Pediatric Basic Life Support(BLS) Special situations

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Neepa Shah, M.B.B.S.[2]

Overview

Pediatric Basic Life Support is a life-saving skill comprising of high quality CPR (Cardiopulmonary Resuscitation) and Rescue Breadths with Artificial External Defibrillator (AED).

• Bystander CPR - Bystander resuscitation plays a key role in out of hospital CPR. A study by Maryam Y Naim et all found out communities, where bystander CPR is practiced, have better survival outcomes in children less than 18 years from out of hospital cardiac arrest(CA)

• Two studies (Total children 781) concluded that about half of the Cardio-Respiratory arrests in children under 12 months occur outside the hospital.
• Good Prognostic Factor upon arrival at the emergency department-
  • The short interval between arrest and arrival at the hospital.
  • Less than 20 minutes of resuscitation in the emergency department.
  • Less than 2 doses of epinephrine.

Special situations

Resuscitation in special circumstances

Child with a tracheostomy tube or stoma.

• The caregiver (Parents, nurse, or teacher) should be trained in how to use the tracheostomy tube.
• If there is a cardiac arrest in a child with a tracheostomy start immediately CPR with compressions followed by ventilation of 2 rescue breaths.
• Ventilation
  • Give rescue breaths from mouth to a tracheostomy tube, if the chest does not rise to suction the tube, if still there is no chest rise then can give mouth to stoma ventilation or bag-mask ventilation if available.

Child with spinal trauma

• Steps to follow in a pediatric trauma case with cardiac arrest.
• Look for airway obstruction.
• If there is bleeding try to tie a tourniquet and apply external pressure.
• If spinal trauma is suspected try to avoid cervical spine movement.
  • In spinal trauma ventilation should be done with caution apply jaw thrust and do not tilt head.
  • If the jaw thrust is not successful then one rescuer would minimize the motion of the cervical spine and the other rescuer should attempt to give rescue breadth by head still and chin lift method.
  • To achieve a neutral position for a child while in supine posture a study by Nypaver M et all mentions that the back needs to be elevated in children less than 7 years.
  • In children less than 7 years its found that they have a disproportionately large head compared to their full bodies and when in a supine position the neck gets flexed.
    • To prevent cervical motion changes should be made to the backboard.
    • Changes like Raise the chest by putting a double mattress pad or use a recess for the occiput to lower the head.

Child drowning

• The rescuer should try to get the drowning child as soon as possible out of the water and start CPR after checking pulse and ventilation.
• If the rescuer has training in In water resuscitation start ventilation in water

Below is the IWR (In Water Resuscitation) guidelines

• Check if the child is breathing or conscious in the water.
  • If the child is breathing quickly swim back and get the child out of the water.
  • If the child is not breathing then give rescue breaths if spinal trauma is suspected then try to immobilize the spine while opening the airway and try to reach the shore as soon as possible.
  • If the distance to reach the shore is more than 5 minutes, try to give one more rescue breath 12-16 breaths/minute.