PERFORMING RESCUE BREATHING AND CARDIO PULMONARY

RESUSCITATION
(INFANT / CHILD)
NCM 109
RLE Skills Lab

DEFINITION
Cardio Pulmonary Resuscitation (CPR)
is the basic life-saving skill that is used in the event of cardiac, respiratory, or cardio-
pulmonary arrest to maintain oxygenation by providing external cardiac compressions and /or
artificial respiration.
Rationale
1. This life-saving skill is initiated in the event that an individual is found with or develops
the absence of a pulse or respiration or both.
2. CPR must be initiated immediately once cardiac or pulmonary arrest has occurred. Lack
of O2 to the tissue can result to permanent cardiac & brain damage within 4 - 6 minutes.
3. The basic goals of CPR, which are referred to as the CABD of emergency resuscitation:
a. Check for Circulation
b. Establish Airway
c. Initiate Breathing
d. Defibrillate
GOAL of BLS: According to AHA 2020 Guideline
ROSC: Return of Spontaneous Circulation

Equipment
OUTSIDE CLINICAL OR HOSPITAL SETTING:
• Hard, flat surface
• Body substance isolation items (gloves, face shield, mask, etc.)
• AED or automated external defibrillator
NOTE: Gloves ON and Mask ON all the time
CLINICAL SETTING:
• Hard flat surface (chest compression board)
• Personal Protective Equipment (gloves, face shield, mask, etc.
• Ambu-bag
• Oral airway (varied sizes)
• Emergency drugs
• Emergency resuscitation cart including defibrillator
• Pocket Face Mask

Planning and Implementation

GENERAL GUIDELINES:
1. Differentiate between emergency resuscitation that occurs in the hospital setting versus
those occurring in the non – clinical environment.
2. Maintain an ongoing assessment of the cardiac & respiratory status throughout
emergency resuscitation efforts.
3. Be aware of the emergency response systems available in each new environment.
4. Face masks with one way valves are recommended for trained rescuers.
5. Use a pediatric dose attenuating system for children 1-8 years of age. If not available,
and child is in cardiac arrest, a standard AED may be needed.
6. There is no recommended for or against the use of an AED in infants less than one year
of age.
7. All clients in cardiac arrest receive resuscitation unless a “do not resuscitate” order is
present. Consider the comparison on Cardio-Pulmonary Resuscitation for child and
infant.
Comparison on CPR for Child and Infant

CHILD (1 TO 8 YEARS OLD) INFANT (UNDER 1 YEAR – NOT

TO INCLUDE NEWBORN)

COMPRESSION 2 hands or 1 hand (heel of the hand)

AREA
(optional for very small child) on the lower half of the
breastbone(sternum)---CHILD
2 fingers or 2 thumbs encircling the center of the chest, just below the
nipple line.
if the rescuer is unable to achieve the recommended depth, it may be
reasonable to use the heel of one hand.—INFANT

DEPTH 1/3 of diameter) 2 inches or 5cm 1/3 of diameter) (1 ½ inches 4cm)

HOW TO HEEL OF ONE HAND OR 2 2 FINGERS

COMPRESS HANDS

RATE APPROXIMATELY 100 PER MINUTE

COMPRESSION – 30 : 2 FOR 1 RESCUER

VENTILATION
15 : 2 FOR 2 RESCUERS
RATIO

NUMBER OF 5 CYCLES FOR 1 RESCUER

CYCLES PER
10 CYCLES FOR 2 RESCUERS
MINUTE

COUNTING FOR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
STANDARDIZATION 28 29 AND 1 – THEN BREATHE, BREATHE; UP TO 5 CYCLES;
PURPOSES BREATHE, BREATHE

CHILD INFANT

OPENING OF AIRWAY HEAD TILT – CHIN HEAD TILT – CHIN LIFT

LIFT
LOCATION FOR CHECKING CAROTID PULSE BRACHIAL PULSE
THE PULSE

METHOD MOUTH - TO - MOUTH - TO - MOUTH

MOUTH OR MOUTH AND NOSE
TO NOSE

BREATHS NORMAL BREATH (1 SECOND PER BREATH)

RATE 20 BREATHS FOR 1 MINUTE (1 BREATH FOR

EVERY 3 SECONDS)

COUNTING FOR BREATHE -1, 1001, BREATHE

STANDARDIZATION
1, 1002 BREATHE
PURPOSES: MNEMONIC OF 1
BREATHE EVERY 3 FOR CHILD 1, 1003 BREATHE
OR INFANT
1, 1004 BREATHE
1, 1005 BREATHE
1, UP TO 1020, BREATHE
CPR: ONE RESCUER - CHILD (ONE YEAR OF AGE TO ONSET OF
ADOLESCENCE)

ACTION RATIONALE

1. Assess responsiveness by tapping or gently

shaking the client while shouting “are you To prevent injury & assist in assessing the level of
okay?” assess for possible injury to neck consciousness and possible etiology of crisis.
before moving the victim.

2. If unresponsive, activate the local

To prevent paralysis. Respiratory arrest is more
emergency response system if outside the
common in children than cardiac arrest.  The child
hospital.  If in hospital setting, initiate
is more likely to benefit from initiation of CPR.
agency policy for calling a code.

3. Position client in a supine position on hard,

To facilitate successful cardiac massage.
flat surface or cardiac board.

4. Apply appropriate body substance isolation

To prevent infection.
items if available

5. Open airway by slight head tilt-chin lift To initiate a patent airway for successful artificial
method respirations.

6. Assess for breathing: look, listen and feel To prevent potential injury, CPR should not be
administered to a client with spontaneous
for air movement (10 seconds)
respiration or pulse.

7. Give rescue breaths if the victim is not To prevent air leakage.

breathing. Occlude nostrils with the thumb
and index finger of the hand on the  
forehead that is tilting the head. Form a seal
over victim's mouth or appropriate To confirm open airway.
respiratory assistive device and give two
breaths that make the client rise.  

8. Palpate carotid pulse for 10 seconds. If

To prevent injury, chest compressions should be
absent, begin external cardiac
avoided to clients with pulse.
compressions.

9. External cardiac massage is performed as To prevent irreversible brain and tissue damage.
follows: Proper positioning and technique is essential to
allow for maximum compression of the heart and
A. Kneel at client’s side parallel to the client’s reduce risk of fractures. Incomplete chest recoil is
sternum

B. Remove clothing to visualize chest

C. Place heel of one hand on the client’s sternum at

the nipple line. Other hand over the forehead associated with decreased coronary and cerebral
perfusion.
D. Keep arms straight with shoulders directly over
your hands  

E. Compress chest 1/3 of the diameter (2 inches or

5cm) at a rate of 100 compressions/min

F. Allow chest recoil completely after

compressions.

10. After 5 cycles of 30 compressions and 2

ventilations, allow AED to analyze the
To prevent irreversible brain and tissue damage.
rhythm. If AED does detect a rhythm and
needs shock, continue chest compressions.

11. Continue CPR and rhythm analysis until

emergency providers arrive or when the
client begins to move.

12. Place in recovery position (side-lying).

1. Follow actions for one rescuer CPR for a

child. Give cycles of 15 compressions and
2 rescue breaths. Use AED after 5 cycles of
compressions and breaths.
CPR: ONE RESCUER - INFANT (UNDER 1 YEAR OF AGE)
ACTION RATIONALE

1. Assess responsiveness

A. Activate EMS

B. Position on a flat surface.

Refer to rationale of 1-7 for a child.
C. Apply appropriate body substance isolation.

D. Position self and open airway

E. Assess respirations
2. If unresponsive, activate EMS and get
AED if available. Send 2nd rescuer (if To initiate emergency assistance and provide
available) to do this, while you stay with oxygenation and circulation.
the infant.
3. If respirations are absent, begin rescue
To prevent irreversible and brain damage.
breathing
Proper positioning is essential for the following
reasons:
A. Avoid overextension of the infant’s neck
A. It is believed that over extension of infant’s
B. Make a tight seal over both the infant’s nose
head can cause closing or narrowing of the
and mouth and gently administer artificial
airway
respirations.
B. Making a complete seal over the infant’s
C. Give 2 rescue breaths (1 second each) with
mouth and nose prevents air leakage
visible chest rise.
4. Assess circulatory status using the
brachial pulse. If no pulse, perform
external chest compressions.
5. Perform compressions: To ensure proper positioning.

A. Maintain position parallel to the infant A. Allows maximum compression of the heart
between sternum and vertebrae
B. Position on a flat surface.
B. Compression over xiphoid process can
C. Position the hands by drawing an imaginary lacerate the liver.
line between nipples. Place two fingers on the
breastbone, just below this line. Press chest bone C. Keeping other fingers and hands off the chest
down 1/3 of the diameter (1&1/2 inches or 4cm) during compressions reduces the risk of rib
the depth of the chest. Deliver 100 compressions
 fractures.
per minute. Allow chest to recoil after each
compression.
D. Keeping one hand on the infant’s forehead
helps maintain an open airway.
To prevent further injury. Respiratory arrest is
6. After 5 cycles of CPR (30 compressions:
more common in children and infants than
ventilations), activate EMS.
cardiac arrest.
7. Resume CPR until emergency response
providers arrive or the infant begins to To prevent irreversible brain and tissue damage.
move.
To keep in mind that etiology of respiratory and
8. Place in a recovery position (cuddle). cardiac arrest is different for infants and requires
modification of CPR sequence.
9. Follow actions for the procedure "CPR
One Rescuer for Infants" with the
following changes.

a. Provide 15 compressions to 2 ventilations.

b. Use two thumb-encircling hands technique  

for compressions. Place both thumbs side by
side in the center of the infant's breastbone, just
below the nipple line. Encircle infant's back with
both hands and use thumbs to depress the
breastbone 1/2 inch to 1 inch depth of infant's
chest
When to Stop CPR
Spontaneous signs of circulation and breathing restored
Transferred to higher facility
Operator is too exhausted to continue
Physician assumes responsibility or asks you to stop
Scene becomes unsafe
Signed waiver to stop CPR

Evaluation and Documentation

1. Client experienced improved clinical status, as evidenced by patent airway with
spontaneous respirations & return of cardiac circulation.
2. Client does not have damage inflicted by incorrect positioning for CPR.
3. Note the time & condition when the client was found.
4. Record interventions implemented including time, results of implementations, orders
received from physician, vital signs, time of incident & general status of the client
afterwards.
5. Record any medication given.
6. If incident occurred in a non-institutional setting, report for findings & interventions to
aid personnel when they arrive.