4. BLS

Question 1

Definition of ‘infant’ and ‘child’

Answer 1

Infant <1 year
Child 1-18yrs

Question 2

What is the main origin of cardiorespiratory arrest in children?

Answer 2

Hypoxia - therefore prompt rescue breath administration is key

Question 3

What is the most common arrhythmia arising from hypoxia in children

Answer 3

Bradycardia becoming asystole, therefore effective BLS is more important than access to defib

Question 4

What is the out of hospital BLS algorithm

Answer 4

SSSABC
- safety
- stimulate (place one hand on forehead, tug hair, shout)
- shout for help
- airway (head tilt chin lift/jaw thrust/look in mouth)
- breathing (look/listen/feel for 10 seconds, then either recovery position or 5 rescue breaths checking effectiveness by watching chest rise and fall)
- circulation (chest compressions)

Question 5

What should you do if child starts breathing after rescue breaths?

Answer 5

Continue providing 12-30 breaths per minute

Question 6

Describe CPR in children (1-8 years)

Answer 6

depress lower half of sternum by 1/3rd of chest depth
find compression point which is 1 finger above xiphisternum
rate 100-120
15 compressions:2 breaths
Use 1 or 2 hands depending on size of child

Question 7

Describe CPR in infants (<1 year)

Answer 7

Either 2 finger technique, or the
two-thumb encircling technique if there are two rescuers present

Question 8

How do rescue breaths differ in and out of hospital?

Answer 8

In hospital - use a bag valve mask with 100% oxygen if possible
Out of hospital - mouth to mouth

Question 9

List features of an effective cough when a child is choking

Answer 9

crying
loud cough
able to take in a breath before coughing
fully responsive

Question 10

List features of an ineffective cough when a child is choking

Answer 10

cyanosis
reduced consciousness
quiet/silent cough
unable to breathe
unable to vocalise

Question 11

How should you manage a conscious child with an effective cough

Answer 11

Encourage to keep coughing

Question 12

How should you manage a conscious child with an ineffective cough

Answer 12

Back blows

Question 13

How are back blows delivered in an infant

Answer 13

5 sharp back blows with heel of hand
Hold in head down prone position across lap

Question 14

How are back blows delivered in a child

Answer 14

same as infant, or have the child in a forward-leaning position

Question 15

What should be done if 5 back blows do not relieve a choking infant?

Answer 15

Chest thrusts
- turn patient supine and still in head down position
- deliver 5 chests thrusts (position = 1 finger above xiphisternum)
- sharper in nature and slower than chest compressions

Question 16

What should be done if 5 back blows do not relieve a choking child?

Answer 16

Abdominal thrusts
- stand/kneel behind the child
- perform heimlich manouevre between umbilicus and xiphisternum

Question 17

What should you do if choking infant/child becomes unconscious?

Answer 17

Move to BLS algorithm
- you can do one sweep in mouth when assessing airway if you see something
- still give 5 rescue breaths
- proceed to CPR (15:2) even if breaths are not making chest rise/fall