Figure 24.1 Advanced Paediatric Life Support Algorithm Reproduced with the kind permission of the Resuscitation Council (UK)
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Young person resuscitation
When involved in resuscitation it must be noted that there are differences to the resuscitation algorithm that are dependent on whether the patient is an infant (under 1 year of age), a child or young person (over 1 year of age) or if they are an adult. For the purposes of this section resuscitation is focused on a young person who is over 1 year of age.
Safe to approach
Always ensure that it is safe to approach the patient and that there are no obvious hazards.
Stimulate
Try to gain a response from the patient. This can be by calling their name or stroking their forehead or ears. If they respond, keep them comfortable and call for help. If they are unresponsive, continue with the young person resuscitation algorithm.
Shout
Shout for help and ensure that someone contacts the paediatric arrest team so that further assistance is provided.
Airway
Ensure that the mouth is clear from obstruction and then place the head into a ‘head tilt chin lift’ position so enable the airway to be fully opened. If there are concerns that the young person has been involved in a trauma then a jaw thrust should be performed to ensure that the head remains in a neutral position and is in alignment with the cervical spine.
Breathing
Once the airway has been opened it is important to look, listen and feel for breathing for 10 seconds. Look to see the rise and fall of the chest, listen for any breath sounds and feel for breath being expelled from the mouth and/or nose. If there is no breathing or ineffective breathing then five effective rescue breaths must be given. If any of the breaths are not effective then they must be repeated until the young person has received five effective breaths.
Circulation
When the five rescue breaths have been delivered, the next step is to palpate a central pulse. In the case of the young person a central pulse can be palpated at the site of the carotid artery. A pulse must be counted for 10 seconds. If there is no pulse or there is a pulse of less than 60 beats a minute then chest compressions must be commenced at a ratio of 15 compressions to two breaths. The landmark for chest compressions is two finger breadths above the xiphisternum; using the heel of the hand or both hands interlocked to deliver the chest compressions depending on the size of the child.
While cardiopulmonary resuscitation (CPR) is being carried out it is vital that a monitor is attached to the young person to determine what rhythm their heart is in and therefore if it is a shockable or unshockable rhythm.
- Shockable rhythms: pulseless ventricular tachycardia and ventricular fibrillation
- Unshockable rhythms: pulseless electrical activity (PEA) and asystole.
If the young person requires defibrillating the amount of energy that should be used is 4 joules per kilogram.
If the young person is in cardiac arrest, the pulse and heart rhythm must be rechecked every 2 minutes and the appropriate course of action taken.
Definitive care
It is important to note that while not all young people have a spontaneous return of circulation, some do make a very good recovery from a cardiac arrest. If a young person responds to the treatment then plans should be made for them to be admitted to either an intensive care unit on site or to another hospital where they have the expertise and facilities to care for them.
If the young person does not survive the cardiac arrest it is imperative that support services are put into place for the family to offer comfort during their bereavement and also that a debrief is carried out for all staff who were involved in the resuscitation to allow them an opportunity to discuss their feelings and the situation.
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