Paediatric Resuscitation Guidelines

Pediatric resuscitation guidelines are outlined by the pediatric chain of survival developed by the American Heart Association. The pediatric chain of survival is prevention, early access, early CPR, early defibrillation and early advanced care. The guidelines are adapted to account for challenges in children's anatomy. Children have unique needs and challenges due to smaller, underdeveloped anatomical structures and physiological systems. Special emphasis is also given to the prevention of accidents.

Prevention

• Accidents are the number one killer of children and adults ages one to twenty-four, according to the National Institutes of Health. Accidental deaths include motor vehicle collisions, falls, drownings and poisonings. Prevention of childhood accidents should include proper installation and use of child car seat restraints, locked medicine and cleaning product cabinets and supervision around pools, playground equipment and other areas where drownings and falls can occur.

Early Access

• Early access means getting professional help to the child as soon as possible. It begins by first ensuring that the scene of the incident is safe. Then it is necessary to assess the victim's consciousness by asking "Are you okay?" Children may not be able to respond depending on their stage of development. Rub the child's sternum with your knuckles in a fist or flick on the sole of the foot for an infant. This will help you assess the child's level of responsiveness. You should perform two cycles of CPR before calling 9-1-1 or another local emergency number. If other people are available, the rescuer should designate a specific individual to make the emergency call and another to retrieve an AED.

Early CPR

• CPR focuses on the ABCs: airway, breathing and circulation. First, look in the child's airway. If there is a visible obstruction, remove it. Gently lift the child's chin to tilt the head back slightly to the so-called sniff position. The movement is very slight and looks as if the child has just smelled something. A child's trachea, or windpipe, is very soft, and if the neck is extended too much it will cut off airflow. Next, check breathing. Look, listen and feel for movement of air in and out of the lungs. Finally, check circulation for the presence of a pulse. Check pulse at the carotid artery in pediatric patients older than one year. If the patient is an infant, check the pulse on the brachial artery located on the inside of the upper arm between the biceps and triceps muscles.

  Begin chest compressions after the ABCs have been assessed. CPR, or cardiopulmonary resuscitation should only be performed on an unconscious child without a pulse. Pediatric chest compressions should be done 100 times per minute. Compressions should be about one-third to one-half the depth of the child's chest. After 30 compressions, give two breaths. Breaths should be delivered slowly and evenly over a one to one and a half second interval.

Early Defibrillation

• Cardiac arrest in children is most often caused by respiratory failure. This is why it is important to provide rescue breathing before activating 9-1-1. But in the event of cardiac arrest, automatic external defibrillators, or AEDs, were developed to shock the heart back into a viable rhythm. AEDs are located in many public buildings and have easy to follow instructions. Some even talk you through the steps. Special pediatric pads come with the AED and should be used in place of the larger, adult pads.

Early Advanced Care

• Survival is dependent on all the links in this chain. However, access to advanced care in the hospital is especially vital. A child's body is better able to compensate than adult patients during the early stages of distress but will enter a rapid decline often without warning. The hospital provides equipment, medications and personnel that cannot be accessed in the field to support a child in a deteriorating condition.