Cmplex Care Hub Manual: Basic Life Supprt fr Children with a Trachestmy This Manual is written t fllw the 2016 Australian Resuscitatin Cuncil guidelines (www.resus.rg.au) and the RCH Clinical Practice Guidelines Table f Cntents 1. Basic life supprt... 2 2. D.R.S.A.B.C... 2 2.1 Danger... 2 2.2 Respnse... 2 2.3 Send fr help... 2 2.4 Airway... 2 2.5 Breathing... 2 2.6 Cmpressins... 3 2.7 Defibrillate... 3 3. Rescue breathing Techniques... 4 3.1 Breathing thrugh the ne way valve... 4 3.2 Rescue breathing using the resuscitatin bag... 5 3.3 Giving breaths when unable t re-insert Trachestmy after an emergency change... 6 3.4 Psitining fr breaths via the upper airway... 6 4. Cardiac cmpressins... 7 4.1 Hw t d cardiac cmpressins... 7 5. Management f a Blcked Trachestmy tube... 9 5.1 Partial airway bstructin and child is respnsive... 9 Signs f a partial blckage:... 9 5.2 Managing a partial airway bstructin... 10 5.3 Severe airway bstructin child is respnsive... 10 5.4 Signs f a cmplete blckage:... 10 5.5 Emergency care f a blcked single cannula trachestmy... 10 5.6 Emergency care f a blcked inner and uter cannula trachestmy 10 5.7 Child becmes uncnscius and is nt breathing... 11 6. Calling an ambulance... 11 6.1 Making the call... 11 6.2 T assist the ambulance fficers... 11 6.3 If the child is taken t hspital... 11 Versin 4.0 Date revised 2017 next due 2019 Page 1 f 11
1. 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 nurse will teach it t yu (the supprt wrker) using the D.R.S.A.B.C methd. 2. D.R.S.A.B.C 2.1 Danger Check the area and make sure there is n danger t yu, the child r thers. If it is safe t d s, remve the danger r remve yurself and the child 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 shulder (trapezius) muscle 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 with a backing bard/hard surface, under their back. 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 Tilt the child s head back and lk in the trachestmy Suctin the trachestmy. If the catheter passes and suctins easily cntinue t breathing (sectin 2.5) If there are thick secretins r yu have difficulty passing suctin catheter instill 0.5ml saline and repeat suctin If yu cannt pass the suctin catheter nrmally int the trachestmy it is mst likely blcked. Cmplete an emergency tube change. (sectin 10 Trachestmy manual) Quickly check the muth and nse are clear. If it is safe t d s, 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. 2.5 Breathing Opening the airway and clearing the airway (suctining r changing trachestmy) 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: Page 2 f 11
Lk fr the rise and fall f the chest Listen fr breath sunds Feel fr air cming ut f their trachestmy If the child is nt breathing nrmally and is unrespnsive give tw breaths int the trachestmy tube using the resuscitatin bag r ne way valve. Watch t see that the chest rises and falls (see sectin 3 fr a full explanatin f breathing techniques) If the chest des nt rise and fall and yu have nt already dne this: d an emergency trachestmy change- see Sectin 10 in Lking after a child with a Trachestmy Cre Manual. If the chest des nt rise and fall and yu have dne an emergency tube change mve nt cmpressins. If the child remains unrespnsive and nt breathing nrmally, 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 return t DRSABC 2.6 Cmpressins 30 cmpressins fllwed by 2 breaths (see sectin 4 fr descriptin n cmpressins) 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 Defibrillate If an AED (autmatic external defibrillatr) is available fr the child yu care fr fllw the instructins fr use as supplied by the machine manufacturer (nt trained by RCH). Page 3 f 11
3. Rescue breathing Techniques 3.1 Breathing thrugh the ne way valve Open the airway by placing the child n their back. Then place a rlled twel (r similar) under shulders fr better access t trachestmy. Attach the ne-way valve t the trachestmy (the valve nly fits ne way) The end with the lip is the end yu give breaths int Place yur muth n the ne way valve and blw gently int the valve, watching t see that the child s chest rises. Then remve yur muth frm the valve s that the child s chest can fall (exhale). Yu dn t have t take the ne way valve ff fr the child t breathe ut If the child s chest des nt rise: Cver the child s muth and nse with yur hand t stp air cming ut Suctin the trachestmy (remve the ne way valve t suctin) Cmplete emergency tube change if yu haven t already dne this Cntinue nt chest cmpressins If the child vmits and the ne way valve gets vmit n/in it Remve the ne-way valve Clear the child s airway by suctining the trachestmy and muth (as needed) Shake the valve t remve vmit Blw thrugh the ne-way valve r rinse with water t clear it Cntinue muth t ne way valve rescue breathing The ne-way valve is single use nly. Thrw it ut after yu have used it fr emergency rescue breathing when a spare is available. Image2 Example f rescue breathing using a ne way valve Page 4 f 11
3.2 Rescue breathing using the resuscitatin bag Fr infants under r up t 20 kilgrams (4-6 years) use a 500ml (medium) bag. Children ver 20 kilgrams (4-6 years) use a 2 litre (large) bag If xygen cylinder with high flw meter is available attach it t the resuscitatin bag and turn n the xygen t 15 litres Open the child s airway using head tilt and rlled twel (r similar) under shulders if easily available Attach bag t the trachestmy If air can escape thrugh the child s muth and nse, cver them with ne hand Squeeze the bag and then release the bag While squeezing the bag watch t see if the child s chest rises If the child s chest des nt rise: Check that yu are squeezing the bag hard enugh Check t make sure the air isn t escaping ut the muth r nse Check the bag is cnnected prperly t the trachestmy Suctin if necessary Cmplete emergency tube change if yu haven t already dne this If yu have t d cmpressins and rescue breathing n yur wn, yu may need t remve the resuscitatin bag frm the trachestmy while ding cmpressins t stp the weight f the bag pulling ut the trachestmy. Image 3 Example f rescue breathing using the resuscitatin bag Page 5 f 11
3.3 Giving breaths when unable t re-insert Trachestmy after an emergency change If the Childs trachestmy has fallen ut and yu are unable t insert a new trachestmy fllwing all f the methds utlined in sectin 10.1 f the Trachestmy training manual yu will need t administer breaths in the fllwing way: 1. Give rescue breaths via upper airway (nse and muth), yu may need t blck r tape ver the stma if yu feel air escaping 2. If yu are unable t give breaths via the upper airway, as a last resrt give the child breaths by placing the flat face shield ver the stma and then giving muth t stma breaths 3.4 Psitining fr breaths via the upper airway Age/weight f Child Required head psitin Example picture Infant (birth t 1 year) Yung Child 1-8 years (r under 25 kg) 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. 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. Page 6 f 11
Older child/ adult 8-14 years( r ver 25 kg) Hyperextensin full 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. All ages Jaw thrust use in the event f a suspected spinal injury. Grasp the angle f the lwer Jaw and lift with bth hands ne n each side mving the jaw frward. If lips are clsed, pen the lwer lip with yur thumb. 4. Cardiac 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 4.1 Hw t d cardiac cmpressins 1. Place the child n their back n a hard surface, such as the flr, r in bed with a backbard r hardbard such as a chpping bard behind their upper middle back. Page 7 f 11
2. Place fingers r hands n the centre f the chest, lwer half (see table 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 Yu must stp the cmpressins t give the tw breaths 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 breaths. Place the child 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 fr cmpressins Tw fingers r tw thumbs Centre f chest Lwer half f sternum (breastbne) Example picture f hand psitin fr cmpressins Page 8 f 11
Yung Child 1-8 years (r under 25 kg) Heel f ne r tw hands Centre f chest Lwer half f sternum (breastbne) Older child/ adult 8-14 years (r ver 25 kg) Tw hands, ne n tp f the ther Centre f chest Lwer half f sternum (breastbne) 5. Management f a Blcked Trachestmy tube 5.1 Partial airway bstructin and child is respnsive This means that the child s airway is partly blcked. The child is still breathing, may be cughing, crying and in distress. Fd, tys, vmit and secretins can blck a trachestmy. Signs f a partial blckage: having difficulties breathing, r struggling t get their breath, breathing faster r harder the child may be restless the vice r nise frm the trachestmy may sund luder r whistle Change in clur (blue, pale, grey) If mnitred they may have a drp in xygen levels r changes t the heart rate Page 9 f 11
5.2 Managing a partial airway bstructin Reassure the child and suctin them Cntinue t watch the child and suctin trachestmy as needed using the suctin, saline (0.5ml), suctin technique as required If the child gets wrse call an ambulance 000 and fllw the steps fr a severe airway bstructin 5.3 Severe airway bstructin child is respnsive This means that the child s airway is s blcked that they can t clear it n their wn r it isn t cleared with usual suctining. If the blckage isn t remved the child will becme uncnscius and will stp breathing. 5.4 Signs f a cmplete blckage: Trying t breathe but n air mving in r ut f trachestmy breathing faster r harder the child may be restless Child may be agitated Change in clur (blue, pale, grey) If mnitred they may have a drp in xygen levels r changes t the heart rate Unable t pass suctin catheter int the trachestmy tube 5.5 Emergency care f a blcked single cannula trachestmy Prcedure: Prceed t the next step nly if the prblem is nt yet fixed 1. Perfrm hand hygiene 2. Suctin the trachestmy 3. Instil saline 0.5ml int the trachestmy cunt t 10 and suctin again 4. Insert the suctin catheter 0.5cms further than the recmmended suctin length t try and remve any mucus plug at the base f the trachestmy tube 5. Perfrm an emergency trachestmy change (refer t Emergency trachestmy change sectin 10 in the Trachestmy Manual) 6. If this des nt relieve the bstructin call an Ambulance 000 NB. Perfrm basic life supprt if child becmes unrespnsive 5.6 Emergency care f a blcked inner and uter cannula trachestmy Prcedure: Prceed t the next step nly if the prblem is nt yet fixed 1. Perfrm hand hygiene 2. Remve the inner cannula 3. Suctin the uter cannula 4. Instil saline 0.5ml int the uter cannula cunt t 10 and suctin again 5. Insert catheter 0.5cms further than the recmmended suctin length t remve any mucus plug at the base f the trachestmy tube 6. If this des nt relieve the bstructin call an Ambulance 000 Page 10 f 11
NB. Perfrm basic life supprt if required at any stage 5.7 Child becmes uncnscius and is nt breathing Call an ambulance 000 if yu have nt already dne s Cmplete an emergency trachestmy change if the trachestmy is blcked and yu haven t already dne this Start rescue breathing and cardiac cmpressins (BLS) Cntinue BLS until the ambulance arrives r the child becmes respnsive and starts breathing nrmally 6. Calling an ambulance 6.1 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 child? Is the child cnscius? Is the child breathing? D nt hang up. The phne peratr will give yu instructins; yu may be asked further questins. 6.2 T assist the ambulance fficers Answer calmly and accurately Tell the phne peratr that the child has a trachestmy Identify the prperty clearly and give the nearest intersectins r street names If pssible, 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 6.3 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 If a child s parents are nt present, supprt wrkers are required t stay with the child nly until the ambulance leaves t take the child t hspital. Supprt wrkers d nt travel in the ambulance. Page 11 f 11