# Basic Life Support- Child & Infant

## Overview

This module describes how to resuscitate a child or infant in cardiac arrest using a simple algorithmic approach.

## Indications

1. Unresponsive patient

## Contraindications

1. None

## Patient information & consent

This procedure is done during an emergency, so consent is generally implied.

## Preparation

Basic life support is an emergency procedure.

In hospital, always:

1. Know where defibrillators, transcutaneous pads, and red trolleys are kept. Know the relevant staff and keep your seniors’ contact details close at hand.
2. Familiarise yourself with the defibrillators in your work area. Check that they are maintained regularly and have pads and the correct connections.
3. Keep unstable patients in resuscitation bays with continuous monitoring.

In out of hospital situations:

1. Carry gloves and a CPR protective device.
2. In public places such as airports and malls, look out for AEDs and first aid stations attached to walls.
3. Memorise emergency phone numbers, or keep them on your cell phone, to call for help.

## Site & Positioning

To perform Basic Life Support, a patient should be lying flat on their back on a firm surface. There should be space behind the head of the bed for staff to stand to give rescue breaths.

## Procedure

Use medical asepsis with non-sterile gloves.

1. Hazards
   Hazards

   Check that the scene is safe for you and the patient. Look for any body fluid spills, trip hazards etc. which is more likely in out-of-hospital scenarios. Put on gloves. Follow Transmission-Based Precautions as required.

2. Hello: Tap the patient’s shoulder and shout “Hello/Are you okay!”. Look for a

   response
   response

   If the patient responds, stop the BLS algorithm.

   .

3. Help: If unresponsive, shout for nearby help.

   - Hospital: alert other healthcare providers or activate the emergency response system.
   - Prehospital: activate Emergency Medical Services (“CPR in progress”), and send someone to direct the ambulance on arrival.
   - If alone, get the AED/Defibrillator and emergency equipment. If someone else is available, send them to get it.

4. Assess for 10 sec by simultaneously feeling the pulse and checking for breathing

   - Breathing: with ear close to mouth, scan the victim’s chest for rise and fall
   - Pulse: Palpate the carotid pulse on the side closest to you for at least 5 but no more than 10 sec.

5. If the patient is

   - breathing normally and has a pulse: place in recovery position and monitor until help arrives
   - not breathing normally but has a pulse: provide rescue breaths at 1 assisted breath every 2-3 seconds (about 20-30 breaths per minute) with basic airway manoeuvres
   - not breathing normally and has no pulse: immediately start CPR.

6. If starting CPR:

   - One rescuer - 30 Chest compressions: 2 Breaths
   - Two rescuers - 15 Chest compressions: 2 Breaths
   1. Give compressions at a rate of almost 2 compressions/sec, or 100-120 compressions/min. Minimise interruptions.
   2. Open the airway using a head-tilt chin-lift or jaw thrust.
   3. Give rescue breaths at 1/sec looking for chest rise.

7. Repeat step 6 until the defibrillator or AED arrives and follow the algorithm, keeping in mind that cardiac arrest in children and infants are often due to airway and breathing problems. If defibrillation indicated: deliver shock and resume CPR immediately after defibrillation. If not, resume CPR.

8. Continue CPR in cycles of 2 min or until prompted by AED to check rhythm. Continue until signs of life are present, or until your senior declares death.

## Troubleshooting

I don’t have a CPR protective device for mouth-to-mouth breaths.

Give hands-only CPR (continuous compressions without breaths) until equipment such as a BVM resuscitator arrives.

I’m unsure about the quality of my chest compressions.

Check the following:

1. Centre compressions on the lower half of the sternum, compressing ⅓ of the depth of the chest.
2. Ensure good chest recoil (don’t lean on the chest between compressions).
3. Your shoulders should be directly above your hands, elbows straight.
4. Stand on a step or kneel on the bed so that your hips are higher than the patient’s chest.
5. Minimise interruptions.
6. Change chest compressors every 2 min to avoid fatigue.

I’m unsure about the quality of my rescue breaths.

Ensure correct head position. Consider using an oropharyngeal or nasopharyngeal airway. Ensure that you are pulling the face into the mask using an EC grip, rather than leaning on the patient’s face. Continuously monitor chest rise.

My patient is moving but I still can’t find a pulse.

Patients in cardiac arrest may have movements such as twitching or writhing. If there is no pulse and the patient is not responding to your prompts, continue CPR.

I heard something crack under my hands.

Rib and sternal fractures are not uncommon. Continue CPR, but ensure your hand placement is correct.

There are no child pads in the defibrillator.

Adult pads can be used on children. Ensure that the pads are not touching each other.

## Risks

1. Unsuccessful CPR
2. Bruising
3. Rib/sternal fractures
4. Pneumothorax
5. Defibrillator burns
6. Healthcare worker exposed to infectious substances

## References

1. Resuscitation Council of Southern Africa. Basic Life Support Algorithm. 2021.