Both ventilation and compression are
important for victims of cardiac arrest when the oxygen stores become depleted:
about 2 - 4 min after collapse from ventricular fibrillation (VF), and
immediately after collapse for victims of asphyxial arrest. Previous guidelines
tried to take into account the difference in causation, and recommended that victims
of identifiable asphyxia (drowning; trauma; intoxication) and children should receive
1 min of CPR before the lone rescuer left the victim to get help. But most
cases of sudden cardiac arrest out of hospital occur in adults and are of
cardiac origin due to VF (even though many of these will have changed to a
non-shockable rhythm by the time of the first rhythm analysis). These
additional recommendations, therefore, added to the complexity of the
guidelines whilst applying to only a minority of victims.Many children do not
receive resuscitation because potential rescuers fear causing harm. This fear
is unfounded; it is far better to use the adult BLS sequence for resuscitation
of a child than to do nothing. For ease of teaching and retention, lay people should be taught to use the adult sequence for children who
are not responsive and not breathing normally,
with the single modification that the chest should be compressed by one third of its depth. However, the following minor
modifications to the adult sequence will make it even more suitable for use in
children:
· Give 5 initial rescue
breaths before starting chest compressions (adult BLS
sequence of actions 5B).
· If you are on your own,
perform CPR for 1 min before going for help.
· Compress the chest by one
third of its depth. Use two fingers for an infant
under 1 year; use one or
two hands for a child over 1 year as needed to
achieve an adequate depth
of compression.
The same modifications of
five initial breaths, and 1 min of CPR by the lone rescuer before getting help,
may improve outcome for victims of drowning. This modification should be taught
only to those who have a specific duty of care to potential drowning victims
(e.g. lifeguards). If supplemental oxygen is available, and can be brought to
the victim and used without interruption in CPR (e.g., by attaching to a
resuscitation face mask), it may be of benefit. Drowning is easily identified.
It can be difficult, on the other hand, for a layperson to recognise when
trauma or intoxication has caused cardiorespiratory arrest. If either cause is
suspected the victim should be managed according to the standard BLS protocol.
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