Pediatric Basic Life Support(BLS) Special situations: Difference between revisions

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(/* Special situations{{cite journal| author=Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW | display-authors=etal| title=Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resusci...)
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*** Changes like Raise the chest by putting a double mattress pad or use a recess for the occiput to lower the head. <ref name="pmid2912996">{{cite journal| author=Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA| title=Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. | journal=J Bone Joint Surg Am | year= 1989 | volume= 71 | issue= 1 | pages= 15-22 | pmid=2912996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2912996  }} </ref>
*** Changes like Raise the chest by putting a double mattress pad or use a recess for the occiput to lower the head. <ref name="pmid2912996">{{cite journal| author=Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA| title=Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. | journal=J Bone Joint Surg Am | year= 1989 | volume= 71 | issue= 1 | pages= 15-22 | pmid=2912996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2912996  }} </ref>


*Child drowning
*Child drowning<ref name="pmid20956229">{{cite journal| author=Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW | display-authors=etal| title=Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2010 | volume= 122 | issue= 18 Suppl 3 | pages= S862-75 | pmid=20956229 | doi=10.1161/CIRCULATIONAHA.110.971085 | pmc=3717258 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956229  }} </ref>
=Special situations<ref name="pmid20956229">{{cite journal| author=Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW | display-authors=etal| title=Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2010 | volume= 122 | issue= 18 Suppl 3 | pages= S862-75 | pmid=20956229 | doi=10.1161/CIRCULATIONAHA.110.971085 | pmc=3717258 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956229  }} </ref>=
 
Resuscitation in special circumstances:
*Child with a tracheostomy tube or stoma.
**The caregiver (Parents, nurse, or teacher) should be trained in how to use the tracheostomy tube.
**If there is a cardiac arrest in a child with a tracheostomy start immediately CPR with compressions followed by ventilation of 2 rescue breaths.
**Ventilation-
***Give rescue breaths from mouth to a tracheostomy tube, if the chest does not rise to suction the tube, if still there is no chest rise then can give mouth to stoma ventilation or bag-mask ventilation if available.
*Child with spinal trauma
*Steps to follow in a pediatric trauma case with cardiac arrest.
*Look for airway obstruction.
*If there is bleeding try to tie a tourniquet and apply external pressure.
*If spinal trauma is suspected try to avoid cervical spine movement.
**In spinal trauma ventilation should be done with caution apply jaw thrust and do not tilt head.
**If the jaw thrust is not successful then one rescuer would minimize the motion of the cervical spine and the other rescuer should attempt to give rescue breadth by head still and chin lift method.
**To achieve a neutral position for a child while in supine posture a study by Nypaver M et all<ref name="pmid8304600">{{cite journal| author=Nypaver M, Treloar D| title=Neutral cervical spine positioning in children. | journal=Ann Emerg Med | year= 1994 | volume= 23 | issue= 2 | pages= 208-11 | pmid=8304600 | doi=10.1016/s0196-0644(94)70032-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8304600  }} </ref> mentions that the back needs to be elevated in children less than 7 years.
**In children less than 7 years its found that they have a disproportionately large head compared to their full bodies and when in a supine position the neck gets flexed.
***To prevent cervical motion changes should be made to the backboard.
*** Changes like Raise the chest by putting a double mattress pad or use a recess for the occiput to lower the head. <ref name="pmid2912996">{{cite journal| author=Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA| title=Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. | journal=J Bone Joint Surg Am | year= 1989 | volume= 71 | issue= 1 | pages= 15-22 | pmid=2912996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2912996  }} </ref>
*Resuscitation of a drowning child
*Resuscitation of a drowning child
**The rescuer should try to get the drowning child as soon as possible out of the water and start CPR after checking pulse and ventilation.
**The rescuer should try to get the drowning child as soon as possible out of the water and start CPR after checking pulse and ventilation.
**If the rescuer has training in In water resuscitation start ventilation in water  
**If the rescuer has training in In water resuscitation start ventilation in water  
Below is the IWR (In Water Resuscitation) guidelines<ref name="pmid15451583">{{cite journal| author=Szpilman D, Soares M| title=In-water resuscitation--is it worthwhile? | journal=Resuscitation | year= 2004 | volume= 63 | issue= 1 | pages= 25-31 | pmid=15451583 | doi=10.1016/j.resuscitation.2004.03.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15451583  }} </ref>
Below is the IWR (In Water Resuscitation) guidelines<ref name="pmid15451583">{{cite journal| author=Szpilman D, Soares M| title=In-water resuscitation--is it worthwhile? | journal=Resuscitation | year= 2004 | volume= 63 | issue= 1 | pages= 25-31 | pmid=15451583 | doi=10.1016/j.resuscitation.2004.03.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15451583  }} </ref>
***Check if the child is breathing or conscious in the water.
*Check if the child is breathing or conscious in the water.
***If the child is breathing quickly swim back and get the child out of the water.
**If the child is breathing quickly swim back and get the child out of the water.
***If the child is not breathing then give rescue breaths if spinal trauma is suspected then try to immobilize the spine while opening the airway and try to reach the shore as soon as possible.
**If the child is not breathing then give rescue breaths if spinal trauma is suspected then try to immobilize the spine while opening the airway and try to reach the shore as soon as possible.
***If the distance to reach the shore is more than 5 minutes, try to give one more rescue breath 12-16 breaths/minute.
**If the distance to reach the shore is more than 5 minutes, try to give one more rescue breath 12-16 breaths/minute.


The following algorithm describes the steps to be taken for in-water resuscitation
The following algorithm describes the steps to be taken for in-water resuscitation

Revision as of 14:57, 19 June 2020

Special situations[1]

Resuscitation in special circumstances:

  • Child with a tracheostomy tube or stoma.
    • The caregiver (Parents, nurse, or teacher) should be trained in how to use the tracheostomy tube.
    • If there is a cardiac arrest in a child with a tracheostomy start immediately CPR with compressions followed by ventilation of 2 rescue breaths.
    • Ventilation-
      • Give rescue breaths from mouth to a tracheostomy tube, if the chest does not rise to suction the tube, if still there is no chest rise then can give mouth to stoma ventilation or bag-mask ventilation if available.
  • Child with spinal trauma
  • Steps to follow in a pediatric trauma case with cardiac arrest.
  • Look for airway obstruction.
  • If there is bleeding try to tie a tourniquet and apply external pressure.
  • If spinal trauma is suspected try to avoid cervical spine movement.
    • In spinal trauma ventilation should be done with caution apply jaw thrust and do not tilt head.
    • If the jaw thrust is not successful then one rescuer would minimize the motion of the cervical spine and the other rescuer should attempt to give rescue breadth by head still and chin lift method.
    • To achieve a neutral position for a child while in supine posture a study by Nypaver M et all[2] mentions that the back needs to be elevated in children less than 7 years.
    • In children less than 7 years its found that they have a disproportionately large head compared to their full bodies and when in a supine position the neck gets flexed.
      • To prevent cervical motion changes should be made to the backboard.
      • Changes like Raise the chest by putting a double mattress pad or use a recess for the occiput to lower the head. [3]
  • Child drowning[1]
  • Resuscitation of a drowning child
    • The rescuer should try to get the drowning child as soon as possible out of the water and start CPR after checking pulse and ventilation.
    • If the rescuer has training in In water resuscitation start ventilation in water

Below is the IWR (In Water Resuscitation) guidelines[4]

  • Check if the child is breathing or conscious in the water.
    • If the child is breathing quickly swim back and get the child out of the water.
    • If the child is not breathing then give rescue breaths if spinal trauma is suspected then try to immobilize the spine while opening the airway and try to reach the shore as soon as possible.
    • If the distance to reach the shore is more than 5 minutes, try to give one more rescue breath 12-16 breaths/minute.

The following algorithm describes the steps to be taken for in-water resuscitation

  1. ↑ 1.0 1.1 Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW; et al. (2010). "Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S862–75. doi:10.1161/CIRCULATIONAHA.110.971085. PMC 3717258. PMID 20956229.
  2. ↑ Nypaver M, Treloar D (1994). "Neutral cervical spine positioning in children". Ann Emerg Med. 23 (2): 208–11. doi:10.1016/s0196-0644(94)70032-x. PMID 8304600.
  3. ↑ Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA (1989). "Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous". J Bone Joint Surg Am. 71 (1): 15–22. PMID 2912996.
  4. ↑ Szpilman D, Soares M (2004). "In-water resuscitation--is it worthwhile?". Resuscitation. 63 (1): 25–31. doi:10.1016/j.resuscitation.2004.03.017. PMID 15451583.
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