Basic resuscitation in children

FUNDAMENTALS OF FIRST AID
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Basic resuscitation in children

Fundamentals of First Aid (OPMP)

У newborns and infants the most common causes of circulatory arrest are sudden neonatal death syndrome, pulmonary diseases (pneumonia, acute bronchospasm), airway obstruction, drowning, sepsis, neurological diseases.

In children of the first years of life (over 1 year old), the main cause of circulatory arrest is injuries, most often as a result of car accidents (especially if seat belts are not used), pedestrian injuries (when the child runs into the roadway), bicycle injuries (especially head injuries) , drowning, burns and gunshot wounds.

In children, the main resuscitation measures are carried out in approximately the same way as in adults, but there are some features:

If the resuscitator acts alone, he carries out basic resuscitation activities until the arrival of the resuscitation team.

When performing mechanical ventilation in children under 6 months, the resuscitator wraps his mouth around the mouth and nose of the child at the same time. In children older than 6 months, breathing is performed "mouth-to-mouth", and the child's nose is pinched with the thumb and forefinger.

The airway is secured by raising the chin or pushing the child's lower jaw forward. The air is blown in slowly (within 1-1,5 s), during pauses the resuscitator breathes deeply to maximize the oxygen content and reduce the concentration of carbon dioxide in the exhaled air.

In the absence of spontaneous breathing in a child of the first years of life, the most important resuscitation measure is mechanical ventilation. Care must be taken with regard to the pressure and volume of each portion of air (these figures vary significantly depending on the age of the child and airway resistance). The volume of each breath is considered adequate if it causes a calm chest rise. The rate of mechanical ventilation for children of the first years of life is 20 respiratory movements per 1 min.

Identification of airway obstruction. If the chest does not rise during ventilation, this indicates the need for more tidal volume (or more pressure) or airway obstruction. Since the most common cause of obstruction is an incomplete opening of the airway, the position of the head of the resuscitated person should be carefully repositioned (unless there is reason to suspect an injury to the cervical spine), and then mechanical ventilation should be attempted again.

Circulation assessment. It is recommended to check the pulse in children under one year old on the brachial artery, and in children over one year old - on the carotid artery.

Indirect heart massage. Infants are pressed with middle and ring fingers on the lower third of the sternum (approximately one finger thick below the level of the nipples); the other hand is used by the rescuer to hold the child's head in a position that ensures airway patency. The depth of depression of the sternum is from 1,5 to 2,5 cm, the frequency of pressure is 100 times per minute.

For children aged 1-8 years, pressure is applied to the lower third of the sternum (approximately the thickness of a finger above the xiphoid process) with the proximal part of the palm. The depth of depression of the sternum is from 2,5 to 4 cm, the frequency of pressure is at least 100 times per minute.

The ratio of the frequency of pressure to the rate of ventilation for children of the first years of life is maintained at a level of 5:1 - regardless of how many people are involved in resuscitation. The child's condition is reassessed 1 min after the start of resuscitation, and then every 2-3 min.

Authors: Aizman R.I., Krivoshchekov S.G.

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