european resuscitation council. summary causes of cardiorespiratory arrest bls sequence in...

European Resuscitation CouncilEuropean Resuscitation Council

Summary

Causes of cardiorespiratory arrestBLS sequence in paediatricsAED in childrenForeign body airway obstruction relieve

BLS

Recognition of a person in cardiac or respiratory arrest

Delivery of oxygen to vital organs by CPRWithout the use of adjuncts

Paediatric cardiorespiratory arrest

Secondary to hypoxia, acidosis, inappropriate perfusion

Terminal Rhythm: Bradycardia, Pulseless Electrical Activity → Asystole

Out-of-hospital arrest is « hypoxic and hypercapnic with respiratory arrest preceding asystolic cardiac arrest»

Comparison with adult arrest

Ventricular Fibrillation in children is more rare than in adult 6-9% to 15-24% (SIDS excl) of cardiac arrest

Secondary to metabolic anomaly : 4H/4THypothermia TamponadeHypoxia Toxics - drugsHyper/hypokalaemia Thrombo-embolismHypovolaemia Tension-

pneumothorax

Activation of the EMS system

In child less than 8 years

All: Drowning, Trauma, Poisonning

Single rescuer summons help (EMS)

after one minute of BLS

“call fast”

Activation of the EMS system

In child older than 8 years All: Witnessed sudden collapse,

Known cardiopathySingle rescuer summons help (EMS) immediately to provide rapid access

to AED

“call first”

SSafetyafety

Ensure rescuer’s safety firstThen ensure victim’s safety (even

trauma)Use barrier devices (infectious diseases)Look for clues of what has caused the

emergency

SStimulatetimulate

Establish responsiveness Never shake a child

Tactile stimulation• Maintaining C-spine (stabilise forehead)• Shake arm or tug hair

Verbal stimulation• Child’s name• “Wake up”• “Are you alright”

SShout for assistancehout for assistance

Single rescuer: shouts for help while remaining with the child and starts CPR

Multiple rescuers: one rescuer provides BLS while one rescuer activates EMS system

Airway

Head tilt-chin lift

To open the airway, lift the tongue that occludes the AW by

Neutral position More head extension

Airway

Jaw thrust

To open the airway, lift the tongue that occludes the AW by

Checking the airway

Look into the mouth Ensure no foreign body is presentRemove with ONE gentle finger sweepAvoid blind finger sweep

(further impaction, soft tissue damage)

Breathing

Check breathing: Look, Listen, FeelFor up to10 seconds

If the childIf the child

Is breathing spontane-

ously and effectively

Maintain AWSummon helpPlace in recovery

position

Has no detectable,

spontaneous, effective

breathingDeliver rescue breaths

Rescue Breaths

Deliver up to 5 breaths to ensure 2 effective

Slow breath : 1 to 1.5 second each Minimise gastric distension Optimise oxygen delivered

Deep rescuer’s breath between each rescue breath Optimise amount of oxygen Minimise amount of expired CO2

Rescue Breaths

Mouth-to-mouth and nose technique

Rescue Breaths

Mouth-to-mouth technique

CCirculationirculationAssess for signs of circulation

For up to 10 secondsPulse

Brachial or femoral pulse in infant

Carotid pulse in childSigns of life

Cough Movement Normal breathing (no gasp)

If signs of circulation areIf signs of circulation are

Absent or pulse is very

slow + poor perfusionDeliver external chest

compression Depress 1/3 to ½ of A/P Ø

thorax Rate : 100/min (actual 60-80

min) Ratio : 5 compressions for

1 rescue breath

Found

Reassess breathingGive rescue breaths

(20 cpm)Reassess

CCirculationirculation

ECC in Infant

Two-fingers technique Two-thumbs technique

CCirculationirculation

ECC in Child < 8 years

CCirculationirculation

ECC in Child > 8 years

Ratio 15:2

RReassess

ECC produces a palpable central pulseReassess briefly after one minute and

summon helpContinue CPR non-stop

Activate EMS System

Take the child with you to continue CPRInformations

Detailed location, phone number Type of accident, number and age of

victims Severity and urgency (ALS) Confirm reception of message

Duration of CPR

ROSC and spontaneous respirationQualified team arrivesRescuer exhausted

Automated External Defibrillator (AED)

Evaluates the victim’s ECGDetermines if a “shockable”

rhythm is presentCharges the “appropriate” doseWhen activated by operator,

delivers a shockProvides synthesised voice

prompts to assist the operator

AED in children?Class Indeterminate recommendation in children < 8 years

Recommended (Class IIb) for children older than 8 years in the pre-hospital setting (ILCOR 2000) Most arrests in young children are of respiratory origin In this class of age arrests rhythms are mainly

asystole and PEA VF may occur in up to 25% of cardiac arrest when

SIDS are excluded Prompt defibrillation is the definitive treatment for VF

and pulseless VT CPR remains the most important step of Paeds-BLS

Recommendation (Circulation 2003; July)

ILCOR consensus statement for AED in children May be used for children 1-8 years of age with no

signs of circulation Should deliver a child dose Arrhythmia detection algorithm with high specificity

for paediatric shockable rhythms (i.e not recommend shock delivery for non-shockable rhythms)

Insufficient evidence to support recommendation for or against the use of AEDs in children < 1 year of age

For single rescuer, 1 minute of CPR before any other action (i.e. activating EMS or AED attachment)

Defibrillation is recommended for documented VF/pulseless VT. (Class I)

FBAO in conscious victim

Assess breathing adequacy

If conscious level

deteriorated

5 Abdominal Thrusts

5 BackBlows

Assess Airway

CHILD

Unconscious FBAO

Algorithm

5 BackBlows

5 Chest Thrusts

Assess Airway

INFANT

FBAO in unresponsive child

Unable to achieve chest

movements on 5 attempts of

breaths

Unconscious Victim

5 Back Blows

5 Chest Thrusts

Check mouth

Open Airway

Attempt 5 Rescue Breaths

5 Back Blows

5 Chest thrusts

Open Airway

Check mouth

Attempt 5 Rescue Breaths

5 Abdominal

Thrusts

Recovery positionTo avoid the back-fall of the tongue in the

pharynx and hence obstruction of AWTo avoid risk of aspiration of vomit,

secretions…

Recovery position

Principles As near a true lateral position as possible Patent airway maintained Child easily observed and monitored Child stable cannot roll over Free drainage of vomit/secretion No pressure on chest (impeding breathing) Can be turn easily on their back for BLS

?

ConclusionsWe discuss about…

•Results of BLS

•Sequence of Paeds-BLS

•Use of AED in children

•FBAO