PHILIPPINE HEART ASSOCIATION

Council on Cardio-Pulmonary Resuscitation

PEDIATRIC BASIC LIFE SUPPORT

 Pediatric Chain of Survival

For best survival and quality of life, Pediatric Basic Life

Support (BLS) should be part of a community effort that
includes prevention of injury and arrest, early and effective
CPR, prompt access to the emergency medical services
(EMS) system, and prompt pediatric advanced life support
(PALS). These 4 links form the American Heart
Association (AHA) Pediatric Chain of Survival. The first 3
links constitute Pediatric BLS.
Epidemiology

The epidemiology of pediatric cardiopulmonary

arrest is different from that of adults.

Sudden primary cardiac arrest in

young children is uncommon.
Epidemiology
More commonly, injury or disease causes respiratory
or circulatory failure which progresses to
cardiopulmonary failure with hypoxemia and
acidosis culminating in pulseless cardiac arrest

Pediatric CP arrest occurs most commonly

at either end of the age spectrum – in children
younger than 1 year and adolescence
Prevention of Cardiopulmonary
Arrest
The major causes of death in infants
and children are
1. respiratory failure
2. sudden infant death syndrome (SIDS)
3. sepsis
4. neurologic diseases
5. drowning
Injuries

 The most common fatal childhood injuries

amenable to prevention are:’

1. motor vehicle passenger injuries

-proper restraints. responsible drivers,
avoidance of alcohol

2. pedestrian injuries
- children supervision
Injuries

 The most common fatal childhood injuries

amenable to prevention are:’

3. bicycle injuries
-helmet use

4. burns
-smoke detectors

5. firearm injuries
-gunfree house
House Bill 9851 (Samboy Lim Bill)
Authored by Cong. Joseller Yeng Guiao

Seeks to require students in both private and public

schools to undergo Cardiopulmonary Resuscitation
Training at east once prior to gaduation
 Why The Need For
CPR Training?
CPR is the best treatment for
cardiac arrest until the arrival
of an Automated External
Defibrillator (AED) and advanced
cardiovascular (ACLS) care.
 What is CPR?
Cardiopulmonary Resuscitation
(CPR)
it is the artificial method of circulating blood and
oxygen through a body and attempting to keep the
brain alive.
When initiated in 4 minutes the survival rate is
43%
When initiated within 4 to 8 minutes the survival
rate is 10%
The Sequence of Pediatric BLS:
The CABs of CPR and EMS Activation
Pediatric BLS includes sequential
assessments and motor skills designed to support
or restore effective ventilation and circulation to the
child in respiratory or cardiorespiratory arrest.

When cardiorespiratory arrest is present or

impending, prompt access to advanced life support is
also required.
 When will you do CPR?

CPR must be started as soon as

possible after the heart stops beating
or if breathing either stops or is
ineffective. Any delay in starting CPR
reduces the chances of survival.
In addition, the brain cells begin to die
after 4-6 minutes without oxygen.
The Sequence of Pediatric BLS:
The CABs of CPR and EMS Activation

Pediatric BLS includes sequential

assessments and motor skills designed to support
or restore effective ventilation and circulation to the
child in respiratory or cardiorespiratory arrest.

When cardiorespiratory arrest is present or

impending, prompt access to advanced life support is
also required.
The AHA-recommended steps for resuscitation are known as
DRS CAB:
Check for DANGER
Check for a RESPONSE
SEND for help
C directs rescuers to perform 30 COMPRESSIONS
to patients who are unresponsive and not breathing
normally, followed by 2 rescue breaths
A directs rescuers to open the AIRWAY
B directs rescuers to check Breathing but no need to
deliver RESCUE BREATHS

D directs rescuers to attach an AED as soon as it is

available and follow prompts
MNEMONICS: DRS CAB
 Safety of Rescuer and Victim
Always make sure that the area
is safe for you and the victim.
Determine Responsiveness
Gently tap the victim and ask loudly, "Are
you okay?" Call the child’s name if you
know it.
 Responsive Patient
Look for movement. If the person is responsive, he or she
will answer or move.
Quickly check to see if the person has any injuries or
needs medical assistance.
If necessary, leave the victim to phone EMS, but return
quickly and recheck the victim’s condition frequently.
Children with respiratory distress often assume a position
that maintains airway patency and optimizes ventilation.
Allow the child with respiratory distress to remain in a
position that is most comfortable.
Assess Need for CPR
To assess the need for CPR, the lay
rescuer should assume that cardiac
arrest is present if the victim is
unresponsive and not breathing or
only gasping.
 Call for Help
If no response CALL FOR HELP by
shouting for ambulance or Emergency
Medical System and ask for an Automarted
External Defibrillator( which is available in
offices and building floors).
Change in CPR Sequence
(C-A-B Rather Than A-B-C)
Change in CPR Sequence (C-A-B Rather Than
A-B-C)
2010 (New):
Initiate CPR for infants and children with chest

compressions rather than rescue breaths.

CPR should begin 30 compressions (for
resuscitation of infants and children by 2
healthcare providers) rather than with 2
ventilations
C - A- B ! Same as in adults
High quality chest compressions are essential to generate
blood to vittal organs and achieve Return Of Spontaneous
Circulation

Vast majority of victims are adults with VF

Beginning CPR with 30 chest compressions rather than 2

2 ventilations leads to a short delay to first compression
in adults

 All rescuers should be able to start chest compressions

immediately
 CPR -Circulation
Health care provider – Always do PULSE
CHECK ( 5- 10 seconds)
 brachial artery – infants
 carotid or femoral – child/adult

Lay -do chest compressions right away

BLS Sequence for infants and children

Infants BLS – less than 1 year old

Child BLS – 1 year to start puberty

Adult BLS – at and beyond puberty

Chest Compression
All victims in cardiac arrest need chest
compressions. Remember in the first
few minutes of a cardiac arrest, victims
will have oxygen remaining in their
lungs and bloodstream, so starting CPR
with chest compressions can pump that
blood to the victim's brain and heart
sooner.
Chest Compression

Research shows that rescuers who

started CPR with opening the
airway took 30 critical seconds
longer to begin chest compressions
than rescuers who began CPR with
chest compressions.
RATIO OF CHEST COMPRESSION TO
Number of Breaths

Lone rescuer – 30:2

2 rescuers – 15:2
Check pulse every 2 minutes
Indications for Chest Compression
No pulse

Heart Rate/Pulse rate of less than 60 beats per

minutes

Lay rescuer
Compression
For an infant, lone rescuers (whether lay rescuers or
healthcare providers) should compress the sternum
with 2 fingers placed just below the intermammary
line or the two encircling hand technique. Do not
compress over the xiphoid or ribs. Rescuers should
compress at least one third the depth of the chest, or
about 4 cm (1.5 inches).
 Chest Compressions
Locating hand position
for chest compression in
child. Note that the
rescuer’s other hand is
used to maintain head
position to facilitate
ventilation.
COMPRESSION
For a child, healthcare providers should compress the
lower half of the sternum at least one third of the AP
dimension of the chest or approximately 5 cm (2 inches)
with the heel of 1 or 2 hands.
Chest Compressions

To give chest compressions, compress the

lower half of the sternum but do not compress
over the xiphoid. After each compression allow
the chest to recoil fully because complete chest
reexpansion improves blood flow into the
heart.
The following are
characteristics high quality
chest compressions:
1. "Push fast": push at a
rate of approximately
100 compressions per
minute.
2. Release completely to
allow the chest to
fully recoil.
3. Minimize
interruptions in chest
compressions.
The following are
characteristics of high
quality chest
compressions:
1. "Push hard": push
with sufficient force
to depress the chest
approximately one
third to one half the
anterior-posterior
diameter of the
chest.
Chest Compression
Between each compression, rescuers
should avoid leaning on the chest to
allow it to return to its starting
position.
Chest Compression
Rescuers should avoid stopping chest
compressions and avoid excessive
ventilation.
AIRWAY MANAGEMENT
Obstruction of the airway
An unconscious casualty has no control over his or her
muscles, including the muscles that control the
tongue. The relaxed tongue will fall backwards across
the airway, and cause an obstruction. If a breathing
unconscious casualty remains on his or her back, the
risk of airway obstruction is increased.
Ensuring an open Airway
Method use to open the airway
Tilt/Chin Lift
HEAD TILT CHIN LIFT
To perform the head tilt-chin lift
maneuver, place one of your
hands on the patient’s forehead
and apply gentle, firm, backward
pressure using the palm of your
hand. Place the fingers of the
other hand under the bony part
of the chin. Lift the chin forward
and support the jaw, helping to
tilt the head back. This
manoeuvre will lift the patient’s
tongue away from the back of
the throat and provide an
adequate airway.
Ensuring an open Airway
Jaw Thrust
The jaw-thrust manuver is considered an
alternate method for opening the airway
Jaw Thrust
This maneuver is
accomplished by kneeling
near the top of the
victim’s head, grasping
the angles of the patient’s
lower jaw, and lifting with
both hands, one on each
side. This will displace the
mandible jawbone)
forward while tilting the
head backward.
AIRWAY MANAGEMENT
Obstruction of the airway
An unconscious casualty may also have
material in the mouth such as food, blood or
vomitus, which may obstruct the airway. It is
vital that if such material is present it is
removed as soon as possible by FINGER
SWEEP
 CPR - BREATHING

To asses breathing…look for chest rise

and listen and feel for the air
If not breathing (or rescuer in doubt)
Give rescue breaths – 2 breaths
To assess effectiveness – look for chest
rise
Make a better seal or reposition
Check for foreign body obstruction
To give breaths to an infant, use a
mouth-to-mouth-and-nose technique;
Mouth-to-Mouth-and-Nose
Technique
To give breaths to a child, use a mouth-to-
mouth technique. Make sure the breaths are
effective (note for chest rises).
Each breath should take about 1 SECOND. If
the chest does not rise, reposition the head,
make a better seal, and try again. It may be
necessary to move the child's head through
a range of positions to provide optimal
airway patency and effective rescue
breathing.
COORDINATE CHEST COMPRESSIONS AND
BREATHING
After giving 2 breaths, immediately give 30
compressions. The lone rescuer should continue this
cycle of 30 compressions and 2 breaths for
approximately 2 minutes (about 5 cycles) before
leaving the victim to activate the emergency response
system and obtain an automated external defibrillator
(AED) if one is nearby.
The recommended compression-to-ventilation ratio is

30:2 for single rescuers:

 Recovery Position
Assess: If the patient is breathing normally, and
pulse is present then the patient should be placed
in the recovery position and monitored. Transport
if required, or wait for the EMS to arrive and take
over.
Recovery Position
Putting someone in
the recovery
position will keep
the airway clear and
open. It also ensures
that any vomitus or
fluid wont cause the
victim to choke.
 Recovery Position
Assess: If the patient is breathing normally, and
pulse is present then the patient should be placed
in the recovery position and monitored. Transport
if required, or wait for the EMS to arrive and take
over.
What to do if the person recovers
during CPR
If the person is not breathing, continue
full CPR until the ambulance arrives.
Be ready to recommence CPR if the
person stops breathing or becomes
unresponsive or unconscious again. Stay
by their side until medical help arrives.
Talk reassuringly to them.
The AHA-recommended steps for resuscitation are known as
DRS CAB:
Check for DANGER
Check for a RESPONSE
SEND for help
C directs rescuers to perform 30 COMPRESSIONS
to patients who are unresponsive and not breathing
normally, followed by 2 rescue breaths
A directs rescuers to open the AIRWAY
B directs rescuers to check Breathing but no need to
deliver RESCUE BREATHS

D directs rescuers to attach an AED as soon as it is

available and follow prompts
FOREIGN BODY AIRWAY
OBSTRUCTION
Foreign-Body Airway Obstruction
(Choking)
Death from FBAO is an uncommon but
preventable cause of death.
Most reported cases of FBAO in adults are
caused by impacted food and occur while the
victim is eating.
Most reported episodes of choking in infants
and children occur during eating or play, when
parents or childcare providers are present.
The choking event is therefore commonly
witnessed, and the rescuer usually intervenes
while the victim is still responsive.
Foreign bodies may cause either mild or severe
airway obstruction.

The rescuer should intervene if the choking

victim has signs of severe airway obstruction.
1. These include signs of poor air exchange
2. increased breathing difficulty, such as a
silent cough, cyanosis, or inability to speak or
breathe.
 FBAO
(Choking)
The victim may clutch
the neck, demonstrating
the universal choking
sign.

Quickly ask, "Are you

choking?" If the victim
indicates "yes" by
nodding his head without
speaking, this will verify
that the victim has
severe airway
obstruction.
If the victim can speak,
cough or breathe, do not
interfere.
If the victim cannot speak,
cough or breathe, give
abdominal thrusts (the
Heimlich maneuver).
Heimlich Maneuver
Reach around the victim's waist.
Position one clenched fist above
navel and below rib cage.
Grasp fist with other hand.
Pull the clenched fist sharply and
directly backward and upward under
the rib cage 6 to 10 times quickly.
In case of extreme obesity or late
pregnancy, give chest thrusts.

Stand behind victim.

Place thumb of left
fist against middle
of breastbone, not
below it.
Grab fist with right
hand.
Squeeze chest 4
times quickly.
 Continue uninterrupted
until the obstruction is
relieved or advanced life
support is available.

In either case, the

victim should be examined
by a physician as soon as
possible. chest thrusts
 If Victim Becomes Unconscious

1. Position victim on back,

arms by side.
2. Shout for "Help". Call the
local emergency number.
3. Perform finger sweep to try Finger Sweep
to remove the foreign body.
4. Perform rescue breathing. If
unsuccessful, give 6-10
abdominal thrusts (the
Heimlich maneuver).

Abdominal Thrusts
5. Repeat sequence: perform
finger sweep, attempt rescue
breathing, perform abdominal
thrusts, until successful.

6. Continue uninterrupted
until obstruction is removed or
advanced life support is
available. When successful,
have the victim examined by a
physician as soon as possible.

7. After obstruction is
removed, begin the ABC's of
CPR, if necessary.
Conscious Infant (Under 1 year old)

1. Support the head and neck with one hand.

Straddle the infant face down over your
forearm, head lower than trunk, supported on
your thigh.

2. Deliver four back

blows, forcefully, with
the heel of the hand
between the infant's
shoulder blades.

Back Blows
3. While supporting the head,
immediately sandwich the
infant between your hands
and turn onto its back, head
lower than trunk.

4. Using 2 or 3 fingers (see

illustration for finger position),
deliver four thrusts in the
sternal (breastbone) region.
Depress the sternum 1/2 to 1
inch for each thrust. Avoid the
tip of the sternum. Chest Thrusts

5. Repeat both back blows and chest thrusts until foreign

body is expelled or the infant becomes unconscious.
 Unconscious Infant
1. Shout for help. Call the local emergency number.
2. Perform tongue-jaw lift. If you see the foreign body,
remove it.
3. Attempt rescue breathing.
4. Perform the sequence of back blows
and chest thrusts as described for
conscious infant.
5. After each sequence of back blows
and chest thrusts, look for the foreign
body and, if visible, remove it.
6. Attempt rescue breathing. Repeat
steps 4 and 5.
7. If foreign body is removed and victim
is not breathing, begin the ABC's of CPR.
Conscious Child (Over 1 year old)
To dislodge an object from the airway of a child:
Perform abdominal thrusts (the Heimlich maneuver)
as described for adults. Avoid being overly forceful.
Unconscious Child (Over 1 year old)

If the child becomes unconscious, continue as

for an adult except:
Do not perform blind finger sweep in children up to
8 years old. Instead, perform a tongue-jaw lift and
remove foreign body only if you can see it.

{Note: Abdominal thrusts are not recommended in

infants. Blind finger sweeps should not be performed
on infants or small children.}
 Relief of Foreign-Body Airway Obstruction

When FBAO produces signs of severe

airway obstruction, rescuers must act quickly
to relieve the obstruction.

If mild obstruction is present and the

victim is coughing forcefully, do not interfere
with the patient’s spontaneous coughing and
breathing efforts.
Relief of Foreign-Body Airway
Obstruction
Attempt to relieve the obstruction only if signs of
severe obstruction develop:
1. the cough becomes silent
2. respiratory difficulty increases and is
accompanied by stridor
3. the victim becomes unresponsive.
 Activate the EMS system quickly if the patient is
having difficulty breathing.
For responsive adults and children >1 year of age with severe
FBAO, case reports show the feasibility and effectiveness of
back blows or "slaps," abdominal thrusts, and chest thrusts.

Case reports and 1 large case series of 229 choking episodes

report that approximately 50% of the episodes of airway
obstruction were not relieved by a single technique.

The likelihood of success was increased when combinations

of back blows or slaps, abdominal thrusts, and chest thrusts
were used.
Although chest thrusts, back
slaps, and abdominal thrusts
are feasible and effective for
relieving severe FBAO in
conscious (responsive) adults
and children 1 year of age, for
simplicity in training we
recommend that the
abdominal thrust be applied
in rapid sequence until the
obstruction is relieved.
 If abdominal thrusts
are not effective, the
rescuer may consider
chest thrusts. It is
important to note that
abdominal thrusts are
not recommended for
infants <1 year of age
because thrusts may
cause injuries.
Because abdominal thrusts can cause injury,
victims of FBAO who are treated with
abdominal thrusts should be encouraged to
undergo an examination by a physician for
injury.
 Pathophysiology
The brain may sustain damage after blood
flow has been stopped for about FOUR
MINUTES and irreversible damage after
about SEVEN MINUTES.[ Typically if blood
flow ceases for one to two hours, the cells of
the body die. Because of that CPR is
generally only effective if performed within
seven minutes of the stoppage of blood
flow. 
 CARDIAC ARREST
Cardiac arrest, also known
as cardiopulmonary arrest or circulatory
arrest, is the cessation of normal 
circulation of the blood due to failure of the
heart to contract effectively. Medical
personnel may refer to an unexpected
cardiac arrest as a sudden cardiac
arrest (SCA).
 CARDIAC ARREST
Arrested blood circulation prevents delivery
of oxygen to the body. Lack of oxygen to the
brain causes loss of consciousness, which then
results in abnormal or absent breathing. Brain
injury is likely to happen if cardiac arrest goes
untreated for more than five minutes. For the
best chance of survival and neurological
recovery, immediate and decisive treatment is
imperative.
 What is CPR?
Cardiopulmonary Resuscitation
(CPR)
it is the artificial method of circulating blood and
oxygen through a body and attempting to keep the
brain alive.
When initiated in 4 minutes the survival rate is
43%
When initiated within 4 to 8 minutes the survival
rate is 10%
 CARDIAC ARREST
Cardiac arrest, also known
as cardiopulmonary arrest or circulatory
arrest, is the cessation of normal 
circulation of the blood due to failure of the
heart to contract effectively. Medical
personnel may refer to an unexpected
cardiac arrest as a sudden cardiac
arrest (SCA).
 CARDIAC ARREST
Arrested blood circulation prevents delivery
of oxygen to the body. Lack of oxygen to the
brain causes loss of consciousness, which then
results in abnormal or absent breathing. Brain
injury is likely to happen if cardiac arrest goes
untreated for more than five minutes. For the
best chance of survival and neurological
recovery, immediate and decisive treatment is
imperative.
 Pathophysiology
The brain may sustain damage after blood
flow has been stopped for about FOUR
MINUTES and irreversible damage after
about SEVEN MINUTES.[ Typically if blood
flow ceases for one to two hours, the cells of
the body die. Because of that CPR is
generally only effective if performed within
seven minutes of the stoppage of blood
flow. 
When the heart stops, the absence of oxygenated
blood can cause irreparable brain damage in only
a few minutes. Death will occur within eight to 10
minutes. Time is critical when you're helping an
unconscious person who isn't breathing
How does CPR work?
All the living cells of our body need a steady
supply of oxygen to keep us alive.

CPR works because you can breathe air into the

victim’s lungs to provide oxygen into the blood.
When you press on the chest, you move oxygen -
carrying blood through the body.
 Pathophysiology
CPR is used on people in cardiac arrest
in order to oxygenate the blood and
maintain a cardiac output to keep vital
organs alive. Blood circulation and
oxygenation are required to transport 
oxygen to the tissues.
 Pathophysiology
The brain may sustain damage after blood
flow has been stopped for about FOUR
MINUTES and irreversible damage after
about SEVEN MINUTES.[ Typically if blood
flow ceases for one to two hours, the cells of
the body die. Because of that CPR is
generally only effective if performed within
seven minutes of the stoppage of blood
flow. 
 CPR
CPR is indicated for any person who is unresponsive
with no breathing, or who is only breathing in
occasional agonal gasps, as it is most likely that they
are in cardiac arrest. If a person still has a pulse, but is
not breathing (respiratory arrest), 
artificial respirations may be more appropriate, but
due to the difficulty people have in accurately
assessing the presence or absence of a pulse,

In those with cardiac arrest due to trauma CPR is

considered futile in the pulseless case, but still
recommended for correctible causes of arrest.
 Pathophysiology
The heart also rapidly loses the ability to
maintain a normal rhythm. Low body
temperatures, as sometimes seen in near-
drownings, prolong the time the brain
survives. Following cardiac arrest, effective
CPR enables enough oxygen to reach the
brain to delay brain death, and allows the
heart to remain responsive to defibrillation
 attempts.
 Pathophysiology
The brain may sustain damage after blood
flow has been stopped for about FOUR
MINUTES and irreversible damage after
about SEVEN MINUTES.[ Typically if blood
flow ceases for one to two hours, the cells of
the body die. Because of that CPR is
generally only effective if performed within
seven minutes of the stoppage of blood
flow. 
When the heart stops, the absence of oxygenated
blood can cause irreparable brain damage in only
a few minutes. Death will occur within eight to 10
minutes. Time is critical when you're helping an
unconscious person who isn't breathing
How does CPR work?
All the living cells of our body need a steady
supply of oxygen to keep us alive.

CPR works because you can breathe air into the

victim’s lungs to provide oxygen into the blood.
When you press on the chest, you move oxygen -
carrying blood through the body.