Notes

Procedure for Two-Person Pediatric Rescue

Working in a Team
During an emergency, teamwork is critical to providing the highest level of care possible. Teamwork involves a group of people working together to achieve a common goal. In the case of cardiac arrest, that goal is to save a life. Elements of effective teamwork include:
- Understanding roles and responsibilities
- Good communication
- Perform a debriefing


The BLS procedure for two-person pediatric rescue is similar to the two-person adult rescue and includes the following steps:
1. Verify the scene is safe.
2. Check for responsiveness.
3. Simultaneously check pulse and breathing and determine next action.
4. Perform high-quality CPR.
5. Attempt defibrillation.
6. Assist in the recovery position.

Step 1 – Verify the Scene is Safe
Survey the scene around the victim and verify that it's safe to approach. If the scene doesn't seem safe, back off and alerts the emergency response system.
Observe the victim. Treat immediate life-threatening injuries. Look for clues as to what may have caused the emergency. Ask bystanders what happened.

Step 2 – Check for Responsiveness
If present, obtain consent from a parent or legal guardian to begin care.
Tap a child on the shoulder or an infant on the heel and ask loudly, "Are you OK?"
If the victim does not respond, one rescuer should activate the emergency response system appropriate to the setting and retrieve an AED. The other rescuer should check the victim’s pulse and breathing.

Step 3 – Simultaneously Check Pulse and Breathing
Make sure the victim is in the supine, or face-up, position and open their airway using the head-tilt/chin-lift technique. If spinal trauma is suspected, use the jaw thrust technique.
Check for a pulse. Check for a carotid artery or femoral artery pulse on a child. For an infant, check for a brachial artery pulse.
At the same time, check for normal breathing.
Feel for a pulse and check for normal breathing for at least 5 seconds but no longer than 10 seconds.
Determine Next Action
-The pulse and breathing checks are used to determine the next course of action:
-If the victim has a definite pulse and is breathing normally, do not begin CPR. Place the victim in the recovery position and monitor. Re-evaluate their pulse and breathing every 2 minutes
-If the victim has a definite pulse but no normal breathing:
-Give one rescue breath every 3 to 5 seconds or about 12 to 20 breaths per minute. Each breath should last about 1 second. Lesson 4 provides more information on rescue breathing.
-Re-evaluate pulse and breathing every 2 minutes.
-If the pulse decreases to 60 beats per minute or less with signs of poor perfusion, then start CPR. Signs of poor perfusion may include cool extremities, paleness, patchy skin appearance, and turning blue.
-If the victim lacks normal breathing and a pulse, the victim is in cardiac arrest – begin CPR.

Step 4 – Perform High-Quality CPR replay
Perform high-quality pediatric CPR until an AED is available:
1. Generally, the victim should not be moved. However, if their current position or location does not allow for effective CPR, move them as needed.
2. Expose the victim’s chest to bare skin. Any type of clothing or under garments will hinder CPR and the use of an AED.
3. One rescuer should perform chest compressions. The second rescuer should provide 2 rescue breaths after 15 chest compressions. Do not stop chest compressions for longer than 10 seconds to give rescue breaths.
4. Rescuers should switch positions about every 2 minutes, or 5 cycles, to prevent fatigue from doing chest compressions. Typically, this switch can be done when the AED is analyzing the heart rhythm.
5. Repeat the CPR cycle, 15 compressions to 2 breaths, until a valid reason to stop occurs. More Info

Step 5 – Attempt Defibrillation
When an AED is available, it should be used immediately. Follow all the prompts provided by the AED. More Info
While one rescuer sets up the AED, the other rescuer should continue with chest compressions.
The AED will analyze the heart rhythm. If it is shockable, deliver one shock.
After delivering a shock, or if the rhythm is not shockable, immediately start CPR.
When the AED is checking the heart’s rhythm or delivering a shock, the rescuers should stop working on the victim and stand clear. All rescuers present should use the closed-loop communication to indicate that everyone is clear of the victim.

Step 6 – Assist to Recovery Position If the victim begins to show signs of ROSC, such as coughing, crying, or movement, assist the victim to the recovery position. Always follow local protocols, but generally use the following procedures.
For a child, use the same procedure as an adult to assist the victim to the recovery position. -
=For an infant:
-Place the infant face down over your forearm.
-Support the head and the neck with your hand but keep the mouth and nose clear.
-Hold the head slightly lower than the body.