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PAEDIATRIC Basic Life Support (BLS)
GUIDELINES FOR HEALTHCARE PROFESSIONALS

The Resuscitation Council (UK) recommend to rescuers who have been taught adult BLS, and have no specific knowledge of paediatric resuscitation, to follow the adult sequence. Modifications to the adult sequence will, however make it more suitable for use in children. Those modifications have been included in my booklet.

In their guidelines, The Resuscitation Council (UK) advise a more detailed protocol for ‘healthcare professionals with a duty to respond to paediatric emergencies’. The difference in that protocol is summarised here for the benefit of those to whom it may concern.

A ‘child’ is referred to mean an infant or child under the age of puberty unless otherwise stated.

1. Open the child’s airway in the position found.

2. If you have difficulty opening the airway, try the jaw thrust method: place the first two fingers of each hand behind each side of the child’s jaw bone and push the jaw forward.

3. If you suspect a neck injury try to open the airway by jaw thrust alone. If this is unsuccessful, add head tilt a small amount at a time until the airway is open.

4. While performing rescue breaths note any gag or cough response to your action. These responses, or their absence, will form part of your assessment of ‘signs of circulation.

5. Rescue breaths should take between 1-1.5 seconds.

6. If unable to get the child’s chest to rise: - Check child’s mouth for obstruction without making blind finger sweeps. - Ensure adequate head tilt and chin lift but also that neck is not over extended. - If head tilt/ chin lift is still unsuccessful, try jaw thrust method - Make up to 5 attempts before moving on to chest compressions

7. After 5 rescue breaths, check for circulation. Do this by looking for any coughing, movement or normal breaths. Check for a pulse (if you are trained and experienced) but ensure you take no longer than 10 seconds. Take the carotid pulse in the neck of a child and the brachial pulse in the upper arm of an infant.

8A. If you are confident you can detect the signs of circulation within 10 seconds, continue rescue breathing until the child breaths effectively on his own, when he should placed into the recovery position and reassessed regularly.

8B. If there is no signs of circulation, or no pulse, or a slow pulse (less than 60 per min. with poor perfusion) or you are unsure start compressions.

9. Compression for a child (1 year - puberty). To locate the lower third of the child’s sternum, chest compressions should be one fingers breadth above the xiphisternum, which is located by finding the angle where the lowest ribs join at the middle.

10. For all children and infants CPR ratio should be 15:2, however lone rescuers may use a ratio of 30:2 particularly if they are having difficulty with the transition between compression and ventilation.

11 Compression in infants (0 -12 months). The lone rescuer should compress the sternum with the tips of two fingers, however if there are two or more rescuers, use the encircling technique as follows: - Place both thumbs flat, side by side, on the lower third of the sternum (as above), with the tips pointing towards the infant’s head. - Spread the rest of both hands, with the fingers together, to encircle the lower part of the infants rib cage with the tips of the fingers supporting the infant’s back. - Press down of the lower sternum with your two thumbs to depress it approximately one-third of the depth of the infant’s chest.

12. The only exception to performing 1 min CPR before going for help is in the case of a child with a witnessed, sudden collapse when the rescuer is alone. In this case cardiac arrest is likely to be the cause and the child may need defibrillation. Seek help immediately if there is no one to go for you.

AUTHORS NOTE:
It seems that the Resuscitation Council (UK) have provided us with three possible guidelines or routines when faced with a child or baby who is not breathing, and these are:

1. Use the ADULT guidelines if that is the only way you have been trained in CPR.

2. Modify the adult guidelines to include 5 rescue breaths etc. (as in this booklet).

3. Use enhanced skills including, jaw thrust, pulse checks etc if you are a healthcare professional and trained in these skills.

Whatever guideline you have been trained, it is important you at least do something as without intervention (and research shows people don’t intervene for fear of doing more harm) in the case of a non-breathing child or infant, they will probably perish.