Pediatric BLS for Two or More Rescuers
Pediatric BLS for Two or More Rescuers
Short Description
This algorithm ensures that a pediatric patient receives the appropriate BLS care when more than one rescuer is available.
Algorithm at a Glance
- Ensure scene safety
- Identify responsiveness
- Check for pulse and respirations
- Perform CPR as needed
- Use an AED when available
Goals for Management
The rescuer will be able to:
- Quickly recognize the need for BLS
- Intervene quickly using rescue breathing (if trained) and high-quality CPR
- Prevent deterioration
The Pediatric BLS for Multiple Rescuers Algorithm
This algorithm outlines the steps for assessing and managing children presenting with a need for basic life support when multiple rescuers are present.
Two or More Rescuers BLS HCP Pediatric Cardiac Arrest Algorithm
Related Video – Understanding the Pediatric Cardiac Arrest Algorithm for Two or More Rescuers
Box 1: Ensure Scene Safety
The rescuer looks around the environment to ensure safety before tending to the child. If the scene is not secure, the rescuer moves the child to a safe area. If the area is safe, the rescuer does not attempt to move the child because movement can worsen the injury.
Box 2: Unresponsive Child
The rescuer taps the child’s shoulder, rubs his feet or belly, and shouts, “are you all right?” If the child does not respond, the second rescuer leaves to find help and activates the emergency response system. The first rescuer can use a cell phone and put the dispatcher on speakerphone for communication.
Box 3: Visualize Chest Rise and Check Pulse
The first rescuer looks for breathing while checking for a pulse in less than 10 seconds.
- If a pulse is present with normal breathing, the rescuer proceeds to Box 3a.
- If a pulse is present with abnormal or absent breathing, the rescuer proceeds to Box 3b.
- If no pulse is present with abnormal or absent breathing, the rescuer proceeds to Box 4.
Box 3a: Pulse Present and Normal Breathing
If the child is breathing and has a pulse, the rescuer should stay with the child until EMS arrives.
Box 3b: Pulse Present and Abnormal Breathing
If the child is not breathing but has a pulse > 60 bpm, the rescuer begins rescue breathing, providing one breath every 2–3 seconds. The rescuer also checks the child’s pulse every 2 minutes. If the child has no pulse and no breathing at any time, the rescuer proceeds to box 4.
Related Video – Understanding Agonal Breathing
Related Video – Rescue Breathing for Children
Related Video – Understanding Infant Rescue Breathing
Box 4: Initiate CPR
The first rescuer begins CPR with 30 compressions followed by two rescue breaths until the AED arrives. When a second rescuer is available, the rescuers change the compression to ventilation ratio to 15 compressions followed by two rescue breaths.
Box 5: Attach AED
When the AED is available, the second rescuer opens the unit and follows the verbal instructions. The rescuer attaches the pads per the diagram on the AED. Compressions are paused to allow the AED to analyze the heart rhythm.
- If the AED determines the child’s rhythm is shockable, it will tell the rescuers to deliver a shock. The rescuers proceed to Box 6.
- If the AED determines that the child’s rhythm is nonshockable, it will tell the rescuers to continue CPR. The rescuers proceed to Box 7.
Related Video – How to Use an AED for Children
Related Video – Using an AED for an Infant
Box 6: Administer Shock
The rescuers ensure that no one is touching the child and push the shock button on the AED. The rescuers immediately resume CPR following the shock.
Box 7: Resume CPR
The rescuers immediately resume high-quality CPR until advised by the AED to stop for a rhythm check. The rescuers continue to provide CPR and shocks until the child moves or EMS arrives.
A rescuer performs infant CPR.
A rescuer performs child CPR.
Related Video – 2 Rescuer CPR For Children
Related Video – How to Perform CPR / BLS on an Infant
Understanding BLS for Two or More-Rescuers
The two-rescuer approach is much the same as the single-rescuer approach, except that more tasks can be delegated and performed simultaneously as additional volunteers arrive on the scene.
The rescuers must first verify that the scene is safe to tend to the patient and then check for responsiveness. The first rescuer assesses breathing and pulse, taking no more than 10 seconds, and determines whether high-quality CPR should be initiated or continuous assessment of the child, watching for changes in their condition until help arrives.
If high-quality CPR is necessary, the first rescuer will begin while the second rescuer activates the emergency response system, retrieves an AED, and returns to assist with resuscitation. A two-rescuer approach is used when the second rescuer returns to assist.
If the patient is an infant, the two thumb-encircling hands technique is preferred when two rescuers are present during CPR. If only one rescuer is present, chest compressions are performed using the two-finger approach. If the patient is a child, then either one hand or two hands may be utilized.
The patient’s clothing should be moved to expose the chest when chest compressions are initiated. The compression-to-ventilation ratio is 15:2 when two rescuers are present. Rescuers should switch roles every 2 minutes or five cycles to avoid fatigue.
To perform the two thumb-encircling hands technique, the rescuer places two thumbs side by side on the bottom half of the breastbone, avoiding the tip of the breastbone. The thumbs may overlap in a small infant. The rescuer’s hands encircle the infant’s chest, with the fingers supporting the infant’s back.
The thumbs depress the infant’s chest at a rate of 100–120 compressions per minute, to a depth of at least 1.5 in (4 cm), or one-third of the anterior-posterior diameter of the chest. After every 15 compressions, the rescuer pauses to allow the second rescuer to deliver two ventilations, each over 1 second and producing visible chest rise. This technique provides better blood flow to the heart and has the added benefit of allowing access to the infant’s head so the second rescuer has room to work.
Key Takeaway
- Single-rescuer compression to ventilation ratio = 30:2
- Two-rescuer compression to ventilation ratio = 15:2
Two-Thumb Encircling Hands Technique
Related Video – 2 Rescuer CPR For Children
Related Video – How to Perform CPR / BLS on an Infant
Two-Rescuer BLS Approach
AED for Infants and Children < 8 Years Old
Automated external defibrillator (AED) devices all follow the same basic steps, regardless of manufacturer. However, the operation of each machine may be slightly different. Although the AED machine comes with easy-to-use instructions, the BLS rescuer must become adept by practicing with the AED.
Some AED models can be used for both pediatric and adult patients. These AEDs reduce the shock energy level for pediatric patients. They include child pads for patients < 8 years old. In some models, the insertion of the child pad leads into the AED machine converts the AED into the pediatric mode. Other AEDs may have a pediatric switch. The rescuer should be aware of this and switch it to pediatric mode before activating the AED.
Adult pads are used if pediatric pads are not available. It is better to defibrillate a shockable rhythm with an adult dose than not to deliver any shock at all.
Key Takeaway
- If available, use pediatric AED pads to deliver a pediatric energy dose.
- If not available, use adult equipment.
Related Video – How to Use an AED for Children
Related Video – Using an AED for an Infant
Interchangeable pediatric/adult cartridges for AED4 change the AED settings to proper energy level.
Interchangeable pediatric/adult cartridges for AED4 change the AED settings to proper energy level.
Some AED pads will have anterior-posterior placement while others have anterolateral placement.
Pads are placed as indicated by the illustration on the AED pad packaging. When applying the pads, rescuers need to ensure the pads do not touch each other or overlap. Some pads require anterior-posterior (AP) positioning, i.e., front and back. Others require anterolateral placement, i.e., one pad placed on the right upper chest and the other placed left of the sternum on the left side.