Paediatric_Basic_Life_Support_flashcards

Question 1

What is the recommended compression:ventilation ratio for lay rescuers in paediatric basic life support?

Answer 1

Lay rescuers should use a compression:ventilation ratio of 30:2.

Question 2

What is the recommended compression:ventilation ratio for rescuers with a duty to respond?

Answer 2

Rescuers with a duty to respond should use a compression:ventilation ratio of 15:2.

Question 3

How does the Resuscitation Council define an infant and a child?

Answer 3

An infant is defined as a child under 1 year, and a child is between 1 year and puberty.

Question 4

What are the key initial steps in the paediatric basic life support algorithm?

Answer 4

The key initial steps are: check if the child is unresponsive, shout for help, open the airway, look, listen, and feel for breathing, give 5 rescue breaths, and check for signs of circulation.

Question 5

How should rescuers check for signs of circulation in infants and children?

Answer 5

In infants, rescuers should check the brachial or femoral pulse. In children, they should check the femoral pulse.

Question 6

What is the recommended rate of chest compressions for both infants and children?

Answer 6

The recommended rate of chest compressions is 100-120/min for both infants and children.

Question 7

What is the recommended depth of chest compressions for infants?

Answer 7

The recommended depth of chest compressions for infants is at least one-third of the anterior-posterior dimension of the chest (approximately 4 cm).

Question 8

What is the recommended depth of chest compressions for children?

Answer 8

The recommended depth of chest compressions for children is at least one-third of the anterior-posterior dimension of the chest (approximately 5 cm).

Question 9

Where should chest compressions be applied in children?

Answer 9

In children, chest compressions should be applied to the lower half of the sternum.

Question 10

What technique should be used for chest compressions in infants?

Answer 10

In infants, a two-thumb encircling technique should be used for chest compressions.

Question 11

summarise

Answer 11

Paediatric basic life support

The 2015 Resuscitation Council guidelines made the following changes to paediatric basic life support
compression:ventilation ratio: lay rescuers should use a ratio of 30:2. If there are two or more rescuers with a duty to respond then a ratio of 15:2 should be used
age definitions: an infant is a child under 1 year, a child is between 1 year and puberty

Key points of algorithm (please see link attached for more details)
unresponsive?
shout for help
open airway
look, listen, feel for breathing
give 5 rescue breaths
check for signs of circulation
infants use brachial or femoral pulse, children use femoral pulse
15 chest compressions:2 rescue breaths (see above)
chest compressions should be 100-120/min for both infants and children
depth: depress the lower half of the sternum by at least one-third of the anterior-posterior dimension of the chest (which is approximately 4 cm for an infant and 5 cm for a child)
in children: compress the lower half of the sternum
in infants: use a two-thumb encircling technique for chest compression

Question 12

A 2-year-old boy with meningococcal septicaemia arrests on the ward. You are the first person to attend. After confirming cardiac arrest and following paediatric BLS protocol, what is the rate you should perform chest compressions at?

140-160 compressions per minute
160-180 compressions per minute
120-140 compressions per minute
100-120 compressions per minute
80-100 compressions per minute

Answer 12

The UK Resuscitation Council’s Paediatric Basic Life Support guideline states that chest compressions for children of all ages must be performed at a rate of 100-120 per minute. Compressions should depress the sternum by at least a third of the depth of the chest.

Lay persons and those not trained in paediatric resuscitation are advised to use the adult chest compression to rescue breaths ratio of 30:2, however those caring for children and trained to do so should use a ratio of 15:2.

Note that you must still carry out your initial danger-response-airway-breathing-circulation sequence.

For the full paediatric BLS guideline please see https://www.resus.org.uk/resuscitation-guidelines/paediatric-basic-life-support/#sequence

Question 13

An 11-month-old infant has become lifeless in the waiting room at the GP for an unknown reason. Paediatric basic life support is initiated and chest compressions are provided.

What method of chest compressions is correct to use in this situation?

• 1 hand compressing the lower half of the sternum
• 1 hand compressing the upper half of the sternum
• 2 hands compressing the lower half of the sternum
• One-thumb encircling technique
• Two-thumb encircling technique

Answer 13

Two-thumb encircling technique

Paediatric BLS: in infants use a two-thumb encircling technique for chest compression

The correct answer is the two-thumb encircling technique and should be given to infants aged younger than one.

1 hand compressing the lower half of the sternum is the incorrect answer as this should be used in basic life support for a child aged older than 1 year.

2 hands compressing the upper half of the sternum is incorrect in this situation as this is the method that should be used in adult life support.

The third option of 2 hands compressing the lower half of the sternum is not a recognised method of providing chest compressing in any circumstance.

One-thumb encircling technique is not a recognised technique to provide chest compressions.

Question 14

A 3-year-old boy is rushed to the emergency department by his parents who are reporting that he is unresponsive. On examination, the child shows no response and no airway obstruction is identified. On auscultation and palpation of the chest, no breath sounds are identified. Following five rescue breaths, there is still no sign of life.

What is the most appropriate next step?

• Administer chest compressions over the lower half of the sternum using the heel of your hand
• Administer chest compressions over the upper half of the sternum using the heel of your hand
• Administer chest compressions using the encircling technique
• Administer chest compressions using the two-fingers technique
• Initiate a further round of rescue breaths

Answer 14

Administer chest compressions over the lower half of the sternum using the heel of your hand

Paediatric BLS: in children compress the lower half of the sternum

Administer chest compressions over the lower half of the sternum using the heel of your hand is correct. This patient needs to be managed as per the paediatric basic life support (BLS) guidelines. After the airway and breathing are assessed and the patient does not appear to have signs of life, basic life support should be commenced with five initial rescue breaths. If there are still no signs of life then the resuscitation team needs to be called (2222) and the team should commence chest compressions. For a child, you should be using the heel of your hand over the lower half of the sternum for high-quality chest compressions. This is because the lower half of the sternum provides the best anatomical position to give direct pressure on the heart.

Administer chest compressions over the upper half of the sternum using the heel of your hand is incorrect. Whilst chest compressions are needed as per BLS guidelines, the upper half of the sternum is the incorrect anatomical position. Additionally, the lower half of the sternum allows for a deeper depth of compression, in turn generating the force needed to move blood.

Administer chest compressions using the encircling technique is not correct. Whilst chest compressions are needed, the encircling technique is used when you have two rescuers and are initiating chest compressions on an infant. Given the age of this patient, this technique is not appropriate.

Administer chest compressions using the two-fingers technique is incorrect. Whilst chest compressions are needed, a two-finger technique is the technique of choice when a single rescuer is performing chest compressions on an infant. Given the age of this patient, this technique would not be appropriate here.

Initiate a further round of rescue breaths is incorrect. The BLS guidelines state to make up to 5 attempts to achieve effective breaths. If still unsuccessful, move on to chest compressions. Given this patient has already had 5 attempted rescue breaths, a further round would be inappropriate here.

Question 15

A 4-year-old boy is brought in to surgery by his mother. He has reportedly been drowsy and pyrexial for the past 2 hours. Whilst waiting to be seen he becomes unresponsive. One of your GP colleagues performs an urgent assessment whilst the practice nurse calls 999. He is making no respiratory effort so 5 rescue breaths are given. As you arrive your colleague cannot detect a brachial or carotid pulse. What is the most appropriate course of action?

Start chest compressions/ventilations at a ratio of 5:1
Check for a femoral pulse
Start chest compressions/ventilations at a ratio of 15:2
Give a further 5 rescue breaths
Start chest compressions/ventilations at a ratio of 30:2

Answer 15

Start chest compressions/ventilations at a ratio of 15:2

As two trained members of staff are present the ratio of chest compressions to ventilations should be 15:2

Question 16

A 5-year-old boy has an anaphylactic reaction following the ingestion of nuts. He is brought to the emergency department however, on arrival he shows no signs of life.

What is the correct treatment?

2 rescue breaths then 15 chest compressions to every 1 ventilation breaths
2 rescue breaths then 15 chest compressions to every 2 ventilation breaths
5 rescue breaths then 15 chest compressions to every 1 ventilation breaths
5 rescue breaths then 15 chest compressions to every 2 ventilation breaths
5 rescue breaths then 30 chest compressions to every 2 ventilation breaths

Answer 16

5 rescue breaths then 15 chest compressions to every 2 ventilation breaths

In paediatric basic life support, the ratio of compressions to breaths is 15:2

5 rescue breaths then 15 chest compressions to every 2 ventilation breaths is the correct answer. In a child, 5 rescue breaths should be administered and the correct ratio during cardiopulmonary resuscitation is 15 chest compressions to 2 ventilation breaths. For a child under 1, the two-thumb encircling or two-finger techniques should be used. For a small child, the one-handed technique should be used. For a larger child, the two-handed technique can be used (as for adults).

30:2 is incorrect. This is the correct ratio of compressions to breaths in adult cardiopulmonary resuscitation.

Question 17

A 3-year-old boy is brought into resus in cardiac arrest. The patient was brought in by ambulance with his mother. She is too distraught to give any history other than the child had been okay when she had left the room. He was found unconscious on her return so an ambulance was called.

Which of the reversible causes of cardiac arrest are most likely in this situation?

Hypothermia
Hypovolaemia
Hypoxia
Tension pneumothorax
Thrombus

Answer 17

Hypoxia

The most common causes of arrest in children are respiratory

The most likely cause of this arrest was hypoxia as the most common cause of paediatric arrest is a respiratory arrest. In this case, hypoxia is likely due to a choking episode due to the child’s age and the lack of a clear history for another cause. Choking episodes are common causes of collapse and arrest in young ambulant children, particularly toddlers.

There is nothing to suggest that the patient was hypothermic and the lack of trauma in the history makes hypovolaemia and tension pneumothorax less likely. Thrombus is not as common in children as adults.

Question 18

You are a doctor working on the paediatric ward. A 6-year-old patient has become unresponsive. After calling another doctor to assist, you open the patient’s airway and feel for breathing, but the child is not breathing. You give five rescue breaths while the other doctor checks for a femoral pulse, which is not present. Now you decide to start CPR while waiting for further help to arrive.

What is the appropriate rate of chest compressions and ratio of chest compressions:rescue breaths to use in this child?

Chest compressions rate of 100-120/min, ratio of 15:2
Chest compressions rate of 100-120/min, ratio of 30:2
Chest compressions rate of 120-150/min, ratio of 15:2
Chest compressions rate of 120-150/min, ratio of 30:2
Chest compressions rate of 80-100/min, ratio of 15:2

Answer 18

Chest compressions rate of 100-120/min, ratio of 15:2

Paediatric BLS: chest compressions should be 100-120/ min for both infants and children

Chest compressions rate of 100-120/min, ratio of 15:2 is the correct answer. Chest compressions should be at a rate of 100-120/min for CPR for both infants and children. This is the same rate that should be used in adults. A ratio of 15:2 should be used for CPR in infants and children when there are two or more rescuers with a duty to respond, as in this scenario.

A ratio of 30:2 is used in infants and children when CPR is being performed by lay rescuers. This is the same ratio used for CPR in adults.

It is important not to perform chest compressions too fast. Higher rates don’t give a long enough diastolic phase for blood to return to the ventricles. Therefore chest compressions rate of 120-150/min are too fast and not recommended.

In paediatric BLS you reduce the pressure by only using one hand but the rate of compressions is the same. Chest compressions rate of 80-100/min are incorrect as they would not move enough blood to perfuse all the vital organs.