Although Cardio Pulmonary Resuscitation (CPR) should be performed by certified and trained first aid personnel, bystanders can be instrumental in the survival of a child who is suffering a heart attack. Follow this procedure, updated to the American Health Association (AHA) 2010 guidelines, to learn how to perform CPR on children. For children under one year of age, the protocol for pediatric CPR should be followed, for others the protocol for adults.
The major change is that compression-only CPR, according to the AHA, is as effective as the traditional method of mouth-to-mouth resuscitation, which is therefore now optional. However, for children, opening the airways and artificial respiration are more useful than for adults, because they are more likely to have breathing problems - adults are more likely to suffer from heart problems, which is why heart compressions are of vital importance.
Steps
Step 1. Check that the scene is free of hazards
When confronted with someone unconscious, if you choose to help, you need to quickly make sure that you are not going to be in danger. Are there any exhaust emissions? Gas stoves? Fires? Are there any inactive power lines?
- In case of danger for you or the victim, see if there is a way to cope. Open a window, turn off the stove, or put out the fire if possible. Do everything you can to counter the danger.
- If there is nothing you can do to counter the danger, move the victim. The best way to do this is to put a blanket or coat under the victim and drag.
Step 2. Check if the victim is conscious by shaking her by the shoulders and calling out loud:
"Are you OK?".
- If he answers, he is conscious. Maybe she was just asleep or unconscious. If the situation still seems emergency (for example the victim has trouble breathing, seems to alternate between consciousness and unconsciousness, still remains unconscious, etc.) call for help, start first aid and take measures to prevent or treat the possible state of shock.
- If the victim does not respond, continue as follows:
- Send someone for help, such as calling the emergency room. If you are alone, do not call until you have completed two minutes of CPR.
- Call 112 in Europe, 911 in North America, 000 in Australia and 111 in New Zealand.
Step 3. Check the victim's pulse
The check should last no more than 10 seconds. If the victim has no pulse, continue with CPR and the following steps.
- You can check the neck (carotid) - try to feel a pulse on the side of the neck closest to you, placing the tips of the first two fingers sideways to the Adam's apple.
- You can check the pulse (radial) - put the first two fingers on the victim's wrist, towards the thumb part.
- Other places you can check are the groin and ankle. To check the groin (femoral), press the tip of two fingers in the middle of the groin area. To check the ankle (posterior tibialis), place two fingers on the inside of the ankle.
Step 4. Perform CPR for two minutes (approximately five CPR cycles) and then call the emergency department before resuming
If possible, send someone else for an automated external defibrillator (AED), if present in the building.
Step 5. Remember the abbreviation CAB - Chest Compression, Airway, Breathing (from English Breathing)
In 2010, the AHA changed the recommended procedure by recommending chest compressions before airway opening and artificial respiration. Chest compressions are more crucial for correcting abnormal heart rhythms (ventricular fibrillation or pulseless ventricular tachycardia), and because a cycle of 30 compressions takes only 18 seconds, opening the airway and artificial respiration are not delayed in meaningfully.
Step 6. Perform 30 chest compressions
Hold your hands on top of each other and place them on the breastbone, which is the center of the chest at the height of the nipples. Your ring finger should be above the nipple (to reduce the chances of fracturing one or more ribs).
- Compress the chest, with stiff elbows, pushing down about 5 cm (one third the thickness of a child's chest).
- Perform 30 of these compressions, practicing them at a rate of at least 100 compressions per minute (the rate corresponds to the pace of "Stayin 'Alive" by the Bee Gees). If there are two rescuers they should take turns, each should perform sets of 30 compressions followed by 2 breaths.
- Allow the chest to fully relax after each squeeze.
- Minimize breaks for alternating rescuers or preparing for shocks. Try to limit the length of interruptions to less than 10 seconds.
Step 7. Make sure the airways are open
Place one hand on the forehead of the victim and 2 fingers under the chin, and tilt the head back to open the airway (in case of suspected trauma to the neck, instead of lifting the chin, pull the jaw in the direction of traction of the neck). If the jaw pull fails to open the airways, carefully tilt the head by lifting the chin.
Step 8. If there are no vital signs, place a breathing mask (if available) over the victim's mouth
Step 9. Practice two breaths
Keeping the airways open, use the fingers that are on the forehead to close the victim's nostrils. Make your mouth fit snugly against the victim's and exhale for about a second. Make sure you exhale slowly, so that the air goes into the lungs and not the stomach. Keep an eye on the victim's chest.
- If the insufflation is successful, you should see a noticeable rise in the chest and feel the air enter. If the insufflation is successful, perform a second one.
- If insufflation fails, reposition the victim's head and try again. If it still fails, the victim may have an airway obstruction. Do abdominal compressions (Heimlich maneuver) to remove the obstruction.
Step 10. Repeat the cycle of 30 chest compressions and 2 breaths
CPR should be given for 2 minutes (5 compression and insufflation cycles) before re-evaluating vital signs. Continue CPR until someone replaces you, emergency responders arrive, you are too exhausted to continue, an AED is available for immediate use, or your pulse and breathing (vital signs) resume being present.
Step 11. If an AED is available, turn it on, place the electrodes as directed (one over the chest on the right and the other on the left side), allow the AED to analyze the heart rhythm, and if recommended, send a shock, then having turned everyone away from the patient
Resume chest compressions immediately after shock for another 5 cycles before re-evaluating vital signs.
Advice
- Get proper training from qualified organizations in your area. Training by experienced personnel is the best way to prepare for an emergency.
- If you need to move the victim, try to disturb the body as little as possible.
- Don't forget to place your hands in the middle of the breastbone, at the height of the nipples.
- Always call the emergency medical service.
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Recommendations on when to call for help may vary from country to country; for example the British recommendations, as opposed to the American ones, suggest calling before starting chest compressions. However, it is essential that:
- Help is on its way
- Chest compressions are practiced for as long as possible, without taking risks.
- If you are unable or unwilling to give artificial respiration, do CPR with compression only. This will also help the victim recover from a heart attack.
