342 Paediatric Emergencies
CARDIOPULMONARY RESUSCITATION2 Ventilation and oxygenation
(i) Give high-flow oxygen, open the airway with head tilt and chin
lift, and look, listen and feel for normal breathing for no more
than 10 s.
(ii) Clear the airway, if breathing is not normal or absent:
(a) ensure there is adequate head tilt and chin lift, but do not
over-extend the neck
(b) position the head in a neutral position in infants <1 year,
as overextension may occlude their airway.
(iii) Provide ventilatory assistance:
(a) perform bag-mask ventilation – leave intubation to an
airway-skilled doctor only:- use a face mask that fits closely over the nose and mouth.
Soft circular plastic masks are ideal - attach a hand-ventilating device. Standard infant
ventilating bags have a volume of 240 mL, require an
oxygen flow rate of at least 4 L/min and are suitable for
children up to 2 years - standard child ventilating bags have a volume of 500 mL
and are suitable for children up to 10 years
(b) insert an oropharyngeal airway under direct vision, if the
child is unconscious with no gag reflex and the tongue is
occluding the airway - measure this airway from the incisors to the angle of the
jaw - insert carefully avoiding damage to the soft palate
(c) give five rescue breaths making certain the child’s chest rises
and falls with each breath.
(iv) If the airway is blocked by an inhaled foreign body:
(a) hold the infant or small child head-down, prone and deliver
up to five blows over the back with the heel of the hand,
between the scapulae
(b) follow with up to five chest thrusts in an infant, in the same
position as for external cardiac compression one finger’s
breadth above the xiphisternum, but sharper and delivered at
a slower rate
(c) perform abdominal thrusts in an older child, if back blows do
not relieve the obstruction (see Heimlich’s manoeuvre,
p. 14).
(v) Have an endotracheal tube ready and both straight and curved-
blade laryngoscopes for the airway-skilled doctor (see Table
11.3):