The document outlines the Pediatric Basic Life Support (BLS) as a community effort focusing on prevention, early CPR initiation, and access to emergency services. It details the procedures for performing CPR, including the recognition of cardiac arrest scenarios, and the relief of foreign body airway obstruction in children, highlighting the critical importance of immediate action and the chain of survival. Additionally, it discusses the unique considerations for different pediatric age groups and emphasizes the importance of injury prevention for optimizing outcomes.

1. Paediatric Basic Life Support
Dr. Fadlulai Abdu-Raheem, MD
Department of Paediatrics,
AMSH, Ado-Ekiti

2. Introduction
• - To ensure optimal survival and quality of life, pediatric basic life support
(BLS) should be approached as a collaborative community effort that
encompasses:
• A. Prevention
• B. Early initiation of cardiopulmonary resuscitation (CPR)
• C. Prompt access to emergency response services
• D. Swift pediatric advanced life support (PALS)
• E. Integrated post-cardiac arrest care
• - These five elements collectively form the pediatric Chain of Survival as
defined by the American Heart Association (AHA), with the initial three
links representing pediatric BLS.

3. Basic Life Support
• - Basic life support involves maintaining an open airway and
supporting breathing and circulation.
• - The primary objective is to sustain adequate ventilation and
circulation until the underlying cause of the arrest can be addressed.

4. Pediatric age groups
• The American Heart Association (AHA) defines three age groups for
pediatric BLS:
• Infants (less than 1 year old),
• Children (1 year old to puberty), and
• Adolescents (puberty to 18 years old).
• Puberty is determined by the presence of secondary sexual
characteristics, such as breast development in females and axillary
hair in males.

5. A. Prevention of Cardiopulmonary Arrest
• - In children over 1 year old, injuries are the leading cause of death.
• - Survival rates for traumatic cardiac arrest are low, underscoring the
importance of injury prevention in reducing fatalities.
• - Motor vehicle accidents are the most common cause of fatal
childhood injuries.
• - Targeted interventions, such as the use of child passenger safety
seats, can significantly decrease the risk of death.

6. B. Cardiopulmonary resuscitation
• Definition
• A set of a life-saving emergency procedure that aims to restore and
maintain adequate circulation and ventilation in infants and children
who suffer from cardiac arrest or respiratory arrest.

7. B. Cardiopulmonary resuscitation
• Significance
• - Immediate bystander CPR is critical for the survival of a child
experiencing respiratory or cardiac arrest.
• - In cases of respiratory arrest, rescue breaths with supplemental
oxygen administration provide vital organs, including the brain, with
oxygen.
• - CPR may also facilitate the restoration of cardiac activity.
• - CPR should be continued until pediatric advanced life support (PALS)
becomes available.

8. B. Cardiopulmonary resuscitation
• Sequence
• i- Ensure the safety of both the rescuer and the victim.
• ii- Assess responsiveness.
• iii- Shout for help and activate the Emergency Response System. A
second rescuer, if present, should obtain an automated external
defibrillator (AED).
• iv- Circulation, Airway, Breathing (CAB)
• vii- If performing CPR alone, after five cycles, activate the Emergency
Response System and obtain an AED. Continue CPR.

13. B (i) Rescuer and Victim Safety
• - Ensuring the safety of the rescuer and the victim is crucial,
particularly when providing CPR outside of a healthcare facility.
• - Examples include situations close to electrical wires or a burning
building, or in a traffic or water.
• - Rescuers should position themselves and the victim in a safe
manner.
• - In cases of trauma, the victim should only be moved if necessary to
ensure the safety of both parties.

14. B (ii) Assessment of Responsiveness
• Gently tap on the shoulders (or shake gently, if an infant) AND
• Shout: "Are you okay?“

15. B (iii) Activate the Emergency Response
System
• Shout for help
• Call 911 (as in the US) or for an ambulance.
• A second rescuer, if present, should obtain an automated external
defibrillator (AED), which are typically stored in clearly marked
cabinets or cases in public places.
• Look at your time/start your timer

16. B (iv) Circulation, Airway, Breathing (CAB)
• - First, properly position the victim.
• - If the victim is unresponsive, move him as a unit to a supine position
on a flat, firm surface (e.g., table, floor, or ground).
• - If there is a suspected head or neck injury, move the child as a unit
only if necessary.
• - For infants, one may need to carry them to a phone for help while
simultaneously initiating CPR.

17. B (iv) Circulation, Airway, Breathing (CAB)
Recognition of Cardiac Arrest
• - Scenario 1
• - Unresponsive BUT breathing and HAS pulse
• - If no evidence of trauma, place child in the recovery position (on his
left side) to maintain a patent airway and reduce the risk of aspiration
• - Wait until emergency responders arrive.

18. B (iv) Circulation, Airway, Breathing (CAB)
Recognition of Cardiac Arrest
• Scenario 2
• - Unresponsive, NOT breathing or only gasping, HAS pulse
• Provide rescue breathing: 1 breath every 3-5 seconds, or about 12-20
breaths/min.
• Check pulse about every 2 minutes, if pulse remains ≤ 60/min with
signs of poor perfusion or absent, commence CPR (like in scenario 3)
• Activate emergency response system (if not already done) after 2
minutes.

19. B (iv) Circulation, Airway, Breathing (CAB)
Recognition of Cardiac Arrest
• Scenario 3
• - Unresponsive, NOT breathing or only gasping, NO pulse
• - For healthcare providers, palpate for pulse brachial pulse in infants
or a carotid or femoral pulse in children.
• - If a pulse is not palpable within 10 seconds or one is uncertain,
initiate chest compressions immediately.
• Lay rescuers should initiate chest compressions without checking for
a pulse.

20. B (iv) Circulation, Airway, Breathing (CAB)
• Begin CPR with cycles of 30 compressions and 2 breaths. (Use 15:2
ratio if second rescuer arrives.)
• After about 2 minutes, retrieve and use AED.
• AED analyzes rhythm.
• Shockable rhythm? Give 1 shock. Resume CPR immediately for about 2
minutes (until prompted by AED to allow rhythm check).
• Unshockable rhythm? Resume CPR immediately for about 2 minutes (until
prompted by AED to allow rhythm check).
• Continue until ALS providers take over or victim starts to move

21. B (iv) Circulation, Airway, Breathing (CAB)
• Enhancing Airflow with Protective Devices
• - Reduce the minimal risk of infection while optimizing ventilation
methods.
• - There are two main types: mouth-to-face shields and mouth-to-
mask technique.

22. Mouth-to-face shields Mouth-to-mask technique

23. B (iv) Circulation, Airway, Breathing (CAB)
(inside the hospital)
• Bag-Mask Ventilation
• - There are two types: self-inflating resuscitator (recommended) and
flow-inflating resuscitator.
• - It's essential to have child and adult sizes available.
• Technique
• - Utilize the E-C clamp technique: Shape your thumb and index finger
into a C to ensure a secure seal of the mask on the child's face.
• - Place the 3rd, 4th, and 5th fingers under the jaw to lift the chin and
jaw, taking care not to exert pressure on the soft tissues underneath.

25. The Five Components of High-Quality CPR
• 1. Maintain chest compressions at an adequate rate.
• 2. Ensure chest compressions reach an adequate depth.
• 3. Allow the chest to fully recoil between compressions.
• 4. Minimize interruptions in chest compressions.
• 5. Avoid excessive ventilation.

26. Neonatal Resuscitation
• - Asphyxia is the primary cause of neonatal arrests.
• - The A-B-C sequence is retained unless a cardiac cause is known.
• - The compression-ventilation ratio remains 3:1 to prioritize
ventilation for reversing newborn asphyxial arrest.
• However, a higher ratio of 15:2 is considered for cardiac etiology.

27. Compressions-Only CPR
• - For infants and children in cardiac arrest, CPR with chest
compressions and rescue breaths is recommended.
• - If bystanders are unwilling or unable to provide rescue breaths,
chest compressions alone should be administered.

28. Foreign Body Airway Obstruction (FBAO)
• - Over 90% of childhood deaths from foreign-body aspiration occur in
children under 5 years old, with infants accounting for 65% of victims.
• - Liquids are the primary choking hazard for infants, while balloons,
small objects, and certain foods (e.g., hot dogs, round candies, nuts,
grapes) pose the most significant risk for FBAO in children.

29. Variations in FBAO Severity
• - FBAO can cause mild or severe airway obstruction.
• Mild obstruction allows the child to cough and make sounds, whereas
severe obstruction results in the inability to cough or make any
sound.

30. Signs of FBAO
• - Sudden onset of respiratory distress accompanied by coughing,
gagging, stridor, or wheezing.
• - The absence of fever or other respiratory symptoms suggests FBAO
as the cause of respiratory distress, especially in the absence of
antecedent cough or congestion.

31. Signs of Severe FBAO in Children and Infants
• - Responsive Child:
• - Universal choking sign (absent in infants).
• - High-pitched sounds during breathing attempts.
• - Inability to cry, cough, or speak forcefully, weak or silent voice.
• - Bluish lips and fingernails.

32. Relief of FBAO
• - Mild
• Advisable not to intervene but closely monitor the victim for signs of
severe airway obstruction.
• Severe
• - Confirm if the child is choking and unable to speak.
• - Position yourself behind the child, wrapping your arms around them.
• - Create a fist with one hand and place it against the center of the child's
abdomen, between the navel and ribs.
• - Administer sub-diaphragmatic abdominal thrusts (Heimlich maneuver)
until the object is expelled or the child becomes unresponsive.

33. Relief of FBAO in Infants
• - Place the infant face down on your forearm, with their head in your
hand for support.
• - Deliver up to 5 back blows using the heel of your free hand.
• - Turn the infant over and provide up to 5 chest thrusts, just below
the nipple line.
• - Alternate between 5 back blows and 5 chest thrusts until the object
is expelled or the infant becomes unresponsive.
• - Avoid abdominal thrusts in infants, as they may cause harm to the
relatively large and unprotected liver.

34. When the FBAO Victim Becomes Unresponsive
• - Commence CPR with chest compressions without performing a
pulse check.
• - After 30 chest compressions, open the airway using the tongue-jaw
lift technique.
• - If a foreign body is visible, remove it, but refrain from blind finger
sweeps to prevent pushing the obstruction deeper into the pharynx
or causing oropharyngeal damage.
• - Attempt to provide 2 breaths and continue with cycles of chest
compressions and ventilations until the object is expelled.
• - If after 2 minutes, if no one has already done so, activate the
emergency response system.

35. References
• (1) Part 4: Pediatric Basic and Advanced Life Support | American
Heart https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-
guidelines/pediatric-basic-and-advanced-life-support.
• (2) Dr. Biobele J. Brown. Basic Life Support in Children. A lecture
delivered on 22 July, 2019 in the College of Medicine, University of
Ibadan.

36. THANK
YOU