First aid for children
Paediatric basic life support and FBAO
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Peter J. Safar
1924 – 2003
Paediatric Life Support (PLS)
1994, 1998, 2000, 2005, 2010, 2015
 The European Resuscitation Council (ERC):
 Guidelines 2015
 www.erc.edu
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ERC Guidelines 2015
1. The incidence of critical illness, particularly cardiopulmonary arrest and
injury in children is much lower than in adults
2. The illnesses and pathophysiological responses of paediatric patients
often differ from those seen in adults
3. Many paediatric emergencies are managed primarily by providers who
are not paediatric specialists and who have limited paediatric emergency
medical experience
 Strong focus on simplification
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Resuscitation of the child is different
from adults
A lot of common in technique, but another starting point in children
 Adults – primary cardiac arrest (cardiac origin)
(sudden, usually sufficient oxygen in the beginning, early defibrillation)
 Children – secondary cardiac arrest (non-cardiac origin)
(hypoxia → respiratory failure → cardiac arrest)
low level of oxygen in the beginning
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Definitions of terms in CPR
• Newly born
• Infant: < 1 year of age
• Child: 1 year – puberty
• Adult
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VS
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VS
Safety
Stimulate
Shout for help
Airway
Breathing
Circulation
Reassess
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1. How to begin
1. Ensure the safety of rescuer and child
2. Check the child’s responsiveness:
 Stimulate + ask loudly (Are you all right?)
 If the child responds by answering or
moving → Leave the child in the position in
which you find him + Reassess him regularly
 If the child does not respond → Shout for
help + Open the child’s airway
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2. Open the child’s airway
Head tilt and chin lift
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2. Open the child’s airway
Jaw trust
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3. Breathing
 Look – chest movements
 Listen – breath sounds at child´s nose and mouth
 Feel – air movement on your cheek
˂10s for decision that breathing is absent
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If the child is breathing normally
 Turn the child on his side into the recovery position
 Lateral position, without obstruction of airways, free drainage of fluid
 Send or go for help—call the emergency services
 Check for continued breathing.
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If the infant is not breathing
5 slow breaths!!!
 Approximately 1s each
 Movement of chest
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If the child is not breathing
5 slow breaths!!!
 Approximately 1s each
 Movement of chest
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No chest movements??
 Open the mouth + remove obstruction
 Open the airways (jaw trust)
 5 slow breaths
 Foreign body obstruction sequence
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4. Circulation
 Movement, coughing, breathing
 Take no more than 10s to Look for signs of life
 Pulse
 infant: a.brachialis child: a.carotis
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4. Circulation
 Circulation is present
→ continue breathing
 Circulation is absent
→ chest compressions / breathing + chest compressions
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Chest compression in infants
 Lower half of sternum
 Compression of sternum with 2
fingers to 1/3 of depth of infant´s
chest (cca 4cm)
 Rate 100/min
 Ratio 15:2
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1 rescuer 2 rescuers
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Chest compression in children over 1
year of age
 Lower half of sternum
 Compression of sternum
with arms straight to 1/3
of depth of child´s chest
(cca 5cm)
 Rate 100/min
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When to call for assistance??
 More than 1 rescuer → one should start with CPR,
another calls
 1 rescuer → perform CPR for 1 min before calling
for assistance
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Only exception:
Sudden collapse + 1 rescuer
(suspect primary cardiac event)
Do not interrupt resuscitation until
1. The child shows signs of life
(starts to wake up, to move, opens eyes
and to breathe normally)
2. More healthcare workers arrive and can
either assist or take over
3. You become exhausted
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Automated External Defibrillation
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Automated External Defibrillation
 For Child > 8 years (cca 25 kg) –
standard adult AED
 For 1 year to 8 year old
 Use attenuated pads if available
 Adult AED may be used if attenuator
device not available
 For < 1 year old
 Use only if manufacturer instructions
indicate it is safe
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Foreign body airway
obstruction (FBAO)
Foreign body airway obstruction
 Sudden onset of coughing, stridor or gagging
 Spontaneous cough is likely – more effective and safer than any
manoeuvres
 If the child is able to breath and cough – encourage spontaneous efforts
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Foreign body airway obstruction
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Foreign body airway obstruction
- infant 
Hold the child in a prone position, head lower than chest
 5 blows between shoulder blades
 5 chest thrusts to the sternum
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3131
Foreign body airway obstruction
- child 
Hold the child in a prone position, head lower than chest
 5 blows between shoulder blades
 5 abdominal thrusts (Heimlich manoeuvre)
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Thanks for your attention…