasping),
Unresponsive PAT Bradypnoea, increased work of
breathing/Grunt/stridor
Cyanosis,SPO2 <94%,

Circulation
Bradycardia with no pulse

Cool peripheries
Liver span =Normal/ increased
BP= not recordable

Immediate high quality CPR can double or triple chances of survival after cardiac arrest
 Infant and child BLS sequence

Management of cardiac arrest

1) Always verify the scene safety (no fire/electrocution/drowning risk)

2) Check for unresponsiveness – Tap the child’s shoulder or the heel of the infant’s foot and shout.
“Are you OK?”

3) If the victim is not responsive, shout for help. Activate the emergency response system.

4) Get the automated external defibrillator (AED) and emergency drugs and equipment ready by
your team

5) Remove the dress covering the chest for appropriate anatomical localisation of mid sternum and
placement of thumb or hand for chest compression
 Management- Airway and breathing

• Open the airway by doing a manual manoeuvre head tilt and chin lift (Figure 3) or
jaw thrust in case of suspected cervical spine injury

• Insert naso or orogastric tube and decompress the stomach

• Use wide bore Yankauer suction catheter for suctioning if there is any vomitus or blood

• Initiate positive pressure ventilation with bag valve mask (BVM) with 100% O2 and
look for gentle chest rise

Note: If you suspect foreign body aspiration, open the victim’s mouth and visualise for any foreign body. If foreign
body visualised, remove before you initiate BVM
Head tilt and chin lift Jaw thrust
Head tilt and chin lift (EC- Clamp) Jaw thrust - Suspected cervical spine injury
 Circulation:
• First check the central pulse
A) Infant: Palpate the brachial pulse
B) Child: Palpate the carotid or femoral pulse
• Chest compression should be initiated immediately if the central pulse is not felt
within 10 seconds or bradycardia without central pulse

Checking femoral pulse

 Immediate chest compression (C-A- B)
The 2010 American Heart Association (AHA) guidelines for CPR and emergency
cardiovascular care (ECC) recommended a change in the CPR sequence from A-B-
C (Airway-Breathing-Circulation/Compression) to C-A-B sequence for Basic and
Advance Life Support except in new born.
C-A-B approach to BLS

C - chest compression

A- Airway

B- Breathing
 The following steps to be done to perform high quality CPR

• Place the infant or child on a flat or firm surface

• The person giving compression should be positioned high enough above the
patient

• Remove the cloth over the chest

• Place only the heel of the hand over the mid sternum avoiding xiphisternum

• Extend the elbows and lean directly over the patient

• Shoulder should be directly above the chest to exert maximum pressure

 Anatomical landmark

Localisation for placing the fingers/hand

a) Infants- just below the imaginary line drawn between the two nipples
avoiding xiphisternum

b) Children- Mid sternum avoiding xiphisternum

For an Infant For a child > 1year
 Compression technique

a)Two finger technique for an infant if there’s a single rescuer

b)Two thumb technique for an infant if there are two rescuers
c)One or two hand technique in children more than one year of age to provide
adequate chest compression
Place the heel of the hand over the mid sternum and the other hand over the first hand
with the fingers interlaced

Two thumb Two finger technique Two hand technique

 Perform High quality CPR

• High quality CPR is crucial during cardiac arrest to provide adequate blood flow
and oxygenation to the brain, heart and other vital organs

• Brain cells could not withstand hypoxia for more than 5 minutes and will go for
irreversible neuronal cell damage

• The early recognition of cardiac arrest and performance of high quality CPR is
essential for the neurologically intact survival

High quality CPR provides only 20-25% of the normal cardiac output
 The five essential component of high quality CPR

1) Push hard
Chest compression
2) Push fast

3) Allow chest to recoil

4) Minimize interruption

5) Avoid excessive ventilation

Chest compression ventilation ratio

Rescuer Chest compression and ventilation ratio

Single rescuer 30:2

Two rescuer 15 :2
 High quality CPR

Push fast Push at the rate of 100 – 120 compressions per minute
Infant – (< 1 year of age ) Push with enough force to
Children (1 year of age to puberty) depress the chest antero
posteriorly at least 1/3 rd the
Push hard depth of the chest.
Infant: 1 ½ inches (4 cm)

Child: 2 inches (5 cm)

Adolescents - Depth of at least 2 inches (5 cm)
but not more than 2.4
inches(6cm)
Allow complete chest
recoil Release completely. This allows the heart to refill with blood.
 Interruptions during chest compressions should be limited to 10 sec
Minimise interruption
or less
Each rescue breath should be given over 1 sec

Each breath should result in visible chest rise

Chest compression and ventilation ratio:

30:2 for single rescuer

Avoid excessive ventilation
15:2 for two or more rescuer.

If the child has sign of puberty, 30:2 irrespective of single or two

rescuer

If advanced airway (like endotracheal tube) is placed, provide

continuous chest compression without pausing for ventilation
 Switch roles

Rescuers should switch roles every five cycles or 2 minutes of CPR (or earlier
if needed) to avoid fatigue which may reduce the quality of CPR
 Defibrillation
• An electric shock is delivered via two
electrodes placed on the patient over the Manual defibrillator with paediatric
paddles
chest

• Dosage: 2 joules/ Kg followed by 4

joules/ kg if refractory to initial dose

• Indication: Shockable rhythms

• ventricular fibrillation

• ventricular tachycardia without pulse

during CPR
Identify the reversible causes for cardiac arrest

If the reversible causes for cardiac arrest are identified and treated
during CPR or immediately after returning of spontaneous circulation
(ROSC), the outcome will be good. These are described as H’s and T’s
 Reversible causes of cardiac arrest- H & T’s
H’s T’s
Hypovolemia Tension Pneumothorax

Hypoxia Tamponade(cardiac)

Hydrogen ion (acidosis) Toxins

Hypoglycaemia Thrombosis of coronary and pulmonary

artery

Hypo/ Hyperkalaemia

Hypothermia
 Common errors in CPR

 Providing positive pressure ventilation without opening the airway

 Chest compression over the ribs or at xiphisternum

 Lifting the thumb or heel of your hand away from the chest wall during
every chest compression

 Bending the elbows, rocking and double crossing during chest compression

 Not initiating the CPR immediately after providing defibrillation