Complex Care Hub Manual Section: Basic Life Support

Transcription

1 Cmplex Care Hub Manual Sectin: Basic Life Supprt Table f Cntents 1. What is basic life supprt? D.R.S.A.B.C.D Danger Respnse Send fr help Airway Breathing Cmpressins Ding cmpressins Muth t mask ventilatin Abut the pcket mask Rescue breathing using the mask Bag and mask ventilatin Rescue breathing using the resuscitatin bag and mask... 9 What yu will need:... 9 Image 3: Example Rescue breathing using the resuscitatin bag and mask Defibrillate Management f a chking child Partial airway bstructin Severe airway bstructin Child is cnscius with a cmpletely blcked airway Child becmes uncnscius after chking Calling an ambulance Making the call T assist the ambulance fficers If the child is taken t hspital Special circumstances Children with Gastrstmy tubes Children wh have suctin available Children wh have xygen available Versin 4.0 Date revised Octber, 2016 Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see Page 1 f 15

2 1. What is basic life supprt? Basic life supprt is where a persn r peple prvide rescue effrts t keep anther persn alive until medical fficers can take ver. The hme care nurses will teach it t yu (the supprt wrker) using the D.R.S.A.B.C.D methd. Children wh have trachestmy tubes are nt cvered under this manual chapter. Please refer t the Cmplex Care Hub Manual chapter: Basic Life Supprt fr Children with a Trachestmy. This sectin is written t fllw the 2016 Australian and New Zealand Cmmittee n Resuscitatin (ANZCOR) guidelines ( Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see Page 2 f 15

3 2. D.R.S.A.B.C.D 2.1 Danger Check the area and make sure there is n danger t yu, the child r thers. If needed and if it is safe either remve the danger r remve yurself/thers frm danger. 2.2 Respnse Check fr a nrmal respnse by tuching and talking t the child. Never shake a baby r child. Tuch: Fr a baby under 1 year: firmly squeeze their earlbe Fr a child ver a year firmly squeeze their Trapezius muscle (nurse will demnstrate). Talk: Call the child s name, give them a simple cmmand such as pen yur eyes. Clap yur hands ludly. If the child is respnding nrmally 1. Check Airway, breathing, circulatin 2. Turn the child nt their side (recvery psitin) If they d nt respnd nrmally: Place them n their back n the grund, r in their bed (need a backing bard/hard surface, under them). 2.3 Send fr help Ring 000 r ask anther adult t d s. Keep the 000 peratr n ludspeaker t assist yu 2.4 Airway 1. Open the child s airway may be all yu need t d t start them breathing again. The airway psitin used depends n the child s age and size. Age/weight f Child Required head psitin Example picture Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see Page 3 f 15

4 Infant (birth t 1 year) Neutral psitin straight/n head tilt Place the child flat n their back. Start in neutral psitin putting ne hand n the frehead, tw fingers under the chin t maintain psitin. Yung Child 1-8 years (r under 25 kg) Sniffing psitin slight head tilt Place the child flat n their back Start in neutral psitin Mve the head int a sniffing psitin by putting ne hand n the frehead, tw fingers under the chin (n the bne, nt the sft tissue) and lifting. This is knwn as a head tilt, chin lift mvement. Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see Page 4 f 15

5 Older child/ adult 8-14 years( r ver 25 kg) Extensin full head tilt Place the child flat n their back Start in neutral psitin Mve the head int a full head tilt psitin by putting ne hand n the frehead, tw fingers under the chin (n the bne, nt the sft tissue) and lifting. This is knwn as a head tilt, chin lift mvement. All ages Jaw thrust can be if yu think the child has a spinal injury r if the head is difficult t keep in psitin Grasp the angle f the lwer jaw (bny part that nurse will shw yu) and lift with bth hands ne n each side mving the jaw frward. If lips are clsed pen the lwer lip with yur thumb. Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see Page 5 f 15

6 2. Check the muth and nse fr freign material such as vmit, fd, small bjects. If freign material can been seen turn the child nt their side with their muth pen and head slightly dwnward t let gravity assist the clearance f any freign material. If yu have suctin available yu can use this t clear the muth/nse. If yu can see smething blcking the airway yu can nly remve it under direct visin using a pincer grip; a blind finger sweeps shuld never be used as yu may further blck the airway. Turn the child t their back and pen their airway when the freign material is remved r if yu are unable t remve the freign material under direct visin. 2.5 Breathing Opening the airway may help the child t breathe again. After pening the airway check if the child is: Breathing nrmally T check if the child is breathing nrmally Lk fr the rise and fall f the chest Listen fr breath sunds Feel fr air cming ut f their nse and muth If the child is nt breathing nrmally and is unrespnsive start cmpressins. If the child is breathing nrmally place them in the recvery psitin and cntinue t watch them clsely. If they stp breathing nrmally begin chest cmpressins befre giving breaths. 2.6 Cmpressins Cardiac cmpressins are when the rescuer (persn perfrming cardiac cmpressins) uses a push and release actin t put t help make the heart beat (cntract) which helps t mve bld arund the bdy. 30 cmpressins fllwed by 2 breaths Keep n ding cmpressins and breaths until the child is respnsive and breathing nrmally r the ambulance arrives and the ambulance fficers take ver 2.7 Ding cmpressins 1. Place the child n their back n a hard surface, such as the flr, r in bed with a backbard behind them. 2. Place fingers r hands n the centre f the chest (see table 1 and pictures belw fr the right technique). 3. Keep yur elbws straight, push dwn n the chest abut ne third f the depth f the chest and then release (up and dwn actin). Use smth rhythmical cmpressins, keeping yur hands n the child at all times. 4. Pace yur cmpressins at a rate f 120 per minute (tw cmpressins every secnd). 5. Give 30 cmpressins fllwed by tw breaths Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see Page 6 f 15

7 Yu must stp the cmpressins t give the tw breaths Yu must prvide tw breaths fr infants/children Nte: If smene else is available ask them t get the resuscitatin mask/resuscitatin bag and mask s that yu can start cardiac cmpressins straight away. If nbdy else is with yu and yu d nt have the breathing equipment immediately available this after the first 30 cardiac cmpressins have been given. 6. As sn as yu have given the tw breaths restart the cmpressins 7. Cntinue the cmpressins and breaths until the child becmes respnsive and is breathing nrmally r an ambulance fficer tells yu t stp. If the child becmes respnsive and is breathing nrmally stp cmpressins and rescue breathing. Place them in the recvery psitin and cntinue t watch them clsely. If they stp breathing nrmally and becme unrespnsive again then restart BLS. Age/weight f Child Infant (birth t 1 year) Hand psitin Tw fingers (tw thumb encircling technique can be used with 2 rescuers) Centre f chest Lwer half f breastbne (sternum) Hand Psitin example picture Yung Child 1-8 years (r under 25 kg) Heel f ne r tw hands Centre f chest Lwer half f breastbne (sternum) Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see Page 7 f 15

8 Older child/ adult 8-14 years( r ver 25 kg) Tw hands, ne n tp f the ther Centre f chest Lwer half f breastbne (sternum) NB: Yu need t cmpress the chest 1/3 depth. Fr an infant: If yu can t d this with tw fingers then use the ne hand technique. Fr a child: If yu can t d this with ne hand then use the tw hand technique. Giving breaths t children The mst cmmn reasn a child needs basic life supprt is that they stp breathing r dn t breathe well enugh t keep gd xygen levels in their bdy. This is called a respiratry arrest. Adults are mre likely t have a heart attack r cardiac arrest. 1. Muth t mask ventilatin 1.1 Abut the pcket mask The pcket mask is used as a barrier between the care wrker and child when cmpleting rescue breathing. It is latex free. 1.2 Rescue breathing using the mask Prcedure 1. Remve the mask frm it s cntainer 2. Cnnect the ne-way valve t the mask 3. Open the child s airway 4. Place the mask n the child s face with the pinted part at the bridge f the nse. The mask must cver the nse and muth. 5. Use bth hands t hld the mask in place, this will help t create a seal between the mask and the child which makes sure there is nwhere fr the air t leak ut 6. Place yur muth n the ne way valve and blw gently. Remve yur muth frm the valve s that yu can take a breath and the child can breathe ut 7. When yu blw in the ne way valve, lk at the child s chest and make sure that the chest rises. If it des nt rise then repsitin the child s airway and mask and try again Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see Page 8 f 15

9 8. Yu must take yur muth ff the ne way valve s that the child can breathe ut 9. Yu dn t have t remve the mask fr the child t breathe ut 10. If the child vmits: Remve the mask Clear the child s airway. Place child in recvery psitin t aid vmit drainage frm muth. Reassess breathing. Shake the mask t remve vmit Blw thrugh the ne way valve t clear it Cntinue muth t mask breathing if child nt breathing Image 2: Example f rescue breathing using a mask 2. Bag and mask ventilatin 2.1 Rescue breathing using the resuscitatin bag and mask Fr infants under r up t 20 kg (Aged 4-6 years) in weight use a 500ml (medium) bag. Children ver 20kg (Aged 4-6 years) use a 2L (large) bag. What yu will need: Resuscitatin bag Resuscitatin mask Prcedure 1. Attach bag t the mask 2. Place resuscitatin mask ver the infant/child s muth and nse with the pinted part f the mask at the bridge f the nse. Check fr a gd seal between the mask and the infant/child s face 3. Ensure the infant s head is in a neutral psitin and that the child s head is in a sniffing psitin whilst mask is n their face. Jaw thrust may be achieved by maneuvering jaw with the hand hlding the mask. Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see Page 9 f 15

10 4. While hlding the mask n the infant/child s face, squeeze the bag and then release the bag 5. While squeezing the bag watch t see if the infant/child s chest rises. If it desn t rise, recheck the psitin f the mask and head and then try squeezing the bag again 6. Yu dn t have t take the mask ff the child t let the child breathe ut 7. If the infant/child starts spntaneusly breathing regularly with clear rise and fall f the chest, then remve the mask frm the infant/child s face as it is difficult fr them t breathe n their wn with this in place. Place them int recvery psitin n their side, a yunger infant may be held Image 3: Example Rescue breathing using the resuscitatin bag and mask 1.1 Defibrillate If an AED (autmatic external defibrillatr) is available fr the child yu care fr fllw the instructins fr use detailed in the defibrillatin guidelines. 3. Management f a chking child Children chke when there is smething blcking their airway. Chking and suffcatin are majr risks fr babies and tddlers, because their airways are small and easily blcked, they are als ften nt able t remve the blckage themselves. If yu bserve a child chking, call 000 as sn as pssible. 3.1 Partial airway bstructin This means that the child s airway is partly blcked. As air can still pass thrugh the narrwed airway the child will still be breathing. They may be cughing, crying and in distress. There als may be sme clur change and excessive dribbling. Fd, tys and vmit can blck an airway Managing a partial airway bstructin If the child can cugh well (effectively) it is a partial bstructin Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see 15 Page 10 f

11 Reassure the child and encurage them t keep cughing d nt try t assist them in any ther way Cntinue t watch the child until they get better If the child gets wrse call an ambulance 000 (if yu have nt already dne s) and fllw the steps fr a severe airway bstructin 3.2 Severe airway bstructin This means that the child s airway is cmpletely blcked and that they can t clear it n their wn (unable t cugh). This means that they are n lnger breathing. If the blckage isn t remved the child s xygen level will drp and they will becme uncnscius. If it is safe t attempt then yu may try t remve any freign bdy e.g. fd, either by suctin (if available) r by turning the child n their side and letting anything drain ut. If suctin is nt available and the blckage is visible fllw this prcedure: Prcedure 1. Place the child int the recvery psitin 2. Using yur pinter finger and yur thumb grasp the bject under direct visin. Never blindly place yur fingers in the child s muth. 3. Pull the bject ut f the muth 4. Assess the child t see if they are breathing nce bject is remved. Mnitr fr signs f bleeding r airway swelling. If unable t remve bject and child is still cnscius, call an ambulance and mve nt back blws and chest thrusts (detailed 8.3) 3.3 Child is cnscius with a cmpletely blcked airway 1. Call an ambulance Start back blws, see table 2 Table 2 Back blws fr an Infant (less than ne year) Place infant face dwn acrss yur knees keeping their head lwer than their chest Back blws fr a child (lder than ne year) If child is able sit, place them n a chair and get them t bend frward. If they are in a wheelchair then lean them (nt the chair) frward, supprting them s they dn t fall t far frward. Or lie them n the flr in the recvery psitin Give ne back blw. Use the heel f yur hand t give a firm back blw between the infant s shulders, pushing upwards as yu give the back blw Check the child after the back blw t see if the freign bdy has cme ut Give ne back blw. Use the heel f yur hand t give a sharp back blw between the child s shulders, pushing upwards as yu give the back blw Check the child after the back blw t see if the freign bdy has cme ut Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see 15 Page 11 f

12 Give up t 5 back blws, checking the infant between each ne Give up t 5 back blws, checking the child between each ne Image 7 Example f back blws fr a child (lder than ne year) If the five back blws haven t gt the freign bdy ut then start chest thrusts (table 3) Table 3 Chest thrusts fr an infant (less than ne year) Place infant face up acrss yur knees r arms, supprting their head and keeping the head lwer than their chest Use tw fingers t give a chest thrust. This is the same finger psitining/technique as cardiac cmpressins but slwer and sharper Check the child after each chest thrust t see if the freign bdy has cme ut Give up t 5 chest thrusts, checking the child between each ne Chest thrusts fr a child (lder than ne year) Lie the child n the flr n their back, r sit them in a chair with their back against the back f the chair and chair against a wall (if in a wheelchair push the chair up t the wall and put breaks n) Use the heel f ne hand t give a chest thrust. This is the same hand psitining/technique as cardiac cmpressins but slwer and sharper Check the child after each chest thrust t see if the freign bdy has cme ut Give up t 5 chest thrusts, checking the child between each ne Cntinue t give alternating back blws and chest thrusts until the ambulance arrives, r the child becmes uncnscius (see belw) Nte: If the freign bdy cmes ut during a chest thrust and the infant/child is n their back place them in recvery psitin s that the freign bdy desn t fall back int their airway. Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see 15 Page 12 f

13 3.4 Child becmes uncnscius after chking Start cmpressins and rescue breathing (BLS) Cntinue BLS until an ambulance arrives r the child is respnsive and breathing nrmally again 4. Calling an ambulance 4.1 Making the call Stay calm Dial 000: ask fr an ambulance Or if yu have a speech r hearing disability dial 106 Natinal Relay Service Be prepared t answer the fllwing questins Where is the lcatin f the emergency? What is the telephne number yu are calling frm? What is the prblem? (What exactly happened?) Wh is hurt and hw many? Hw ld is the patient? Is the patient cnscius? Is the patient breathing? D nt hang up. The phne peratr will give yu instructins; yu may be asked further questins. If the child is registered with MICA please let the peratr knw (the nurse will infrm yu f this during yur training). 4.2 T assist the ambulance fficers Answer calmly and accurately Identify the prperty clearly - give the nearest intersectins r street names If pssible, and nly if there are enugh helpers available: have smene wait utside the lcatin t direct ambulance fficers t the emergency Have any f the child s medicatins available. Find ut the child s apprximate weight frm parent/carer and if they have any allergies. Put any dgs away 4.3 If the child is taken t hspital Once the ambulance arrives, the supprt wrker is n lnger respnsible fr the care f the child as this passes t the ambulance fficers The supprt wrker must nt make any medical decisins in relatin t the child r give any directins as t the care f the child but may prvide the ambulance fficers with infrmatin abut the child s care needs and current cnditin Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see 15 Page 13 f

14 If a child s parents are nt present, supprt wrkers are required t stay with the child until the ambulance leaves t take the child t hspital Supprt wrkers must nt travel in the ambulance with the child r attend t their care in the hspital setting. Shuld the child need t be transprted t hspital by ambulance the supprt wrker is n lnger required t remain with the child, but will be paid fr the duratin f their scheduled shift 5. Special circumstances 5.1 Children with Gastrstmy tubes During rescue breathing air can be accidentally frced int the stmach when giving rescue breaths. Air in the stmach can cause the child t vmit and make it hard t give breaths t the child. If yu are ding rescue breathing t a child with a gastrstmy and yu have extra peple t help yu, the air can be remved (vented) by pening the gastrstmy tube. If the child has a Mic-Key r Bard buttn then yu must attach the crrect venting tube t let the air ut. If the tube isn t attached then the air can t cme ut. Remember that ABC (airway, breathing, circulatin) are the mst imprtant things. Only vent the tube if yu have extra help. 5.2 Children wh have suctin available If the child that yu are ding BLS n has suctin available then yu can use the suctin t clear the airway if needed If the child is chking n a freign bdy yu can use suctin t try and remve the freign bdy. 5.3 Children wh have xygen available While ding BLS, xygen can be attached t the resuscitatin bag t help with rescue breathing. If xygen is available, attach the xygen tubing t the resuscitatin bag with a reservir and turn n the xygen flw: 1. Medium bag: litres f xygen 2. Large bag: 15 litres f xygen Nte: Children with certain medical cnditins shuld nt have high flw f xygen attached, even in an emergency. If the child that yu care fr has a strict maximum flw f xygen then d nt turn the xygen any higher than the maximum but d attach the xygen tubing t the resuscitatin bag. Image 8 Example f medium bag Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see 15 Page 14 f

15 Cmplex Care Hub, Ryal Children's Hspital. This dcument is subject t a disclaimer, see 15 Page 15 f