European Resuscitation Council Guidelines for Resuscitation ... - CPR

18 de 0ctubre de 2010 www.elsuapdetodos.com1246 J.P. Nolan et al. / Resuscitation 81 (2010) 1219–1276• Ensure that there is adequate head tilt and chin lift but also thatthe neck is not over extended.• If head tilt and chin lift has not opened the airway, try the jawthrust method.• Make up to five attempts to achieve effective breaths, if stillunsuccessful, move on to chest compressions.6. Assess the child’s circulationTake no more than 10 s to:• Look for signs of life—this includes any movement, coughing ornormal breathing (not abnormal gasps or infrequent, irregularbreaths).If you check the pulse, ensure you take no more than 10 s.In a child over 1 year—feel for the carotid pulse in the neck.In an infant—feel for the brachial pulse on the inner aspect of theupper arm.The femoral pulse in the groin, which is half way between theanterior superior iliac spine and the symphysis pubis, can also beused in infant and children.7A. If you are confident that you can detect signs of life within 10 s:• Continue rescue breathing, if necessary, until the child startsbreathing effectively on his own.• Turn the child on to his side (into the recovery position) if heremains unconscious.• Re-assess the child frequently.7B. If there are no signs of life, unless you are CERTAIN you can feela definite pulse of greater than 60 beats min −1 within 10 s:• Start chest compressions.• Combine rescue breathing and chest compressions:Chest compressionsFor all children, compress the lower half of the sternum.To avoid compressing the upper abdomen, locate the xiphisternumby finding the angle where the lowest ribs join in the middle.Compress the sternum one finger’s breadth above this; the compressionshould be sufficient to depress the sternum by at leastone-third of the depth of the chest. Don’t be afraid to push too hard:“Push Hard and Fast”. Release the pressure completely and repeatat a rate of at least 100 min −1 (but not exceeding 120 min −1 ). After15 compressions, tilt the head, lift the chin, and give two effectivebreaths. Continue compressions and breaths in a ratio of 15:2. Thebest method for compression varies slightly between infants andchildren.Chest compression in infantsThe lone rescuer compresses the sternum with the tips of twofingers. If there are two or more rescuers, use the encircling technique.Place both thumbs flat side by side on the lower half of thesternum (as above) with the tips pointing towards the infant’s head.Spread the rest of both hands with the fingers together to encirclethe lower part of the infant’s rib cage with the tips of the fingerssupporting the infant’s back. For both methods, depress the lowersternum by at least one-third of the depth of the infant’s chest(approximately 4 cm).Chest compression in children over 1 year of agePlace the heel of one hand over the lower half of the sternum (asabove). Lift the fingers to ensure that pressure is not applied overthe child’s ribs. Position yourself vertically above the victim’s chestand, with your arm straight, compress the sternum to depress it byat least one-third of the depth of the chest (approximately 5 cm).In larger children or for small rescuers, this is achieved most easilyby using both hands with the fingers interlocked.8. Do not interrupt resuscitation until:• The child shows signs of life (starts to wake up, to move, openseyes and to breathe normally or a definite pulse of greater than60 min −1 is palpated).• Further qualified help arrives and takes over.• You become exhausted.When to call for assistanceIt is vital for rescuers to get help as quickly as possible when achild collapses.• When more than one rescuer is available, one starts resuscitationwhile another rescuer goes for assistance.• If only one rescuer is present, undertake resuscitation for about1 min before going for assistance. To minimise interruption inCPR, it may be possible to carry an infant or small child whilesummoning help.• The only exception to performing 1 min of CPR before going forhelp is in the case of a child with a witnessed, sudden collapsewhen the rescuer is alone. In this case, cardiac arrest is likely tobe caused by an arrhythmia and the child will need defibrillation.Seek help immediately if there is no one to go for you.Recovery positionAn unconscious child whose airway is clear, and who is breathingnormally, should be turned on his side into the recoveryposition. The adult recovery position is suitable for use in children.Foreign body airway obstruction (FBAO)Back blows, chest thrusts and abdominal thrusts all increaseintra-thoracic pressure and can expel foreign bodies from the airway.In half of the episodes more than one technique is needed torelieve the obstruction. 465 There are no data to indicate which measureshould be used first or in which order they should be applied.If one is unsuccessful, try the others in rotation until the object iscleared.The FBAO algorithm for children was simplified and alignedwith the adult version in 2005 guidelines; this continues to be therecommended sequence for managing FBAO (Fig. 1.12).The most significant difference from the adult algorithm is thatabdominal thrusts should not be used for infants. Although abdominalthrusts have caused injuries in all age groups, the risk isparticularly high in infants and very young children. This is becauseof the horizontal position of the ribs, which leaves the upperabdominal viscera much more exposed to trauma. For this reason,the guidelines for the treatment of FBAO are different betweeninfants and children. Signs for the recognition of FBAO in a child arelisted in Table 1.2.www.elsuapdetodos.comTable 1.2Signs of foreign body airway obstruction.General signs of FBAOWitnessed episodeCoughing/chokingSudden onsetRecent history of playing with/eating small objectsIneffective coughingUnable to vocaliseQuiet or silent coughUnable to breatheCyanosisDecreasing level of consciousnessEffective coughCrying or verbal response to questionsLoud coughAble to take a breath before coughingFully responsive