Part 11: Pediatric Basic Life Support IV-157 age. 4 The etiology of SIDS remains unknown, but risk respiratory distress to remain in a position that is most factors include prone sleeping position, sleeping on a soft comfortable surface, 5-37 and second-hand smoke. 38,39 The incidence of If the child is unresponsive and is not moving, shout for SIDS has declined 40%040 since the"Back to Sleep" public help and start CPR. If you are alone, continue CPR for 5 education campaign was introduced in the United States in cycles(about 2 minutes). One cycle of CPR for the lone 1992. This campaign aims to educate parents about placing an rescuer is 30 compressions and 2 breaths(see below ). Then infant on the back rather than the abdomen or side to sleep activate the EMS system and get an automated external defibrillator(AED)(see below ). If you are alone and there Drowning is no evidence of trauma, you may carry a small child with Drowning is the second major cause of death from uninten- you to the telephone. The EMs dispatcher can guide you tional injury in children <5 years of age and the third major through the steps of CPR. If a second rescuer is present cause of death in adolescents. Most young children drown at rescuer should immediately activate the EMs system after falling into swimming pools while unsupervised; ado- and get an aEd (if the child is I year of age or older) while descents more commonly drown in lakes and rivers while you continue CPR. If you suspect trauma, the second swimming or boating. Drowning can be prevented by install- rescuer may assist by stabilizing the child's cervical spine ing isolation fencing around swimming pools(gates should (see below ). If the child must be moved for safety reasons, be self-closing and self-latching )I and wearing personal support the head and body to minimize turning, bending, flotation devices (life jackets) while in, around, or on water twisting of the head and neck The BLS Sequence for Infants and Children Activate the EMs System and Get the aED (Box 2) For the purposes of these guidelines, an"infant"is less than If the arrest is witnessed and sudden 27. 43(eg, an athlete who approximately I year of age. This section does not deal with newborn infants(see Part 13: "Neonatal Resuscitation Guide- collapses on the playing field), a lone healthcare provider should activate the EMS system(by telephoning 91l in most lines"). For lay rescuers the"child "BLS guidelines should be locales)and get an AED (if the child is I year of age or older) applied when performing CPR for a child from about I year before starting CPR. It would be ideal for the lone lay rescuer of age to about 8 years of age. For a healthcare provider, the who witnesses the sudden collapse of a child to also activate the EMs system and get an AED and return to the child to about the start of puberty. For an explanation of the differ begin CPR and use the AED. But for simplicity of lay rescuer ences in etiology of arrest and elaboration of the differences education it is in the recommended sequence for lay rescuer and healthcare about 5 cycles(about 2 minutes) of CPR for any infant or rovider cpr for infants. children. and adults. see Part 3 child victim before leaving to phone 911 and get an AED (if “ Overview of cPr appropriate). This sequence may be tailored for some learners These guidelines delineate a series of skills as a sequence (eg, the mother of a child at high risk for a sudden arrhyth mia). If two rescuers are present, one rescuer should begi (eg, starting CPR and activating the EMS system), especially CPR while the other rescuer activates the EMS system and hen more than one rescuer is presen gets the AED. depicted in the Pediatric Healthcare Provider BLs Algorithm Figure 2). The numbers listed with the headings below refer Position the victim to the corresponding box in that algorithm If the victim is unresponsive, make sure that the victim is in Safety of Rescuer and victim sturdy t(face up) position on a flat, hard surface, such as a sturdy table, the floor, or the ground. If you must turn the Always make sure that the area is safe for you and the victim. victim, minimize turning or twisting of the head and neck Move a victim only to ensure the victim's safety. Although exposure to a victim while providing CPR carries a theoret Open the Airway and Check Breathing(Box 3) ical risk of infectious disease transmission, the risk is very In an unresponsive infant or child, the tongue may obstruct low. 42 the airway, so the rescuer should open the airway. 4-4 Check for Response(Box 1) Open the Airway: Lay Rescuer If you are a lay rescuer, open the airway using a head tilt-chin lift maneuver for both injured and noninjured Gently tap the victim and ask loudly, "Are you okay? "Call victims( Class Ila). The jaw thrust is no longer recommended the child,s name if you know it. Look for movement. If the child is responsive, he or she for lay rescuers because it is difficult to learn and perform, is ill answer or move. Quickly check to see if the child has often not an effective way to open the airway, d may cause es or needs medical assistance If necessary, leave spinal movement(Class Ilb the child to phone EMS, but return quickly and recheck th Open the Airway: Healthcare Provider child,s condition frequently. Children with respiratory A healthcare provider should use the head tilt-chin lift distress often assume a position that maintains airway maneuver to open the of a victim without evidence of patency and optimizes ventilation. Allow the child with head or neck trauma.age.34 The etiology of SIDS remains unknown, but risk factors include prone sleeping position, sleeping on a soft surface,35–37 and second-hand smoke.38,39 The incidence of SIDS has declined 40%40 since the “Back to Sleep” public education campaign was introduced in the United States in 1992. This campaign aims to educate parents about placing an infant on the back rather than the abdomen or side to sleep. Drowning Drowning is the second major cause of death from uninten￾tional injury in children 5 years of age and the third major cause of death in adolescents. Most young children drown after falling into swimming pools while unsupervised; ado￾lescents more commonly drown in lakes and rivers while swimming or boating. Drowning can be prevented by install￾ing isolation fencing around swimming pools (gates should be self-closing and self-latching)41 and wearing personal flotation devices (life jackets) while in, around, or on water. The BLS Sequence for Infants and Children For the purposes of these guidelines, an “infant” is less than approximately 1 year of age. This section does not deal with newborn infants (see Part 13: “Neonatal Resuscitation Guide￾lines”). For lay rescuers the “child” BLS guidelines should be applied when performing CPR for a child from about 1 year of age to about 8 years of age. For a healthcare provider, the pediatric (“child”) guidelines apply from about 1 year to about the start of puberty. For an explanation of the differ￾ences in etiology of arrest and elaboration of the differences in the recommended sequence for lay rescuer and healthcare provider CPR for infants, children, and adults, see Part 3: “Overview of CPR.” These guidelines delineate a series of skills as a sequence of distinct steps, but they are often performed simultaneously (eg, starting CPR and activating the EMS system), especially when more than one rescuer is present. This sequence is depicted in the Pediatric Healthcare Provider BLS Algorithm (Figure 2). The numbers listed with the headings below refer to the corresponding box in that algorithm. Safety of Rescuer and Victim Always make sure that the area is safe for you and the victim. Move a victim only to ensure the victim’s safety. Although exposure to a victim while providing CPR carries a theoret￾ical risk of infectious disease transmission, the risk is very low.42 Check for Response (Box 1) ● Gently tap the victim and ask loudly, “Are you okay?” Call the child’s name if you know it. ● Look for movement. If the child is responsive, he or she will answer or move. Quickly check to see if the child has any injuries or needs medical assistance. If necessary, leave the child to phone EMS, but return quickly and recheck the child’s condition frequently. Children with respiratory distress often assume a position that maintains airway patency and optimizes ventilation. Allow the child with respiratory distress to remain in a position that is most comfortable. ● If the child is unresponsive and is not moving, shout for help and start CPR. If you are alone, continue CPR for 5 cycles (about 2 minutes). One cycle of CPR for the lone rescuer is 30 compressions and 2 breaths (see below). Then activate the EMS system and get an automated external defibrillator (AED) (see below). If you are alone and there is no evidence of trauma, you may carry a small child with you to the telephone. The EMS dispatcher can guide you through the steps of CPR. If a second rescuer is present, that rescuer should immediately activate the EMS system and get an AED (if the child is 1 year of age or older) while you continue CPR. If you suspect trauma, the second rescuer may assist by stabilizing the child’s cervical spine (see below). If the child must be moved for safety reasons, support the head and body to minimize turning, bending, or twisting of the head and neck. Activate the EMS System and Get the AED (Box 2) If the arrest is witnessed and sudden2,7,43 (eg, an athlete who collapses on the playing field), a lone healthcare provider should activate the EMS system (by telephoning 911 in most locales) and get an AED (if the child is 1 year of age or older) before starting CPR. It would be ideal for the lone lay rescuer who witnesses the sudden collapse of a child to also activate the EMS system and get an AED and return to the child to begin CPR and use the AED. But for simplicity of lay rescuer education it is acceptable for the lone lay rescuer to provide about 5 cycles (about 2 minutes) of CPR for any infant or child victim before leaving to phone 911 and get an AED (if appropriate). This sequence may be tailored for some learners (eg, the mother of a child at high risk for a sudden arrhyth￾mia). If two rescuers are present, one rescuer should begin CPR while the other rescuer activates the EMS system and gets the AED. Position the Victim If the victim is unresponsive, make sure that the victim is in a supine (face up) position on a flat, hard surface, such as a sturdy table, the floor, or the ground. If you must turn the victim, minimize turning or twisting of the head and neck. Open the Airway and Check Breathing (Box 3) In an unresponsive infant or child, the tongue may obstruct the airway, so the rescuer should open the airway.44 – 47 Open the Airway: Lay Rescuer If you are a lay rescuer, open the airway using a head tilt– chin lift maneuver for both injured and noninjured victims (Class IIa). The jaw thrust is no longer recommended for lay rescuers because it is difficult to learn and perform, is often not an effective way to open the airway, and may cause spinal movement (Class IIb). Open the Airway: Healthcare Provider A healthcare provider should use the head tilt– chin lift maneuver to open the airway of a victim without evidence of head or neck trauma. Part 11: Pediatric Basic Life Support IV-157