BASIC LIFE SUPPORT - PAEDIATRIC

BASIC LIFE SUPPORT - PAEDIATRIC First Issued by/date BKW PCT May 2003 Issue Version Purpose of Issue/Description of Change 3 Policy reviewed. No changes in procedure or legislation since policy revised 12 months ago. Policy remains unchanged. Planned Review Date August 2011 Named Responsible Officer: - Resuscitation Group Approved by Date General Policy Provider Services Governance Group Impact Assessment Screening Complete- September 2006 Full Impact Assessment Required No August 2010 No 18 Key Performance Indicators Incident Reporting Root Cause Analysis

CONTENTS Page Introduction 3 Infant under 1 year 4 For a child under 12 years and over 1 year 6 Dissemination of Policy 8 Document Control 8 Related policies 8 Archiving Arrangements 8 Process for Retrieving Archived Documents 8 Monitoring Compliance of this Policy 8 Appendix 1 - Paediatric Basic Life Support Pathway 9 Appendix 2 Choking Pathway infants under 1 year 10 Appendix 3- Choking Children over 1 year 11 Appendix 4 Critical Incident Review 12 Reference List 12 Appendix 5 Version Control 13 2/13 Basic Life Support - Paediatric

Introduction PAEDIATRIC BASIC LIFE SUPPORT Basic Life Support (BLS) comprises the elements: initial assessment, then airway maintenance, chest compression and expired air ventilation (rescue breathing). Basic life support implies that no equipment is employed; where a simple airway or facemask for mouth to mouth ventilation is used, this is defined as basic life support with airway adjunct. The purpose of BLS is to maintain adequate ventilation and circulation until means can be obtained to reverse the underlying cause of the arrest. It is therefore a holding operation, although on occasions, particularly when the primary pathology is respiratory failure, it may itself reverse the cause and allow full recovery. Failure of the circulation for three to four minutes (less if the child is initially hypoxemic) will lead to irreversible cerebral damage. Delay, even within that time, will lessen the eventual chances of a successful outcome. Emphasis must therefore be placed on rapid institution of basic life support by a rescuer, who nonetheless should follow the recommended sequence of action. In paediatric cases five rescue breaths should be administered prior to the commencement of chest compressions. The following is advised in accordance with the Resuscitation Council (UK) 1. For non-healthcare Professionals: Ratio 30 chest compressions to 2 ventilations 2. For Healthcare Professionals working on their own: Ratio 30 chest compressions to 2 ventilations 3. For Healthcare professionals working with other Healthcare Professionals present: Ratio 15 chest compressions to 2 ventilations Definitions Paediatric Basic Life Support Age definitions are now as follows : Infant under <1 year old Child is between 1 year and up to Puberty No need to diagnose puberty if you think that the patient is a child then treat them as one 3/13

INFANT UNDER 1 YEAR Action Is it safe to approach Check response do not shake Infant unresponsive Shout for help Ensure head tilt in neutral position and chin lift Check breathing 10 seconds Take a breath and cover mouth and nasal apertures of the infant with your mouth, making sure you have a good seal. In a larger infant, if the mouth to mouth-an-nose method is difficult, try the mouth to nose technique. In this, the adult s mouth is placed over the infant s nose and rescue breathing attempted. It may be necessary to close the infant s mouth during rescue breathing to prevent air escaping Rationale Summon emergency services as soon as possible Airway patentcy Crichoid cartilage not fully developed in infants Airway patentcy To ensure adequate oxygenation Blow steadily into the infant s mouth To ensure adequate ventilation and and nose over 1 1.5 seconds sufficient to make the chest visibly rise To ensure air going into the infants lungs Maintain head tilt and chin lift, take your mouth away from the infant and watch for his chest to fall as air comes out To ensure adequate ventilation To ensure air going into the infants lungs Take another breath and repeat this sequence 5 times If you have difficulty achieving an effective breath, the airway may be obstructed Recheck that there is adequate head tilt and chin lift but also that the head is not over extended Try jaw thrust method Recheck the infant s mouth and remove any obstruction. No blind finger sweeps If still unsuccessful, move on to foreign body airway obstruction sequence To ensure adequate ventilation and To ensure air going into the infants lungs 4/13

Action Feel for brachial pulse on the inner aspect of upper arm Take no more than 10 seconds Assess Infant for signs of circulation Swallowing, coughing or spontaneous breathing Rationale To monitor respiration and circulation If heart rate over 60 beats per minute: To ensure adequate oxygenation of continue rescue breathing,if vital organs necessary, until the infant starts breathing effectively on their own Recheck regularly every 10 breaths To ensure adequate oxygenation of vital organs If the infant starts breathing normally To maintain airway on his own but remains unconscious put him in the recovery position If there are no signs of a circulation or unsure or less than 60 after 5 rescue breaths start chest compression 1 finger breath above xiphysternum. To ensure adequate oxygenation of Tips of fingers if lone rescuer. Thumbs vital organs if two or more With the tips of two fingers, press down on the sternum to depress it approximately one third to one half of the infant s chest approx 2-3 cms Release the pressure then repeat at a rate of about 100 times a minute After 15 compressions tilt the head, lift the chin in to the neutral position and give 2 effective breaths Return your hands immediately to the correct position on the sternum and give 15 further compressions Continue compressions and breaths in a ratio of 15:2 until help arrives (30:2 may be acceptable when you are the lone rescuer) Resus for 1 minute and if still alone go for help yourself To ensure adequate oxygenation of vital organs 5/13

FOR A CHILD UNDER PUBERTY AND OVER 1 YEAR Action Rationale Check safe to approach Summon emergency services as soon Child unresponsive summon help as possible Ensure head tilt and chin lift sniffing the Airway patentcy morning air Check breathing for 10 seconds Pinch the soft part of his nose closed with the index finger and thumb of your hand on his forehead Airway patentcy To ensure adequate oxygenation Open his mouth a little, but maintain To ensure adequate ventilation and chin lift Take a breath and place your lips To ensure air going into the Childs around his mouth, making sure that you lungs have a good seal Blow steadily into his mouth over about 1 1.5 seconds watching for his chest to rise Maintain head tilt and chin lift, take your To ensure adequate ventilation and mouth away from the child and watch for his chest to fall as air comes out air going into the child s Take another breath and repeat this sequence 5 times Recheck that there is adequate head tilt and chin lift but also that the neck is not over extended. Try the jaw thrust method If still unsuccessful, move on to foreign body airway obstruction sequence If you are confident that you can detect signs of a circulation (or a pulse over 60 beats per minute if you have been trained to do so) within 10 seconds: continue rescue breathing, if necessary, until the child starts breathing effectively on his own re-check regularly for signs of a circulation taking no more than 10 seconds To ensure lungs If still unsuccessful, move on to foreign body airway obstruction sequence To ensure adequate ventilation and To ensure air going into the child s lungs 6/13

Action Rationale If the child starts to breathe normally on To maintain airway until help arrives his own but remains unconscious turn him into the recovery position. Be ready to turn him onto his back and re-start rescue breathing if he stops breathing If there are no signs of a circulation, or you are at all unsure: (or the pulse rate is very slow less than one per second To ensure adequate ventilation and To ensure cardio-pulmonary ie. 60 per minute and there are signs of poor ie. Unresponsive, immobile)start chest compression combine rescue breathing and chest compression Locate and place the heel of one or two To ensure adequate ventilation and hands 1 finger breaths above the xiphysternum (breast bone) ensuring To ensure cardio-pulmonary that you do not compress on or below the xiphysternum Lift the fingers to ensure that pressure is To avoid possibility of fractures to the not applied over the child s ribs ribs Position yourself vertically above the chest and, with your arm straight, press down on the sternum to depress it approximately one third to one half of the depth of the child s chest To ensure adequate ventilation and To ensure cardio-pulmonary Release the pressure, then repeat at a rate of about 100 times a minute After 15 compressions tilt the head, lift To ensure adequate ventilation and the chin and give 2 effective breaths Return your hand immediately to the correct position on the sternum and give 15 further compressions Continue compressions and breaths in a ratio of 15:2 until help arrives To ensure cardio-pulmonary To ensure adequate ventilation and To ensure cardio-pulmonary Resuscitate for one minute and if still To facilitate effective resuscitation and alone go for help yourself avoid rescuer tiredness 7/13

Dissemination of this Policy This Policy will be available for staff via the intranet. Document Control It is the responsibility of the policy author to ensure archive of old versions of policies and ensure distribution of new versions of policies. Related policies Health Records Policy Incident Reporting Policy Archiving Arrangements Policies need to kept for a minimum of 10 years (DOH 2006 Records Management: NHS Code of Practice) for litigious purposes. It is important that the version of the policy is clearly recorded on the front cover of the policy. First issue relates to the organisation which first issued the policy. This is important when NHS organisations change in case of future claim or complaint. In which case, it is the policy in place at the time of an incident which is used to defend a case. Process for Retrieving Archived Documents When a new version of an existing policy has been distributed for dissemination the team leader or individual responsible for the policy file within each team will need to replace the old policy version for the new one, fill in the version control sheet (Appendix 5 for a worked example) and shred the old copy once instructed to do so by the policy author. Monitoring Compliance of This Policy The Key Performance Indicators identified on the front of this policy will be used to monitor compliance with this document. It is the responsibility of the author of the policy to ensure that they are a robust test of compliance. The policy content will dictate the monitoring questions to be asked. 8/13

Appendix 1 ENSURE SAFE TO APPROACH Paediatric Basic Life Support Unresponsive Open the Airway Check Breathing 10 secs Not breathing normally 5 Rescue breaths Still unresponsive? 10 secs (No signs of a circulation) 15 Chest Compressions 2 Rescue Breaths 9/13

APPENDIX 2 Choking Child under the age of 1 year 10/13

APPENDIX 3 Choking Child Over 1 year Assess severity Severe Airway obstruction (Ineffective cough) Mild Airway obstruction (Effective cough) Unconscious Start CPR Conscious 5 back blows 5 abdominal thrusts Encourage cough Continue to check For deterioration to ineffective cough or relief of obstruction Source : Resuscitation Council (UK) 2005 11/13

APPENDIX 4 Critical Incident Review Each resuscitation attempt must be recorded on a PCT incident form to monitor and improve standards of practice Training PCT Paediatric BLS trainer It is mandatory for all registered ( this is to include nursery nurses) staff that have a client/ patient group which includes children and infants attend a bi- annual Paediatric Basic Life Support session with the exception of the of local agreed services where annual updates are required such as Wirral Walk In Centres, Community Dentistry, Care of the Next Infant (CONI) advisors etc Training programmes will be organised through the Training Department Records of Paediatric BLS training for individuals and their working areas will be maintained on a database at the Training Department All new members of staff that have a client/ patient group which includes children and infants should read this policy as part of their induction programme All new members of staff have a client/ patient group which includes children and infants should have access to Paediatric BLS training as soon as possible after commencing work It is the responsibility of the individual member of staff and their line manager to ensure Paediatric BLS skills are updated Health Visitors Health Visitors who teach Paediatric BLS to parenting groups must initially undertake the Appointed Person First Aid Training Day with yearly updates to maintain their skills. Reference List Resuscitation Council Guidelines (UK) (2005) Resuscitation Guidelines 2005, Adult Basic Life Support, London Resuscitation Council (UK), 9-20 Advanced Life Support Group (ALSG) Advanced Paediatric Life support Provider Manual The Practical approach 4 th edition (2005). Basic Life Support, Oxford, Blackwell Publishing Ltd 4:21-36 12/13

Appendix 5 Example - Version Control Sheet Version Number Date of Removal Author Name Status Live/outdated Shredded Yes/No Replacement Number Comments Signature 1 1/1/2009 Maggie Johnson Outdated Yes 2 1/13 Basic Life Support - Paediatric