Paediatric BLS

Amplified
Checklist

Paediatric BLS - Amplified

Key Differences from Adult BLS

Aetiology

  • Paediatric arrest is almost always respiratory
  • Cardiac causes are rare (unless congenital heart disease)
  • Therefore: prioritise ventilation

Definitions

  • Infant: <1 year
  • Child: 1 year to puberty
  • Adult: signs of puberty onwards

The DRSABCD Sequence

Danger

Same as adult - ensure scene is safe for you and the child.

Response

Infant:

  • Flick sole of foot
  • Call name

Child:

  • Tap shoulders
  • Shout name

Don't shake an infant vigorously.

Send for Help

Single rescuer:

  • 1 minute of CPR first, then call for help
  • (Exception: if witnessed collapse, call immediately - likely cardiac)

Two rescuers:

  • One stays and starts CPR
  • One calls for help and gets AED

Airway

Infant:

  • Neutral position
  • Small roll under shoulders can help
  • Tongue is relatively large

Child:

  • Sniffing position (slight head tilt, chin lift)

Head tilt is contraindicated in trauma - use jaw thrust.

Breathing

  • Look, listen, feel for 10 seconds
  • If not breathing or only gasping → give 5 rescue breaths

Technique:

  • Infant: mouth over nose AND mouth
  • Child: pinch nose, mouth to mouth
  • Aim for visible chest rise with each breath

CPR

Ratio:

  • Healthcare providers: 15:2
  • Lay rescuers: 30:2 is acceptable

Compression depth:

  • At least 1/3 of chest depth
  • Infant: ~4cm
  • Child: ~5cm

Compression technique:

Infant (two-rescuer preferred):

  • Two-thumb encircling technique
  • Thumbs on lower third of sternum
  • Fingers encircle chest

Infant (single rescuer):

  • Two-finger technique
  • Index and middle finger on lower sternum

Child:

  • One or two hands
  • Heel of hand(s) on lower half of sternum

Rate: 100-120/min (same as adult)

Defibrillation

  • Use paediatric pads if available (1-8 years)
  • Standard adult pads for >8 years or >25kg
  • For infants: manual defibrillation preferred (4 J/kg)
  • AED can still be used if nothing else available

Common Causes of Paediatric Arrest

Think respiratory:

  • Airway obstruction (foreign body, croup)
  • Respiratory failure (asthma, bronchiolitis)
  • Drowning
  • Trauma

Think also of:

  • Sepsis
  • Anaphylaxis
  • Poisoning