
Overview
This module describes how to resuscitate a child or infant in cardiac arrest using a simple algorithmic approach.
Indications
- Unresponsive patient
Contraindications
- None
Patient information and consent
This procedure is done during an emergency, so consent is generally implied.
Preparation
Basic life support is an emergency procedure.
In hospital, always:
- Know where defibrillators, transcutaneous pads, and red trolleys are kept. Know the relevant staff and keep your seniors’ contact details close at hand.
- Familiarise yourself with the defibrillators in your work area. Check that they are maintained regularly and have pads and the correct connections.
- Keep unstable patients in resuscitation bays with continuous monitoring.
In out of hospital situations:
- Carry gloves and a CPR protective device.
- In public places such as airports and malls, look out for AEDs and first aid stations attached to walls.
- Memorise emergency phone numbers, or keep them on your cell phone, to call for help.
Site & Positioning
To perform Basic Life Support, a patient should be lying flat on their back on a firm surface. There should be space behind the head of the bed for staff to stand to give rescue breaths.
Procedure
Use medical asepsis with non-sterile gloves.
Troubleshooting
I don’t have a CPR protective device for mouth-to-mouth breaths.
Give hands-only CPR (continuous compressions without breaths) until equipment such as a BVM resuscitator arrives.
I’m unsure about the quality of my chest compressions.
Check the following:
- Centre compressions on the lower half of the sternum, compressing ⅓ of the depth of the chest.
- Ensure good chest recoil (don’t lean on the chest between compressions).
- Your shoulders should be directly above your hands, elbows straight.
- Stand on a step or kneel on the bed so that your hips are higher than the patient’s chest.
- Minimise interruptions.
- Change chest compressors every 2 min to avoid fatigue.
I’m unsure about the quality of my rescue breaths.
Ensure correct head position. Consider using an oropharyngeal or nasopharyngeal airway. Ensure that you are pulling the face into the mask using an EC grip, rather than leaning on the patient’s face. Continuously monitor chest rise.
My patient is moving but I still can’t find a pulse.
Patients in cardiac arrest may have movements such as twitching or writhing. If there is no pulse and the patient is not responding to your prompts, continue CPR.
I heard something crack under my hands.
Rib and sternal fractures are not uncommon. Continue CPR, but ensure your hand placement is correct.
There are no child pads in the defibrillator.
Adult pads can be used on children. Ensure that the pads are not touching each other.
Risks
- Unsuccessful CPR
- Bruising
- Rib/sternal fractures
- Pneumothorax
- Defibrillator burns
- Healthcare worker exposed to infectious substances
References
- Resuscitation Council of Southern Africa. Basic Life Support Algorithm. 2021.