Paediatric Life Support – What every parent should know


Common conditions predisposing to Cardiopulmonary arrest in children are Trauma, Burns, Epiglottitis, deterioration during positive pressure ventilation, tracheostomy, seizures and Coma. The priorities in management are to assess cardiopulmonary status quickly to determine whether the child is

  1. Stable
  2. In Potential respiratory failure or shock
  3. In definite respiratory failure or shock
  4. In Cardiopulmonary failure

Conditions requiring Rapid Cardiopulmonary Assessment and Potential Cardiopulmonary support are

  • Respiratory rate > 60
  • Heart rate - Child < 5 yr old: <80 bpm or > 180 bpm
                       Child > 5 yr old: <60 bpm or > 160 bpm
  • Increased work of breathing (retractions, nasal flaring, grunting)
  • Cyanosis (Bluish discolouration of body)
  • Altered level of consciousness ( irritability, lethargy)
  • Seizures
  • Fever with Petechiael rash
  • Trauma
  • Burns totaling >10% of body surface area.

The following help in a Rapid Cardiopulmonary assessment:

• Airway Patency - Able to maintain independently
                           - Requiring assistance to maintain

• Breathing- - Rate
                   - Mechanics (Retractions, grunting, nasal flare)
                   -Air Entry (Chest expansion, breath sounds, stridor, wheeze)
                   - Skin Colour & Temperature

• Circulation - - Heart rate
                      - Blood Pressure
                      - Peripheral pulses
                      - Skin Perfusion
                      - Brain & Renal Perfusion

HOW TO GIVE MOUTH TO MOUTH RESCUSCITATION

Airway


In an unconscious child airway should be maintained in open position by the Jaw thrust maneuver. (Place 2 or 3 fingers under each side of the lower jaw at it`s angle and lift the jaw upward and outward.)

Breathing


After the airway is opened, if there is no evidence of breathing, rescue breathing should be initiated. (After deep inhalation, place mouth over infant`s nose & mouth and give two slow breaths, pausing after the first breath to take a breath. In an older child, make a mouth to mouth seal and pinch the nose before breathing in.) The correct volume for each breath is the volume that makes the chest rise freely. If not, either the airway is obstructed (choking) or a higher breath pressure is necessary.

Circulation


After delivering two breaths, check for pulse. If no pulse is felt or pulse rate < 60 per minute, start chest compressions. (Place heel of hand over lower half of the breastbone and compress the chest to approximately ½ it`s total depth. Allow relaxation before the next compression.) At the end of 15 compressions 2 breaths should be delivered. This cycle is maintained.