Paediatric BLS

1. Ensure safety
2. Check responsiveness
   1. Gently stimulate the child- ask loudly ‘Can you hear me?’ or ‘Are you alright?’
   2. Do not shake infants; or children with suspected spine injury
      1. If the child responds with noise or movement
         1. Leave them in the position they have been found in; check condition and get help; reassess regularly
3. If the child does not respond
   1. Shout for help
   2. Turn child onto their back and perform head tilt chin lift in a child (to sniffing air position)
      1. Jaw thrust can also be used in children, particularly if C-spine injury is suspected
      2. In infants, lift the chin, if necessary into a neutral position
   3. Look, listen and feel for breathing for no more than 10 seconds (at this point you may also assess for pulse (carotid in children and brachial in infants; alternatively a femoral))
      1. If the child is breathing, turn them onto the recovery position (in an infant, leave them lying supine)
         1. Send for help (call 999 etc) and reassess frequently
      2. If the child is breathing abnormally (e.g. snoring/obstructed), carefully remove any obvious obstruction (do NOT perform finger sweeps) then if still abnormal ->
4. If the child is not breathing
   1. Give 5 rescue breaths (over mouth for child and over nose and mouth in an infant)
      1. If unsuccessful, reassess airway and try again (attempt a maximum of 5 times)
   2. If there is a pulse, continue rescue breathing until help arrives or until the child starts breathing
5. If there is no pulse, start chest compressions
   1. In children, compress the lower half of the sternum (one fingerbreadth above the xiphisternum) by about a third of the depth of the chest (hard and fast) with the heel of your hand.
      1. In infants, compress the chest with the tips of two fingers
   2. 15 chest compressions at around 100-120bpm
   3. Give 2 rescue breaths and repeat compressions at 15:2
      1. If help has not been sought by another, seek help after a minute of resuscitation UNLESS there has been a witnessed sudden collapse which suggests a shockable rhythm (get help ASAP)