Paediatric BLS Scenario - Child Cardiac Arrest

You are working in a nursery and your colleague is accompanying a 3-year-old child who is unwell. Suddenly your colleague frantically calls out for help and screams "He's not breathing!"

You rush to the room in response. Your colleague is holding the limp child in her lap. What will be your first intervention.

• check for a pulse

• begin CPR

• verify that the scene is safe for you and the victim

• scream for more help

Answer explanation

Rationale: AHA BLS Provider Manual, p. 48
The first intervention is to always verify that the scene is safe for you and the victim. This prevents you from becoming a victim yourself.

2. You have verified that the scene is safe, and you, therefore, place the child on the floor. You check for responsiveness by tapping the child's shoulder and shouting "Are you OK?" There is no response from the child. What is your next intervention?

• instruct the assistant to call 999 and get an AED

• check breathing

• begin CPR

• open the airway

Answer explanation

Rationale: AHA BLS Provider Manual, p. 49.
For two-rescuer CPR, after verifying that the scene is safe and establishing unresponsiveness, the first rescuer remains with the victim and the second rescuer goes to activate EMS and get an AED. 

Your assistant has gone to activate emergency response and get the AED. What will you do now?

• check for foreign body in the airway

• begin CPR

• check for a pulse and breathing

• give 2 rescue breaths

Answer explanation

Rationale: BLS Provider Manual, p. 49
After establishing unresponsiveness, the next step is to check for a pulse and breathing.

As you check for a pulse, you remember that the pulse check can be performed in what two locations for a three-year-old child? (Choose the two correct answers)

• radial

• femoral

• brachial

• carotid

Answer explanation

Rationale: AHA BLS Provider Manual, p. 50
For a child (1-year-old to puberty), perform a pulse check by palpating the carotid or femoral pulse.

You palpate for a carotid pulse and scan the victim's chest for rise and fall (signs of breathing). There is no palpable pulse and no sign of breathing. Help has not yet arrived and you are alone. What is your next intervention?

• check for a pulse in a different location

• begin rescue breathing

• begin CPR 15:2

• begin CPR 30:2

Answer explanation

Rationale: AHA BLS Provider Manual, p. 52
For infants and children, perform CPR 30:2 for single-rescuer CPR. One cycle of CPR equals 30 chest compressions and 2 rescue breaths.

Your coworker returns with an AED And states that EMS has been called and is on the way. Your coworker takes over with chest compressions and you are now providing rescue breathing.

(True or False) For CPR in infants and children with two rescuers providing CPR, the compression to ventilation ratio is 30:2.

• True

• False

Answer explanation

Rationale: AHA BLS Provider Manual, p. 52
This is False. The compression to ventilation ratio in infants and children is 15:2 when two rescuers are providing CPR

While your coworker is providing chest compressions, you turn on and attach the AED. After the round of 15 compressions and 2 rescue breaths, you stop CPR to allow the AED to analyze the victim.

(True or False) You may continue rescue breathing while the AED analyzes the patient's rhythm.

• True

• False

Answer explanation

Rationale: AHA BLS Provider Manual, p. 36.
This is False. While the AED is analyzing the victim’s rhythm, be sure that no one is touching the victim, not even the rescuer in charge of giving breaths. This helps ensure that the AED properly reads and interprets the patient’s rhythm.

(True or false) If pediatric AED pads are not available, adult AED pads may be used as an alternative.

• True

• False

Answer explanation

AHA BLS Provider Manual, p. 61. This is true. Adult AED pads may be used on infants and children if child pads are not available. Ensure that the pads do not touch each other or overlap.
Some AED’s have a key or switch that will allow you to deliver a child shock dose. When using the AED with adult pads, the machine may force the adult shock does. This is OK. The higher shock dose is better than no shock.

The AED states "No shock advised." What should you do now?

• restart CPR immediately

• check for a pulse

• push the analyze button on the AED again

• begin only rescue breathing

Answer explanation

Rationale: AHA BLS Provider Manual, p. 49
CPR should be resumed immediately after the AED analyzes the rhythm and no shock is advised.

You and your colleague restart CPR with you providing chest compressions and your colleague providing rescue breathing (15:2). You recall that there are two possibilities for allowing the cessation of CPR.

(True or false) You may stop CPR for two reasons. The two reasons are 1.) If ALS providers arrive to take over CPR, or 2.) If the victim starts to move or show other signs of ROSC.

• True

• False

Answer explanation

Rationale: AHA BLS Provider Manual, p. 48 (box 10)
This is true. The cardiac arrest algorithm for BLS should continue until ALS providers arrive and take over, or the victim starts to move or show other signs of ROSC.