Figure 23.1 Paediatric Life Support Algorithm Reproduced with the kind permission of the Resuscitation Council (UK) Figure 23.2 Correct neutral position of head for successful airway management From Lissauer and Fanaroff (2011) Neonatology at a Glance, 2nd edition. Reproduced with permission of Wiley
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Infant resuscitation
Cardiorespiratory arrest is an uncommon event for most child health nurses but the ability to perform the procedure effectively and efficiently is paramount. This section deals specifically with infant resuscitation (i.e. any child less than 1 year of age but not a newborn baby). This is a concise version of the full procedure offered by Resuscitation Council (UK) and all readers are strongly advised to read this guidance to ensure up-to-date practice while performing this procedure (Figure 23.1). The Paediatric Basic Life Support guidance does not include advice for the layperson and covers the actions of health care professionals with a duty of care (for the full guidance visit www.resus.org.uk).
Unresponsive – shout for help!
- Gently stimulate the infant by loudly asking ‘Are you all right?’ or calling the infant’s name.
- If responsive, leave child in the position you find them unless the infant is in immediate danger or the airway is at risk.
- If there is no response, shout for help.
Open airway
- Turn infant on his/her back on a firm surface where you are able to be directly above the infant.
- Head tilt should be used initially by placing your hand on the forehead to gently tilt the head. While placing your fingertips on to the bony prominence of the child’s jaw, lift the chin into a neutral position.
- If there is difficulty opening the airway or you are concerned about cervical injury, perform a jaw thrust.
- Place fingers either side of the infant’s mandible (jawbone) and push the jaw forward.
- Do not place your fingertips on the soft tissue under the chin as you may block the airway.
If breathing normally, place into the recovery position by:
- Placing in a true lateral position
- In a position that allows observation of the airway and drainage of any secretions
- Does not overly obstruct chest movements
- The infant should be easily positioned on to his/her back from this position if necessary.
Not breathing normally?
Once the airway is open, position the side of your face close to the infant’s face.
| LOOK | for chest movement |
| LISTEN | for breath sounds |
| FEEL | air movement on your cheek |
This should take no more than 10 seconds. If in doubt, assume breathing rate is abnormal and proceed with procedure.
Rescue breaths
If breathing is not normal or absent, clear the airway of any secretion or airway obstructions (do not use finger sweeps to remove obstructions) and give five rescue breaths.
With the head in the neutral position:
- Take a breath and cover the nose and mouth with your mouth
- A good seal can be obtained by not overly opening your mouth and keeping your lips soft
- Blow steadily over 1–1.5 seconds until the chest visibly moves
- Maintain the neutral position while removing your mouth to watch the chest fall before applying the next breath
If you are unable to get a good seal around the nose and mouth in the older infant you may:
- Attempt to just seal the nose or the mouth with the rescuer’s mouth
- If using the nose, be sure to close the mouth while securing the airway to ensure air is not lost.
Signs of life
(should take no more than 10 seconds)
If you are confident in your ability to assess the brachial pulse, look for a pulse greater than 60 beats per minute.
Look for signs of life:
- Movement
- Coughing
- Normal breathing not gasps, infrequent or irregular breaths.
If you are confident that you can detect signs of circulation:
- Continue rescue breaths until the child shows signs of life
- When showing signs of life, place the infant into the recovery position and reassess.
No signs of life
Lone rescuers should:
- Compress the lower half of the sternum with the tips of two fingers. This equates to one finger breath up from the end of the sternum (xiphisternum)
- Depress the sternum by at least one-third the depth of the chest (do not be afraid to push to hard)
- Release the pressure to allow the chest to recoil
- During the cardiac compression stage you are looking for a rate of 100–120 per minute
- Compression to breath rate of 15 : 2
- Reassess after 1 minute, looking for signs of life.
If there are two or more rescuers, then the encircling technique may be utilized:
- In the same position, compression pressure and rate as a single rescuer, place two thumbs on the lower sternum
- Thumbs should be pointing towards the infant’s head.
You must continue resuscitation until:
- The infant shows signs of life
- Further qualified help arrives
- You become exhausted.
Get help as quickly as possible:
- If only one rescuer is present, undertake resuscitation for 1 minute before going for assistance
- With an infant it may be possible to carry them to further assistance to minimize interruptions.
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