First Responder EMS Curriculum for Training Centers in Eurasia

After provision of approximately 20 breaths (slightly longer than 1 minute), the lone rescuershould activate EMS. If adequate breathing resumes and there is no suspicion of neck trauma,turn the child onto the side into a recovery position.If signs of circulation are absent (or, for the healthcare provider, the heart rate is < 60 bpm withsigns of poor perfusion), begin chest compressions. This will include a series of compressionscoordinated with ventilations. If there are no signs of circulation, the victim is > 8 years of age,and an AED is available in the out-of-hospital setting, use the AED. A weight of 25 kgcorresponds to a body length of approximately 50 inches (128 cm) using the Broselow colorcodedtape. For information about use of AEDs for victims > 8 years of age, see "Part 4: TheAutomated External Defibrillator."Provide Chest CompressionsChest compressions are serial, rhythmic compressions of the chest that cause blood to flow to thevital organs (heart, lungs, and brain) in an attempt to keep them viable until ALS can beprovided. Chest compressions provide circulation as a result of changes in intrathoracic pressureand/or direct compression of the heart. Chest compressions for infants and children should beprovided with ventilations.Compress the lower half of sternum to a relative depth of approximately one third to one half theanterior/posterior diameter of the chest at a rate of at least 100 compressions per minute for theinfant and approximately 100 compressions per minute for the child victim. Be sure to avoidcompression of the xiphoid. This depth of compression differs slightly from that recommendedfor the newly born. The neonatal resuscitation guidelines call for compression to approximatelyone third the depth of the chest. The wider range of recommended compression depth andpotentially deeper compressions in infants and children is not evidence based but consensusbased. Chest compressions must be adequate to produce a palpable pulse during resuscitation.Lay rescuers will not attempt to feel a pulse, so they should be taught a compression techniquethat will most likely result in delivery of effective compressions.Healthcare providers should evaluate the effectiveness of compressions during CPR. If effectivecompressions are provided, they should all produce palpable pulses in a central artery (i.e., thecarotid, brachial, or femoral artery). Although pulses palpated during chest compression mayactually represent venous pulsations rather than arterial pulses, pulse assessment by thehealthcare provider during CPR remains the most practical quick assessment of chestcompression efficacy.Exhaled carbon dioxide detectors and displayed arterial pressure waveforms (if invasive arterialmonitoring is in place) can assist the healthcare provider in evaluating the effectiveness of chestcompressions. If chest compressions produce inadequate cardiac output and pulmonary bloodflow, exhaled carbon dioxide will remain extremely low throughout resuscitation. If an arterialcatheter is in place during resuscitation (i.e., during chest compressions provided to a patient inthe ICU with an arterial monitor in place), chest compressions can be guided by the displayedarterial waveform.To facilitate optimal chest compressions, the child should be supine on a hard, flat surface. CPRshould be performed where the victim is found. If cardiac arrest occurs in a hospital bed, placefirm support (a resuscitation board) beneath the patient's back. Optimal support is provided by aresuscitation board that extends from the shoulders to the waist and across the full width of the362 First Responder EMS Curriculum/AIHA, July 2002