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BLS / CPR BASIC GUIDELINES
FOR INFANTS AND CHILDEN
For Final year MBBS
PREPARED BY
PROF. DR. ASMA SHABBIR
HOD PAEDIATRICS DEPARTMENT
FAZAIA MEDICAL COLLEGE
AIR UNIVERSITY
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WHOEVER SAVES ONE LIFE,
SAVES ALL HUMANITY
QURAN VERSE 5:32
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Assess the situation where the victim has collapsed
Paediatric Chain of Survival
Prevention of arrest
Early high quality bystander CPR
Rapid activation of emergency services
Effective advanced life support
Integrated post-cardiac arrest care
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BLS Sequence (2010 guidelines by American Heart Association)
Followed by defibrillation by Automated external
defibrillator (AED) if available
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1- and 2-Rescuer one year of age to puberty BLS
Skills training Criteria and Descriptors
1. Assesses victim (Steps 1 and 2, assessment and activation, must be completed within 10
seconds of arrival at scene):
• Checks for unresponsiveness (this MUST precede starting compressions)
• Checks for no breathing or only gasping
2. Sends someone to activate emergency response system (Steps 1 and 2, assessment and
activation, must be completed within 10 seconds of arrival at scene):
• Shouts for help/directs someone to call for help AND get AED/defibrillator
• If alone, leave the child to activate emergency response system
3. Checks for pulse
• Checks carotid or femoral pulse
• This should take no more than 10 seconds
If no pulse or heart rate < 60/min, start chest compressions
4. Delivers high-quality 1-rescuer CPR (initiates compressions within 10 seconds of
identifying cardiac arrest):
• Correct placement of the hands on the chest
- Lower half of breast bone
- One handed: place heel of the hand
- 2 handed: second hand on top the first or grasping the wrist of the first
hand
- 1 rescuer: heel of the hand just below the nipple line
• Compression rate of at least 100/min
-Delivers 30 compressions in 18 seconds or less
-Adequate depth for age
- Child: at least one third the depth of the chest (approximately 5 cm [2
inches])
• Complete chest recoil after each compression
• Appropriate ratio for age and number of rescuers
- 1 rescuer: 30 compressions to 2 breaths
• Minimizes interruptions in compressions
- Less than 10 seconds between last compression of one cycle and first
compression of next cycle
5. Switches at appropriate intervals as prompted by the instructor (for purposes of this
evaluation)
6. Provides effective breaths with bag-mask device during 2-rescuer CPR:
• Provides effective breaths
- Opens airway adequately
- Delivers each breath over 1 second
- Delivers breaths that produce visible chest rise
- Avoids excessive ventilation
7. Provides high-quality chest compressions during 2-rescuer CPR:
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• Correct placement of hands in center of chest
- Lower half of breast bone
- One handed: place heel of the hand
- 2 handed: second hand on top of the first or grasping the wrist of the first hand
- 2 rescuers: heel of the hand just below the nipple line
• Compression rate of at least 100/min
- Delivers 15 compressions in 9 seconds or less
• Adequate depth for age
- Infant: at least one third the depth of the chest (approximately 5 cm (2
inches])
• Complete chest recoil after each compression
• Appropriate ratio for age and number of rescuers
- 2 rescuers: 15 compressions to 2 breaths
• Minimizes interruptions in compressions:
- Less than 10 seconds between last compression of one cycle and first
compression of next cycle
Fig 1: One handed chest compressions for younger child,
Arms straight, push with force from shoulders
Fig 2: Two handed chest compressions for older child,
Arms straight, push with force from shoulders
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Fig 3: Airway opening in a child, head tilt chin lift, slight extension of neck.
Pinch the nose and give breaths through the mouth (mouth to mouth breathing)
Or use a breathing mask
TECHNIQUE OF MOUTH TO MOUTH BREATHING FOR CHILD
STEP ACTION
1 Hold the victim’s airway open with a head tilt- chin lift
Pinch the nose closed with your thumb and index finger (using the hand on
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the forehead)
3 Take a regular (not deep) breath and seal your lips around the victim’s mouth,
creating an air tight seal.
Give 1 breath (blow for about 1 second). Watch for the chest to rise as you
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give the breath.
5 If the chest does not rise, repeat the head tilt- chin lift.
6 Give a second breath (blow for about 1 second) watch for the chest rise.
If you are unable to ventilate the victim after 2 attempts , promptly return to
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chest compressions.
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1- and 2-Rescuer Infant BLS
Skills Training Criteria and Descriptors
1. Assesses victim (Steps 1 and 2, assessment and activation, must be completed within 10
seconds of arrival at scene):
• Checks for unresponsiveness (this MUST precede starting compressions)
• Checks for no breathing or only gasping
2. Sends someone to activate emergency response system (Steps 1 and 2, assessment and
activation, must be completed within 10 seconds of arrival at scene):
• Shouts for help/directs someone to call for help AND get AED/defibrillator
• If alone, remains with infant to provide 2 minutes of CPR before activating
emergency response system
3. Check for pulse:
• Check brachial pulse
• This should take no more than 10 seconds
If no pulse or heart rate < 60/min start, chest compressions
4. Delivers high-quality 1-rescuer CPR (initiates compressions within 10 seconds of
identifying cardiac arrest):
• Correct placement of hands/fingers in center of chest
- 1 rescuer: 2 fingers just below the nipple line
• Compression rate of at least 100/min
-Delivers 30 compressions in 18 seconds or less
Adequate depth for age
- Infant: at least one third the depth of the chest (approximately 4 cm [1.5nches])
• Complete chest recoil after each compression
• Appropriate ratio for age and number of rescuers
- 1 rescuer: 30 compressions to 2 breaths
• Minimizes interruptions in compressions:
- Less than 10 seconds between last compression of one cycle and first compression
of next cycle
5. Switches at appropriate intervals as prompted by the instructor (for purposes of this
evaluation)
6. Provides effective breaths with bag-mask device during 2-rescuer CPR:
• Provides effective breaths:
- Opens airway adequately
- Delivers each breath over 1 second
- Delivers breaths that produce visible chest rise
- Avoids excessive ventilation
7. Provides high-quality chest compressions during 2-rescuer CPR:
• Correct placement of hands/fingers in center of chest
2 rescuers: 2 thumb-encircling hands just below the nipple line
• Compression rate of at least 100/min
- Delivers 15 compressions in 9 seconds or less
• Adequate depth for age
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- Infant: at least one third the depth of the chest (approximately 4 cm (1.5 inches])
• Complete chest recoil after each compression
• Appropriate ratio for age and number of rescuers
- 2 rescuers: 15 compressions to 2 breaths
• Minimizes interruptions in compressions:
- Less than 10 seconds between last compression of one cycle and first compression
of next cycle
Fig 4: 1 rescuer, 2 finger used for chest compressions
Fig 5: 2 rescuers, 2 finger method for chest compressions
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Fig 6: Airway opening in infant, sniffing or neutral position, cover both nose and mouth of
the infant with your mouth to give breaths or use a breathing mask
TECHNIQUE OF MOUTH TO MOUTH AND NOSE BREATHING FOR INFANT
1. Maintain a head tilt- chin lift to keep the airway open.
2. Place your mouth over the infant’s mouth and nose to create an airtight seal.
3. Blow into the infant’s nose and mouth (pausing to inhale between breaths) to make
the chest rise with each breath.
4. If the chest does not rise, repeat the head tilt- chin lift to reopen the airway and try
to give a breath that makes the chest rise.
5. When the airway is open, give 2 breaths that make the chest rise. (you may need to
try a couple of times to achieve the correct position and maneuver)
Fig 7: Airway opening positions at different ages
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CHOCKING
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Relief of Choking in Victims 1 Year of Age and Older
Recognizing choking in a responsive adult or child
Early recognition of airway obstruction is the key to successful outcome.
Foreign bodies can cause a range of symptoms from mild to severe airway
obstruction.
Mild Airway Obstruction Severe Airway Obstruction
Signs:
• Poor or no air exchange
Weak, ineffective cough or no coughat all
Signs: High-pitched noise while inhaling or no noise
• Good air exchange at all
Can cough forcefully • Increased respiratory difficulty
May wheeze between coughs • Possible cyanosis (turning blue)
• Unable to speak
Clutching the neck with the thumb and
fingers, making the universal chocking sign.
Rescuer Actions Rescuer Actions
• As long as air exchange continues,
encourage the victim to continue
spontaneous coughing and
breathing efforts.
Ask the victim if he or she is chocking. If the
• Do not interfere with the victim's
victim nodes yes and cannot talk, severe
own attempts to expel the foreign
airway obstruction is present and you must try
body but stay with the victim and
to relieve the obstruction.
monitor his or her condition.
• If mild airway obstruction persists,
activate the emergency response
system.
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Abdominal Thrusts with Victim Standing or Sitting
Follow these steps to perform abdominal thrusts on a responsive adult or child who Is
standing or sitting
Step Action
Stand or kneel behind the victim and wrap your arms around the victim's waist
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(Figure 8).
2 Make a fist with one hand.
Place the thumb side of your fist against the victim's abdomen, in the midline,
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slightly above the navel and well below the breastbone.
Grasp your fist with your other hand and press your fist into the victim's
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abdomen with a quick, forceful upward thrust.
Repeat thrusts until the object is expelled from the airway or the victim
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becomes unresponsive.
Give each new thrust with a separate, distinct movement to relieve the
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Obstruction.
Fig 8: Heimlich Maneuver
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Sequence of Actions after Relief of Choking
1. You can tell that you have successfully removed an airway obstruction in an
unresponsive victim if you
Feel air movement and see the chest rise when you give breaths
See and remove a foreign body from the victim's mouth
2. After you relieve choking in an unresponsive victim, treat him or her as you
would any unresponsive victim (i.e. check response, breathing and pulse), and
provide CPR or rescue breathing as needed. If the victim responds, encourage
the victim to seek immediate medical attention to ensure that the victim does
not have a complication from abdominal thrusts.
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Relief of Choking in Infants
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Recognizing Choking in a Responsive Infant
Early recognition of airway obstruction is the key to successful outcome. The trained
observer can often detect signs of chocking.
Foreign bodies may cause a range of symptoms from mild to severe airway obstruction.
Mild Airway Obstruction Severe Airway Obstruction
Signs:
• Poor or no air exchange
Signs:
• Weak, ineffective cough or no cough at all
• Good air exchange
• High-pitched noise while inhaling or no
Can cough forcefully
noise at all
May wheeze between coughs
• Increased respiratory difficulty
• Possible cyanosis (turning blue)
• Unable to cry
Rescuer Actions Rescuer Actions
• Do not interfere with the infant's
own attempts to expel the foreign
body, but stay with the victim and • If the infant cannot make any sounds
monitor his or her condition. or breathe, severe airway obstruction
• If mild airway obstruction persists, is present and you must try to relieve
activate the emergency response the obstruction.
system.
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Relieving Choking in a Responsive Infant
Clearing an object from an infant's airway requires a combination of back slaps and chest
thrusts. Abdominal thrusts are not appropriate.
Follow these steps to relieve choking in a responsive infant
Step Action
1 Kneel or sit with the infant in your lap.
2 If it is easy to do, remove clothing from the infant's chest.
Hold the infant facedown with the head slightly lower than the chest, resting on
your forearm. Support the infant's head and jaw with your hand. Take
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care to avoid compressing the soft tissues of the infant's throat. Rest your forearm
on your lap or thigh to support the infant.
Deliver up to 5 back slaps (Figure 9) forcefully between the infant's shoulder
4 blades, using the heel of your hand. Deliver each slap with sufficient force to
attempt to dislodge the foreign body.
After delivering up to 5 back slaps, place your free hand on the infant's back
supporting the back of the infant's head with the palm of your hand. The
5 infant will be adequately cradled between your 2 forearms, with the palm of one
hand supporting the face and jaw while the palm of the other hand supports the
back of the infant's head.
Turn the infant as a unit while carefully supporting the head and neck. Hold the
6 infant face up, with your forearm resting on your thigh. Keep the infant's head
lower than the trunk.
Provide up to 5 quick downward chest thrusts (Figure 32B) in the middle of
the chest over the lower half of the breastbone (same as for chest compressions
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during CPR). Deliver chest thrusts at a rate of about 1 per second, each with the
intention of creating enough force to dislodge the foreign body.
Repeat the sequence of up to 5 back slaps and up to 5 chest thrusts until the
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object is removed or the infant becomes unresponsive.
Fig 9: Relief of choking in an infant. A, back slaps. B, Chest thrusts
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Relieving Choking in an Unresponsive Infant
Do not perform blind finger sweeps in infants and children because sweeps may
push the foreign body back into the airway, causing further obstruction or injury.
If the infant victim becomes unresponsive, stop giving back slaps and begin CPR.
To relieve choking in an unresponsive infant, perform the following steps:
Steps Actions
Call for help. If someone responds, send that person to activate the emergency
1 response system. Place the infant on a firm, flat surface.
Begin CPR (starting with compressions) with 1 extra step: each time you open the
airway, look for the obstructing object in the back of the throat. If you see an
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object and can easily remove it, remove it.
After approximately 2 minutes of CPR (C-A-B sequence), activate the emergency
3 response system (if no one has done so).
