• Chest compressions are started once signs of
circulatory arrest are identified.
• For the layperson, these include absence of breathing, coughing,
• In addition, for the healthcare worker, lack of an identifiable
pulse is a sign of circulatory arrest.
• Chest compressions are started in infants and children if their
heart rate is less than 60 beats per minute with signs of poor perfusion;
the main mechanism for increasing cardiac output is by increasing
• The combination of bradycardia and poor perfusion is a sign of
imminent cardiac arrest.
• None. However, compressions should be started
with caution if the patient has a known period of prolonged asystole.
• Do-not-resuscitate orders are respected in patients with prior
• No equipment is necessary when patient is on
a firm, flat surface.
• A resuscitation board is used when hospitalized patients are
in a soft bed.
• Multiple studies have shown significant complications during
resuscitation of adults.
• However, cardiopulmonary resuscitation of children results in
significant injuries only about 3% of the time.
• Cardiac arrest in pediatric patients is most
commonly due to respiratory failure. The rescuer attempts to correct
any obvious respiratory compromise.
• Infants with no signs of head or neck trauma may be carried on
the rescuer’s forearm during resuscitation, which allows
the lone rescuer to continue resuscitation while seeking help.
• Compressions are coordinated with ventilation in an unintubated
• Once the patient has been intubated, it is no longer necessary
to coordinate compressions and ventilations.
• However, coordinating compressions and ventilations is suggested
in newborns because it may facilitate adequate ventilation.
• The patient is placed supine on a firm flat surface.
• If the patient is in bed, then a resuscitation board is placed underneath
him or her.
• Any bulky clothing that will interfere with compressions or assessment
is removed or opened up.
• The head and neck are placed in a neutral position.
• The heart lies centrally in the chest between
the lower part of the sternum and the thoracic spine.
• Effective compressions squeeze the heart between the sternum
and spine to eject blood; for this reason, hand placement is over
the lower portion of the sternum.
• The central pulse is located by palpating the brachial, femoral,
or carotid arteries (Figure 6–1).
• The preferred location for checking the
pulse depends on the patient’s age as well as the number
and skill of the rescuers.
• In infants, the brachial pulse is preferred but the femoral pulse
can be used alternatively.
• In older children and adults, the carotid pulse is preferred
but a second or third rescuer may be better able to ...
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