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Information about using the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach to assess and treat patients.

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Securing an airway is a vital task for the anesthesiologist. The pediatric patients have significant anatomical and physiological differences compared with adults, which impact on the techniques and tools that the anesthesiologist might choose to…

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Focused clinical observation is the key in the initial recognition of respiratory distress in an acutely ill child. Keywords: Respiratory Distress, Paediatric Intensive Care Unit, Acute Flaccid Paralysis, High Dependency Unit, Congenital Lobar…

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Oropharyngeal Airway Insertion | Guedel | OPA | ABCDE Emergency | OSCE Guide | UKMLA | CPSA | PLAB 2

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Bronchiolitis in children: diagnosis and management

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This guideline covers diagnosing and managing bronchiolitis in babies and children. It aims to help healthcare professionals diagnose bronchiolitis and identify if babies and children should be cared for at home or in hospital. It describes treatments and interventions that can be used to help with the symptoms of bronchiolitis

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Enquire about Optiflow nasal high flow therapy

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Enquire about Optiflow nasal high flow therapy If you have an enquiry about our products, please provide the following information so a Fisher & Paykel Healthcare representative can contact you. For further details on how this information will be used, see below or go to our privacy statement.

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Those with a duty to respond to paediatric emergencies (usually healthcare professional teams) should use the following sequence:

If the child responds by answering or moving:

If the child does not respond:

Shout for help.

In cases where there is more than one rescuer, a second rescuer should call 999 (outside hospital) to summon emergency medical services (EMS) or call 2222 if in an NHS hospital to summon the clinical emergency team immediately. If calling 999 preferably use the speaker function of a mobile phone.

Turn the child onto their back and open the airway using head tilt and chin lift:

Place your hand on their forehead and gently tilt their head back.

With your fingertip(s) under the point of the child's chin, lift the chin. Do not push on the soft tissues under the chin as this may block the airway.

If you still have difficulty in opening the airway, try the jaw thrust method: place the first two fingers of each hand behind each side of the child's mandible (jawbone) and push the jaw forward (towards you).

Have a low threshold for suspecting injury to the neck. If you suspect this, try to open the airway using jaw thrust alone. If this is unsuccessful, add head tilt gradually until the airway is open. Establishing an open airway takes priority over concerns about the cervical spine.

Keeping the airway open, look, listen, and feel for abnormal/absent breathing by putting your face close to the child's face and looking along the chest whilst simultaneously looking for signs of life.

Look for chest movements:

Listen at the child's nose and mouth for breath sounds.

Feel for air movement on your cheek.

In the first few minutes after cardiac arrest a child may be taking infrequent, noisy gasps. Do not confuse this with normal breathing.

Look, listen, and feel for no more than 10 seconds before deciding - if you have any doubts whether breathing is normal, act as if it is not normal.

Simultaneously look for signs of life (these include any movement, coughing, or normal breathing).

(Note: Studies have shown how unreliable feeling for a pulse is in determining presence or absence of a circulation even for trained paediatric healthcare workers, hence the importance of the need to look for signs of life. However, if a healthcare worker wishes to also check for a pulse this should be done simultaneously with the breathing assessment).
If the child IS breathing normally:

If the child's breathing is abnormal or absent

Give 5 initial rescue breaths.

Although rescue breaths are described here, it is common in healthcare environments to have access to bag-mask devices and providers trained in their use should use them as soon as they are available. In larger children when BMV is not available, competent providers can also use a pocket mask for rescue breaths.

While performing the rescue breaths, note any gag or cough response to your action. These responses, or their absence, will form part of your ongoing assessment of 'signs of life'

Rescue breaths for an infant:

Ensure a neutral position of the head (as an infant's head is usually flexed when supine, this may require some gentle extension) and apply chin lift.

Take a breath and cover the mouth and nose of the infant with your mouth, making sure you have a good seal.

If the nose and mouth cannot both be covered in the older infant, the rescuer may attempt to seal only the infant's nose or mouth with their mouth (if the nose is used, close the lips to prevent air escape).

Blow steadily into the infant's mouth and nose over 1 second sufficient to make the chest rise visibly. This is the same time period as in adult practice.

Maintain head position and chin lift, take your mouth away, and watch for their chest to fall as air comes out.

Take another breath and repeat this sequence four more times.

Rescue breaths for a child over 1 year:

Ensure head tilt and chin lift; extending the head into 'sniffing' position.

Pinch the soft part of the nose closed with the index finger and thumb of your hand on their forehead.

Open the mouth a little but maintain the chin lift.

Take a breath and place your lips around the mouth, making sure that you have a good seal.

Blow steadily into their mouth over 1 second sufficient to make the chest rise visibly.

Maintaining head tilt and chin lift, take your mouth away and watch for the chest to fall as air comes out.

Take another breath and repeat this sequence four more times.

Identify effectiveness by seeing that the child's chest has risen and fallen in a similar fashion to the movement produced by a normal breath.

For both infants and children, if you have difficulty achieving an effective breath, the airway may be obstructed:

1. If there is only one rescuer, with a mobile phone, they should call for help (and activate the speaker function) immediately after the initial rescue breaths. Proceed to the next step while waiting for an answer. If no phone is readily available perform one minute of CPR before leaving the child.

2. In cases where paediatric BLS providers are unable or unwilling to start with ventilations, they should proceed with compressions and add ventilations into the sequence when able (another provider, equipment available).

Following the rescue breaths, if you are confident that you can detect signs of life:

Following the rescue breaths, if there are no signs of life or if you are unsure:

Start good quality chest compressions.

Rate: 100-120 min⁻¹ for both infants and children.

Depth: depress the lower half of the sternum by at least one third of the anterior-posterior dimension of the chest (which is approximately 4 cm for an infant and 5 cm for a child).

Compressions should never be deeper than the adult 6 cm limit (approx. an adult thumb's length).

Release all pressure on the chest between compressions to allow for complete chest recoil and avoid leaning on the chest at the end of a compression.

Allow adequate time for chest recoil to occur (approximately 50% of the whole cycle should be the relaxation phase, i.e., from the start of one compression to the next).

Chest compression pauses should be minimised so that 80% or more of the CPR cycle is comprised of chest compressions.

For all children, compress the lower half of the sternum:

To avoid compressing the upper abdomen, locate the xiphisternum by finding the angle where the lowest ribs join the sternum (breastbone).

Compress the sternum one finger's breadth above this.

After each compression, release the pressure completely then repeat at a rate of 100-120 min⁻¹.

Allow the chest to return to its resting position before starting the next compression.

After 15 compressions, tilt the head, lift the chin, and give rescue breaths.

Continue compressions and breaths in a ratio of 15:2.

Perform compressions on a firm surface.

The best method for compression varies slightly between infants and children.

Chest compression in infants:

Preferably use a two-thumb encircling technique for chest compression in infants - be careful to ensure complete chest recoil after each chest compression. Single rescuers might alternatively use a two-finger technique.

The encircling technique:

Place both thumbs flat, side-by-side, on the lower half of the sternum (as above), with the tips pointing towards the infant's head.

Spread the rest of both hands, with the fingers together, to encircle the lower part of the infant's rib cage with the tips of the fingers supporting the infant's back. Press down on the lower sternum with your two thumbs to depress it at least one-third of the depth of the infant's chest, approximately 4 cm.

For small infants, you may need to overlap your thumbs to provide effective compressions.

Two finger technique: Compress the lower sternum with the tips of two of your fingers (index and middle fingers) by at least one-third of the depth of the infant's chest, approximately 4cm.

Chest compression in children aged over 1 year: Note: Do not interrupt CPR at any moment unless there are clear signs of life (movement, coughing, normal breathing). Two or more rescuers should alternate who is performing chest compressions frequently; the compressing rescuer should switch hands (the hand compressing, the hand which is on top) or the technique (one to 2-handed) to avoid fatigue. Continue resuscitation until:
When to call for assistance

It is vital for rescuers to get help as quickly as possible when a child collapses:

In cases where there is more than one rescuer, a second rescuer should call the EMS immediately upon recognition of unconsciousness, preferably using the speaker function of a mobile phone.

If there is only one rescuer, with a mobile phone, they should call help first (and activate the speaker function) immediately after the initial rescue breaths. Proceed to the next step while waiting for an answer.

If no mobile phone is available and more than one rescuer is available, one (or more) person starts resuscitation while another goes for assistance.

If only one rescuer is present without a mobile phone, undertake resuscitation for about 1 minute before going for assistance. To minimise interruptions in CPR, it may be possible to carry an infant or small child whilst summoning help.

The only exception to performing 1 minute of CPR before going for help is in the unlikely event of a child with a witnessed, sudden collapse when the rescuer is alone with no phone and primary cardiac arrest is suspected. In this situation, a shockable rhythm is likely and the child may need defibrillation. Seek help immediately if there is no one to go for you.

Paediatric BLS modified
Adult sequence with paediatric modifications

Rescuers who have been taught adult BLS, and have no specific knowledge of paediatric resuscitation, should use the adult sequence.

The paediatric modifications to adult CPR should be taught to those who care for children but are unlikely to have to resuscitate them.

Give 5 rescue breaths before starting chest compression.

If you are on your own, perform CPR for 1 min before going for help.

Compress the chest by at least one-third of its depth, approximately 4 cm for an infant and approximately 5 cm for an older child. Use both thumbs or two fingers for an infant under 1 year; use one or two hands for a child over 1 year as required to achieve an adequate depth of compression.

The compression rate should be 100-120 min⁻¹.

Dispatcher-directed CPR

Bystander CPR should be started in all cases when feasible. The EMS dispatcher has a crucial role in assisting untrained bystanders to recognise cardiac arrest and provide CPR. When bystander CPR is already in progress at the time of the call, dispatchers may only provide instructions when asked for, or when issues with knowledge or skills are identified.

The steps of the algorithm for paediatric dispatcher-assisted CPR are very similar to the paediatric BLS algorithm. To decrease the number of changes in rescuer position, a 30:2 C:V ratio might be preferable for a lone rescuer. If bystanders cannot provide rescue breaths, they should proceed with chest compressions only. A child or infant is far more likely to be harmed if the bystander does nothing.

Recovery position

For children and infants with a decreased level of consciousness who do not meet the criteria for the initiation of rescue breathing or chest compressions (CPR), the recovery position may be recommended. The following describes one method of achieving a left lateral position:

Kneel beside the child and make sure that both legs are straight.

Place the arm nearest to you out at right angles to the body, elbow bent with the hand palm uppermost.

Bring the far arm across the chest, and hold the back of the hand against the child's cheek nearest to you.

With your other hand, grasp the far leg just above the knee and pull it up, keeping the foot on the ground.

Keeping the hand pressed against the cheek, pull on the far leg to roll the child towards you onto their side.

Adjust the upper leg so that both hip and knee are bent at right angles.

Tilt the head back to make sure the airway remains open.

Adjust the hand under the cheek if necessary, to keep the head tilted and facing downwards to allow liquid material to drain from the mouth.

Check breathing regularly (at least every minute).

Ensure the position is stable. In an infant, this may require the support of a small pillow or a rolled-up blanket placed behind their back to maintain the position.

It is important to maintain a close check on all unconscious children until the EMS arrives to ensure that their breathing remains normal.

Avoid any pressure on the child or infant's chest that may impair breathing and regularly turn the unconscious child or infant over onto their opposite side to prevent pressure injuries whilst in the recovery position (i.e. every 30 minutes).

In certain situations, such as when the child or infant is breathing spontaneously but requires airway management or when the child has a traumatic injury, the recovery position is not recommended. In these circumstances:

Keep the patient flat, maintain an open airway by either continued head tilt and chin lift or jaw thrust.

For trauma victims, leave the child or infant lying flat and open and maintain the airway using a jaw thrust, taking care to avoid spinal movement.

Automated external defibrillators (AEDs)

Paediatric BLS in case of traumatic cardiac arrest (TCA)

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Paediatric basic life support Guidelines

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Guidelines for healthcare professionals and the general public on giving CPR to a child in cardiac arrest.

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You can utilise any of these resources to find the information you require, you will also need to discuss your own experience and knowledge and use search engines to find evidence based information.

Discuss this within your breakout rooms and nominate 1-2 people to feedback to the main group. Remember you will get out of this exercise what you put in, so work together and any issues we will remain in the main Teams room.

Good Luck!

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The neonatal period is the period of the most dramatic physiologic changes that occur during human life. While the respiratory and cardiovascular systems change immediately at birth, other organ systems evolve slowly with time until the transition from intrauterine to adult physiology is complete. The transitional period of the newborn is a critical time for humans to adapt to life outside the womb. There are distinct physiologic changes during this period, especially regarding the respiratory and cardiovascular systems. The loss of the low-pressure placenta and its ability to facilitate gas exchange, circulation, and waste management for the fetus creates a need for physiologic adaptation.

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NIPPY 4 and 4+ Getting Started - Education by Breas

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In this video we will show you how to get started with your NIPPY 4 and 4+ ventilators

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Bubble CPAP Delivery Therapy | Fisher & Paykel Healthcare

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The Bubble CPAP system is designed to provide consistent pressure through an auto-leveling feature. Learn more about the Bubble CPAP therapy!