Basic Life Support (BLS): Pediatric Algorithm
1. Check responsiveness; if none, follow steps below
Activate emergency response system
Get automated external defibrillator (AED)
2. Check pulse for < 10 seconds; if no pulse, follow steps below
If alone, start high-quality cardiopulmonary resuscitation (CPR) at a compressions-to-breaths ratio of 30:2
If not alone, start high-quality CPR at a compressions-to-breaths ratio of 15:2
Every 2 minutes, check pulse, check rhythm, and switch compressors
In infants, start CPR if heart rate (HR) < 60 bpm and poor perfusion despite adequate oxygen and ventilation
High-quality CPR and changing rescuers every 2 minutes improves a victim’s chance of survival
3. Attach AED as soon as available (for child); if shockable rhythm, defibrillate and then immediately start CPR
Compressions in children aged 1 year to adolescence
Check pulse at carotid artery
Compression landmarks: lower half of sternum between the nipples
Compression method: heel of one hand, other hand on top if needed
Depth: At least one-third anteroposterior (AP) chest diameter
Depth: At least 2 inches (5 cm)
Allow complete chest recoil after each compression
Compression rate: At least 100/min
Compressions-to-ventilations ratio: 30:2 if single rescuer, 15:2 if multiple rescuers
Continuous compressions if advanced airway present
Rotate compressor every 2 minutes
Minimize interruptions in compressions to < 10 seconds
Avoid excessive ventilation
Compressions in infants (< 1 year)
Check pulse at brachial artery
Compression landmarks: Lower half of sternum between the nipples
Compression method: Two fingers or thumb-encircling if multiple providers
Depth: At least one-third AP chest diameter
Depth: At least 1.5 inches (4 cm)
Allow complete chest recoil after each compression
Compression rate: At least 100/min
Compressions-to-ventilations ratio: 30:2 if single rescuer, 15:2 if multiple rescuers
Continuous compressions if advanced airway present
Rotate compressor every 2 minutes
Minimize interruptions in compressions to < 10 seconds
Avoid excessive ventilation
Airway
Children: Head tilted, chin lifted
Infants: Sniffing position
Jaw thrust if trauma suspected (children and infants)
Breathing
Ventilation with advanced airway every 6-8 seconds asynchronous with compressions
Rescue breathing every 3-5 seconds
Deliver at about 1 second/breath
Watch for visible chest rise
Defibrillation
In children, attach and use AED as soon as available
In infants, there are currently no defibrillation recommendations
Minimize interruptions in chest compressions before and after shock
Resume CPR beginning with compressions immediately after each shock
In children, use dose attenuator, if available; otherwise, adult pads may be used
History for SOB
Introduction
Name of historian
Relationship to patient
Name of patient
Age of patient
PC: SOB x ?
Associated symptoms x ?
HPC:
Any chronic illness?
Cardiac, resp. Whether family or personal history
What was happening with patient exactly?
Was the SOB sudden or gradual?
What were the precipitating events? (was the small patient playing with small
toys)
Rest/Excursion?
Is this the first time?
Description of SOB
o Any signs of respiratory distress - Any flaring of the nose? Neck
muscles tighten? Ribs sticking out?
o Are there any features of cyanosis? (Blue lips, blue fingers) is it
peripheral or central
What makes it better or worse?
(squatting may help cardiac lesions, bronchodilators would help resp cause
but not cardiac, sitting forward would help epiglottitis)
Does the patient have a fever? (r/o infection)
In children, fever associated with dyspnea usually implies an infectious
cause, such as pneumonia, croup, or bronchiolitis
Immunizations
Recent travel
? Cardiac cause
Associated anemia – lethargy, heart racing
Heart failure - SOB on feeding or activity, swelling of limbs
? Respiratory cause
Any cough (describe character), runny nose, sneeze, hoarseness, sore throat
Chest pain - Pleuritic chest pain could be caused by pericarditis, pneumonia,
pulmonary embolism, pneumothorax, or pleuritis.
?Anaphylaxis / Drug reaction
Any history of drug intake?
Is he allergic to anything – has he had a recent exposure? Any rash etc
?Aspiration
Difficulty swallowing or frequent vomiting, may indicate gastroesophageal
reflux or aspiration
Ask about exposure to secondhand smoke
Other aspects of hx as normal
In children, the most common causes of acute dyspnea are acute asthma,
pulmonary infections, and upper airway obstruction. Some conditions
associated with dyspnea, such as epiglottitis, croup, myocarditis, asthma,
and diabetic ketoacidosis, are serious and may be fatal. In children, always
consider foreign body aspiration, croup, and bronchiolitis caused by
respiratory syncytial virus
