Child BLS: Life-Saving Techniques for Pediatric Resuscitation

Child BLS is a specialized set of skills and procedures aimed at stabilizing and resuscitating infants and children facing cardiac arrest, respiratory distress, or other life-threatening conditions. Administered by trained medical professionals, caregivers, or bystanders, Child BLS acts as a crucial bridge between the onset of an emergency and the arrival of advanced medical care.

The significance of Child BLS lies not only in the potential to save a child's life but also in mitigating the long-term consequences associated with oxygen deprivation to the brain and vital organs during a cardiac or respiratory event. By promptly initiating effective BLS techniques, the chances of survival and a positive neurological outcome increase significantly. This article will discuss the key aspects of BLS for Children, including one and two rescuer BLS, the pediatric BLS algorithm, and child ventilation.

In What Age Group Is Child BLS Applied?

Child BLS is applied to infants and children up to the age of puberty, typically around 12 to 13 years old. It focuses on addressing the unique anatomical and physiological characteristics of this age group, including airway management, chest compressions, and ventilation techniques.

Child BLS techniques are modified to ensure effective and safe resuscitation for pediatric patients. Neonatal resuscitation is a specialized field that caters to newborns up to 28 days old. The age, size, and developmental stage of the child are considered when applying Child BLS techniques. The goal is to provide life-saving interventions and improve outcomes for infants and children facing cardiac arrest or respiratory distress.

Between Child and Adult BLS, what are the key technique variations?

While the BLS guidelines for adults and children share many similarities, it's important to note that there are also significant differences. These include:

• Compression to breath ratio: The recommended compression to breath ratio for children is 30:2 for one rescuer and 15:2 for two rescuers, and it applies to all age groups.
• Compression depth: The depth of compression for children may differ from that of adults. To effectively perform CPR on a child, compress the chest at least one-third of its depth.
• Response time: If you are alone and find an unresponsive child, perform CPR for two minutes before calling 911. With available cell phones, you can call EMS while remaining with the child using a built-in speakerphone.
• Cause of cardiac arrest: Primary cardiac events are rare in children, and respiratory problems typically precede cardiac arrest. Early intervention for respiratory problems can significantly improve survival rates, making prevention the first link in the Pediatric Chain of Survival.

By understanding these differences and following the appropriate BLS guidelines for children, you can help improve the chances of survival in an emergency situation. Remember always to prioritize prevention and take prompt action to ensure the best possible outcome.

One Rescuer BLS for Children

This BLS algorithm outlines what to do if you are the lone rescuer in an emergency and you see an unconscious pediatric patient.

1. Ensure a Safe Scene

If you're the only responder at an incident involving a child who has suffered a cardiac arrest, be sure to assess the situation before responding. Ensure there isn't anything dangerous nearby and that you and the pediatric victim are safe.

2. Check for Responsiveness

Stimulate and speak to the child. Look at the chest and torso for movement and normal breathing.

If collapse is un-witnessed: Perform 2 minutes of CPR first, then call the emergency response team and bring an AED to the patient.

If collapse is witnessed: Call the emergency response team and bring an AED first, then start CPR.

3. Assess the Patient and Check Pulse

Check the patient for a carotid pulse for 5-10 seconds. While checking the pulse, simultaneously check the patient for absent or abnormal breathing (gasping) by observing the patient's chest for 5-10 seconds.

If there is abnormal breathing, but there is a pulse, then begin only rescue breathing:

• Provide 12-20 rescue breaths per minute.
• Recheck pulse every 2 minutes.

If adequate breathing: Continue to assess the child, maintain a patent airway, and place the child in the recovery position.

If no pulse: Begin 5 cycles of CPR

4. Begin CPR

If the child is unconscious, has no pulse, and not breathing, perform Cardiopulmonary Resuscitation, starting with chest compressions (1 cycle is 30 chest compressions to 2 rescue breaths)

• Place one or both of your hands on the lower sternum of the child, between the nipples.
• Compress the chest at least to 1/3 the depth of the child's chest or 2 inches.
• Provide 100 to 120 compressions per minute. This is 30 compressions every 15 to 18 seconds.
• Allow for full chest recoil with each compression.
• Allow for only minimal interruptions to chest compressions.
• Provide at least 6 rescue breaths per minute.
• Standard CPR with an advanced airway: 12-20 rescue breaths per minute.

5. AED Arrival

The prompt and immediate delivery of defibration is crucial in increasing the chances of survival in cardiac arrest patients.

Power: Turn AED ON and follow the voice prompts.

Attachment: Firmly place the appropriate pads on the child's chest to the indicated locations (pad image).

Analyze: Allow the AED to analyze the rhythm.

If the shock is not indicated: Administer CPR for 2 minutes and recheck the rhythm every 2 minutes. Then, continue CPR until Advanced Life Support is available.

If the shock is indicated:

• Ensure no one touches the patient. Shout "Clear, I'm Clear, you're Clear!" before delivering a shock.
• Press the "shock button" when the crowd is clear of the patient.
• Resume 5 cycles of CPR.

Shockable rhythms include Ventricular Fibrillation or Ventricular Tachycardia.

Two Rescuer BLS for Children:

This guide outlines what to do if there are two or more rescuers in an emergency situation.

1. Ensure a Safe Scene

As with the one responder algorithm, if multiple responders are on site for an emergency involving a child who has suffered a sudden cardiac event, make sure to assess whether the location is safe enough to perform CPR. You want to be able to safely administer CPR before beginning the assessment.

2. Check for Responsiveness

Shake the child's shoulder and ask if he is okay. Look at the chest and torso for movement and normal breathing. If the victim is unresponsive, the first responder should remain within the victim and resumes the BLS sequence while the second responder activates the emergency response system and retrieves the AED or defibrillator. If there are more than two rescuers:

• Rescuer 1 (or more) will stay with the victim.
• Rescuer 2 will activate the Emergency Medical Services
• Rescuer 3 will retrieve an AED.

3. Assess Patient and Check Pulse

The rescuers who stayed with the victim will check the patient for a carotid pulse for 5-10 seconds. While checking the pulse, simultaneously check the patient for absent or abnormal breathing (gasping) by observing the patient's chest for 5-10 seconds.

If the child has adequate breathing:

Monitor the child and maintain a patent airway and place the child in the recovery position.

If there is abnormal breathing, but there is a pulse: Begin rescue breathing

• Provide 12 -20 rescue breaths per minute.
• Recheck pulse every 2 minutes.
• Use a barrier device if available.

4. Begin CPR

If the child doesn't have a pulse and not breathing, Perform Cardiopulmonary Resuscitation, starting with chest compressions. (1 cycle is 15 chest compressions to 2 rescue breaths)

• One rescuer will do the chest compressions, and another will do the rescue breathing.
• The compression to ventilation ratio will be 15:2
• Chest compression rate: 100-120 per minute
• Compression Depth: 2 inches (1/3 the AP diameter of the chest)
• Provide at least 12 rescue breaths per minute.
• Rescuers should switch places every 2 minutes or 5 cycles of CPR.
• Chest recoil should be complete between compressions.
• You should continue cardiopulmonary Resuscitation until the return of spontaneous circulation (ROSC) or until the termination of efforts.

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5. AED Arrival

The rescuer who retrieved the AED applies the AED and follows directions given by the device. The rescuers who stayed with the victim will continue CPR until the defibrillator is ready.

• If a shock is indicated on the device, clear everyone and administer a shock by pressing the shock button. After providing a shock, other rescuers will resume CPR immediately.
• Keep going until the Emergency Medical Services arrives or the victim regains spontaneous circulation.

6. Recovery position

The recovery position maintains a patent airway in the unconscious person.

1. Place the patient close to a proper lateral position with the head dependent to allow fluid to drain.
2. Assure the position is stable and avoid pressure on the chest that could impair breathing.
3. Position patients in such a way that will quickly turn them onto their back.
4. Take protection to stabilize the neck in case of cervical spine injury.
5. Continue to assess and maintain access to the airway.
6. Do not put the victim in the recovery position if it will sustain harm.

Pediatric BLS Algorithm:

The pediatric BLS algorithm is a set of guidelines that should be followed in emergency situations involving children. The algorithm begins with checking the child's responsiveness and calling for emergency medical services. If the child is unresponsive and not breathing normally, the rescuer should initiate BLS by performing chest compressions and rescue breaths in a 30:2 ratio.

If an automated external defibrillator (AED) is available, the rescuer should use it as soon as possible. If not, the child should be transported to the hospital while continuing BLS.

Child Ventilation:

During BLS for children, rescue breaths involve delivering air into the child's lungs using a mask or bag-valve mask. It is crucial to ensure that the mask is the appropriate size for the child. You cannot achieve a proper seal if the mask is too big.The mask should cover the mouth and nose, leaving the eyes and chin uncovered.

• To open the child's airway, use the head-tilt/chin-lift maneuver, as you would with an adult.
• When providing breaths, ensure that each breath lasts for one second
• The rate of rescue breaths should be 10-12 breaths per minute.
• The rescuer should deliver enough air to cause the chest to rise. If the chest does not rise, the rescuer should reposition the mask and try again.
• As with adults, avoid providing breaths too rapidly, as this can lead to stomach distention, vomiting, and potential aspiration of stomach contents.

Child Ventilation Algorithm

Specific Considerations in Child BLS

Child BLS involves unique considerations tailored to the anatomical and physiological characteristics of infants and children. These specific considerations are crucial for providing effective and safe resuscitation to pediatric patients. Let's explore some key aspects:

Airway Management

Children have anatomical differences that impact airway management during resuscitation. Rescuers must employ age-appropriate techniques to open and maintain a patent airway. For infants, the head tilt-chin lift or modified jaw thrust maneuver helps to achieve proper alignment. As children grow older, a chin lift-jaw thrust maneuver becomes more suitable. Rescuers should be mindful of potential obstructions, such as foreign bodies or swollen tissues, and take appropriate measures for their removal.

Chest Compressions

The technique for chest compressions in Child BLS accounts for the child's age and size. Rescuers must adjust compression depth and hand placement based on these factors. The general guideline is to compress the chest at a depth of approximately one-third to one-half the depth of the chest. Proper positioning and adequate force during compressions are essential for effective circulation and oxygenation.

Ventilation Techniques

Ventilation is a critical component of Child BLS. Rescuers should use age-appropriate devices, such as bag-valve-mask systems or pocket masks, to deliver rescue breaths. The volume and frequency of ventilations should be adjusted based on the child's age. For infants, it is recommended to deliver gentle puffs or small breaths, while older children may require larger breaths. Maintaining a proper seal and observing chest rise during ventilation are vital indicators of effective ventilation.

Defibrillation Considerations

Although cardiac arrest in children is often caused by respiratory issues rather than primary cardiac events, certain conditions may require defibrillation. For cases of ventricular fibrillation or pulseless ventricular tachycardia, early defibrillation using an automated external defibrillator (AED) can be life-saving. Rescuers should be prepared to use an AED and follow the device's instructions, ensuring proper pad placement and safe defibrillation if indicated.

How does the Child BLS protocol adapt to situations like drowning or trauma?

Child BLS protocols recognize that certain emergencies, such as drowning or trauma, require specific adaptations. In the case of drowning, the initial steps involve removing the child from the water promptly and initiating Child BLS if the child is unresponsive and not breathing normally. In water-related incidents, it is important to ensure water is not trapped in the airway by carefully tilting the head and lifting the chin, followed by rescue breaths.

For trauma cases, it is crucial to ensure the safety of both the rescuer and the child. When dealing with potential spinal injuries, manual stabilization of the head and neck should be maintained throughout the resuscitation process. Special attention should also be given to controlling bleeding and providing appropriate wound management in cases of severe trauma.

After performing Child BLS, what are the next steps to be taken?

After performing Child BLS, the following steps should be taken:

1. Activate the emergency medical services (EMS) system: Notify the appropriate healthcare professionals of the ongoing emergency and provide relevant details, including the child's age, condition, and location. Prompt activation of the EMS system ensures that advanced medical care is en route to the scene.
2. Continue to provide high-quality CPR: If signs of life are absent, rescuers should continue providing chest compressions and rescue breaths until advanced medical help arrives. Maintaining a consistent rhythm and compression depth is crucial for effective CPR.
3. Handover to advanced medical care: When advanced medical professionals arrive, provide them with a clear and concise report of the events, interventions performed, and the child's response. Follow their instructions and assist in any necessary transition to more advanced resuscitative measures or transport to a healthcare facility.

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BLS for Children is a critical skill that can help save lives in emergency situations. It is important to understand the differences in technique and guidelines for children when performing BLS. By following the one and two rescuer BLS techniques, the pediatric BLS algorithm, and child ventilation guidelines, rescuers can provide the best possible care to children in need.

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