Describe BLS modifications in infants and children.
Technique modifications
Compression rate: 100–120/minute
Compression-to-breath ratio
Single rescuer: 30:2
Two rescuers: 15:2
Postpubertal children/adolescents: Same CPR technique as for adults
Children ≥ 1 year of age until puberty
Chest compressions: Deliver with one hand for smaller children.
Compression depth: 5 cm
Infants < 1 year old
Compression depth: 4 cm
Rescue breaths: Form a seal over both the nose and mouth.
Defibrillation
Children 1–8 years old: If available, use an AED with pediatric attenuation (if no other device is available, use an adult AED).
Infants < 1 year old: If available, use a manual defibrillator (if no other device is available, use an adult AED). [39]
Describe algorithm modifications.
Initial steps (identical to BLS algorithm for adults): Assess scene safety and patient responsiveness, and call for help.
Check for signs of life
Pulse present, no breathing
Administer rescue breaths: 1 breath every 2–3 seconds (20–30 breaths/minute)
If heart rate is ≤ 60 beats/minute: Start CPR.
No pulse, gasping, or no breathing: Start CPR.
Single rescuer sequence
Perform 2 minutes of CPR (30:2 with a compression rate of 100–120/minute) before calling for help or retrieving an AED (if it requires leaving the patient's side).
If a cell phone is available, make an immediate emergency call and perform CPR with the phone on speaker.
Two-rescuer sequence
Direct the second rescuer to call for help and retrieve a defibrillator.
Start CPR at a ratio of 30:2, changing to 15:2 when both rescuers are able to provide CPR.
Rhythm assessment and defibrillation
Shockable rhythm: Defibrillate using pediatric AED pads for children 1–8 years old and continue CPR.
Nonshockable rhythm: Continue CPR immediately.
Endpoints: identical to BLS algorithm for adults.
Describe Neonatal life support.
Compression-to-breath ratio: 3:1 (as hypoxia is the most common cause of arrest in neonates).
Chest compression technique in neonates
Single rescuer: two-finger technique
Perform chest compressions using two fingers (the index and middle fingers) on the lower half of the sternum, just below the intermammary line.
Allows for faster changes between compressions and delivering breaths if only a single provider is present
Two rescuers: two-thumb-encircling hands technique
One rescuer performs chest compressions while the other delivers breaths.
Encircle the chest with both hands, with the thumbs placed over the lower third of the sternum.
Compress the lower sternum with both thumbs.
Results in more effective compressions and higher coronary artery perfusion than the two-finger technique
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