This is a process of providing artificial ventilation and chest compressions to maintain oxygenation and circulation during severe respiratory distress and cardiac arrest. It is often used in emergency situation when the child’s cardiopulmonary activity is compromised.
Aims
· Restore normal breathing
· Improve circulation in a child
· Prevent disability/complication in the brain and other vital organs
Requirements
a. Emergency tray containing the following:
· Pulse oximeter
· Syringes and needles
· Cotton wool swabs
· Adhesive tape
· Antimicrobial solution e.g. methylated spirit
· Gallipot
· Receiver for used swab
· Disposable gloves
· Adrenaline, Atropine
· Dextrose 10%
· IV cannula with plain giving set
b. Self-inflating bag and mask (appropriate size)
c. Oral airways (appropriate size)
d. Laryngoscope
e. Laryngeal mask airway (appropriate size)
f. Pen light
g. Miller blades (sizes 00,0,1)
h. Endotracheal tubes (sizes 2.5, 3.0, 3.5, 4.0mm)
i. Plastic coated stylets
j. Paediatric stethoscope
k. Suction apparatus with tubes
l. Oxygen source/cylinder
m. Glucometer with strips
n. Drip stand with infusion pump
Steps
1. Make resuscitation equipment ready
2. Call for help from team members
3. Quickly introduce self to caregiver
4. Demonstrate five moments of hand hygiene
5. Receive child into an emergency couch
6. Place child on the back of a firm or flat surface
7. Tilt head, support scapular region with padded and lift chin to open airway
8. Assess airway for obstruction
9. Remove visible foreign body in the mouth
10. Suction if secretions are present
11. Place bag valve mask to cover nostrils and mouth to create a tight seal
12. Give one breath 2-3 seconds for two minutes while assessment is ongoing
13. Assess rise and fall of the chest and instruct assistant to palpate for presence of pulse (brachial/carotid femoral) after two minutes
14. Start cardiac compression if pulse is absent or less than 60bpm
15. Place heel of one or both hands below the xiphoid sternum depending on the size of the child
16. Press one-third of anterio-posterior diameter of chest and allow a complete chest recoil between each compression
17. Give two breaths to fifteen compressions per minute
18. Observe for signs of recovery
· Palpable peripheral pulse
· Return of pupil to normal size
· Disappearance of cyanosis and mottling
· Possible return of spontaneous breathing
19. Obtain child’s weight
20. Administer IV adrenaline (1:10,000) 0.1-0.3ml/kg if the heart rate is below 60bpm
21. Give post resuscitation care e.g. administration of oxygen and medication, monitoring of vital signs
22. Invite caregiver to come in and see progress of child
23. Consider endotracheal intubation with Paediatrician/Anaesthetist if child is still unresponsive after series of compressions based on hospital protocol
24. Dispose off, decontaminate and clean used items
25. Appreciate caregiver’s cooperation
26. Document procedure and observations (manual or electronic)
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