CPR Children/Infants

What are the recommended compression-to-ventilation ratios for infants and children?

1 rescuer: 30:2 2 or more rescuers: 15:2

Critical components of chest compressions: infants

Rate: 100 to 120/min Depth: approximately 1 1/2 inches (4 cm) Hand Placement: -1 rescuer places 2 fingers in the center of the chest, just below the nipple line -2 rescuers use the 2 thumb-encircling hands technique in the center of the chest, just below the nipple line -1 rescuer may also use the 2 thumb-encircling hands technique or the heel of 1 hand Chest recoil: allow complete recoil; do not lean on the chest Minimizing interruptions: limit interruptions to less than 10 seconds

Critical components of chest compressions: children

Rate: 100 to 120/min Depth: approximately 2 inches (5 cm) Hand Placement: 2 hands or 1 hand on the lower half of the breastbone Chest Recoil: allow complete recoil; do not lean on the chest Minimizing Interruptions: limit interruptions to less than 10 seconds

Compression-to-ventilation ratio: infants & children

Ratio for 1 rescuer is 30:2 Ratio for 2 or more rescuers is 15:2

The AED detects a shockable rhythm and advises a shock. After delivering 1 shock, you and your partner immediately resume CPR by using what ratio and which compressions technique?

complete cycles of 15 compressions and 2 breaths, and use the 2 thumb-encircling hands technique

You are still performing CPR as a single rescuer. The AED detects a shockable rhythm and advises a shock. After delivering 1 shock, you immediately resume CPR with what ratio of compressions to breaths?

cycles of 30 compressions and 2 breaths

When performing chest compressions for an infant, you can use 2 thumbs or put 2 ________ in the center of the chest, just below the ________ line.

fingers; nipple

The infant is unresponsive when you tap her foot and shout, "Are you OK?" She could be in cardiac arrest. What is your next step?

for 5 to 10 seconds, look for no breathing or only gasping while simultaneously checking the brachial pulse

The child is unresponsive after you tap his shoulders and shout, "Are you OK?" He could be in cardiac arrest. What is your next step?

for 5 to 10 seconds, look for no breathing or only gasping while simultaneously checking the carotid pulse

You check the child's pulse after 2 minutes of providing rescue breaths and cannot feel a pulse. You immediately begin CPR. After performing CPR for 2 more minutes, the child still does not have a pulse and you are still alone. What is your next step?

get and use an AED

What is the recommended depth of compressions in infants?

approximately 1 1/2 inches (4 cm)

When performing high-quality CPR on a child, what is the correct depth of compression?

approximately 2 inches (5 cm)

Pad placement

-some AED pads recommend placing one pad on the chest and one pad on the back for infants and children -follow the pictures on the pad packages for proper placement

After checking for breathing and a pulse, you verify that the child is not breathing normally but has a pulse. His airway is not obstructed. How do you deliver rescue breaths?

1 breath every 2 to 3 seconds, or about 20 to 30 breaths per minute

Witnessed collapse

-if you are alone with no mobile phone, leave the victim to activate the emergency response system and get the AED before beginning CPR. Use the AED as soon as it is available -if you are not alone, send someone to get the AED and begin CPR immediately. Use the AED as soon as it is available

Unwitnessed collapse

-if you are alone, start CPR with cycles of 30:2 -if you are not alone, send someone to get the AED and begin CPR immediately. Use the AED as soon as it is available -after about 2 minutes, if you are still alone, activate the emergency response system and get an AED if not already done -use the AED as soon as it is available

Pad choice

-if your AED includes smaller-sized pads that are designed for children under 8 years of age, use them -if not, use the adult pads while making sure that they don't touch or overlap -do not use the child pads for an adult. The shock dose is too small for an adult

Pediatric BLS algorithm for healthcare providers - single rescuer

1. Verify scene safety 2. Check for responsiveness -tap the victim's shoulders and shout, "Are you OK?" -if the victim is not responsive, shout for nearby help -activate the emergency response system via mobile device *look for no breathing or only gasping and check the pulse (simultaneously). Is a pulse definitely felt within 10 seconds? 3. Normal breathing and a pulse is felt -monitor until emergency responders arrive 4. No normal breathing and a pulse is felt -give rescue breaths every 2 to 3 seconds (20 to 30 breaths per minute) -assess pulse rate for no more than 10 seconds 5. Heart rate <60/min with signs of poor perfusion -start CPR 6. Heart rate > or equal to 60/min -continue rescue breathing -check pulse every 2 minutes -if no pulse, start CPR 7. No breathing or only gasping and no pulse is felt -witnessed: activate the emergency response system, retrieve the AED and begin CPR -unwitnessed: begin CPR immediately 8. CPR -perform cycles of 30 compressions and 2 breaths -when a second rescuer arrives, perform cycles of 15 compressions and 2 breaths -use the AED as soon as it is available 9. After about 2 minutes, if still alone, activate the emergency response system and retrieve the AED (if not already done) 10. Once the AED arrives, check the rhythm: Shockable rhythm -give 1 shock, resume CPR immediately for 2 minutes (until prompted by the AED to allow a rhythm check) Nonshockable rhythm -resume CPR immediately for 2 minutes (until prompted by the AED to allow a rhythm check) 11. Continue CPR until ALS providers take over or the child starts to move

Pediatric BLS algorithm for healthcare providers - 2 or more rescuers

1. Verify scene safety 2. Check for responsiveness -tap the victim's shoulders and shout, "Are you OK?" -if the victim is not responsive, shout for nearby help -first rescuer remains with the child -the second rescuer activates the emergency response system and gets the AED 3. Look for no breathing or only gasping and check the pulse (simultaneously). Is a pulse definitely felt within 10 seconds? 4. Normal breathing and a pulse is felt -monitor until emergency responders arrive 5. No normal breathing and a pulse is felt -give rescue breaths every 2 to 3 seconds (20 to 30 breaths per minute) -assess pulse rate for no more than 10 seconds 6. Heart rate <60/min with signs of poor perfusion -start CPR 7. Heart rate > or equal to 60/min -continue rescue breathing -check pulse every 2 minutes -if no pulse, start CPR 8. No breathing or only gasping, and no pulse is left -begin CPR -the first rescuer begins CPR with a 30:2 ratio -when the second rescuer returns, use a 15:2 ratio 9. Use the AED as soon as it is available 10. Once the AED arrives, check the rhythm: Shockable rhythm -give 1 shock and immediately resume CPR Nonshockable rhythm -immediately resume CPR for about 2 minutes 11. Continue CPR with a ratio of 15:2 until ALS providers take over or the victim starts to move

During CPR on a child, interruptions to chest compressions should be limited to no more than _______ seconds.

10

What is the target rate for chest compressions for children?

100 to 120/min

AED pad placement

Pad choice Pad placement

Pulse check: infant

Follow these steps to check the brachial artery pulse in an infant *Step 1*: place 2 or 3 fingers on the inside of the upper arm, between the elbow and shoulder *Step 2*: then press the fingers to attempt to feel the pulse for at least 5 but no more than 10 seconds. If you do not feel a pulse within 10 seconds, or the heart rate is 60/min or less, begin high-quality CPR, starting with chest compressions

Pulse check: child

To perform a pulse check in a child, feel for a carotid or femoral pulse, follow these steps to check the femoral artery pulse *Step 1*: place 2 or 3 fingers in the inner thigh, midway between the hip bone and the pubic bone and just below the crease where the leg meets the torso *Step 2*: feel for a pulse for at least 5 but no more than 10 seconds. If you do not feel a pulse within 10 seconds, or the heart rate is 60/min or less begin high-quality CPR, starting with chest compressions

During CPR on a child, you should place 1 or 2 hands over the __________ of the __________.

lower half; breastbone

What is the preferred method for pulse check in an infant?

place 2 or 3 fingers on the inside of the upper arm, midway between the infant's elbow and shoulder

You check the infant's pulse every 2 minutes and detect that the heart rate is less than 60/min with signs of poor perfusion. While your colleague begins CPR, what action do you need to take?

power on the AED, follow the prompts, and use the child pads

The infant isn't breathing normally but has a pulse. What do you need to do?

provide rescue breaths, with 1 breath every 2 to 3 seconds

When performing chest compressions for an infant in a 2-rescuer situation, you should put 2 _______ in the center of the chest, on the lower half of the breastbone.

thumbs

After turning on the AED, you follow the prompts. You know to use child pads for infants and for children younger than 8 years, but the pediatric pads are unavailable. What should you do?

use the adult pads