2-Rescuer Pediatric BLS

Initial Assessment

1. Verify Scene Safety: Ensure the area is safe for both rescuers and the victim.
2. Check for Responsiveness:
   • For a child: Tap the child’s shoulder and shout, “Are you okay?”
   • For an infant: Tap the bottom of the infant’s foot and shout, “Are you okay?”
3. Assign Rescuer Roles:
   • First rescuer: Begins resuscitation immediately.
   • Second rescuer: Activates the Emergency Response System (ERS) (e.g., calls 911 or mobilizes Advanced Life Support (ALS) team).
4. Scan for Breathing: Observe the victim’s chest for rise and fall for no more than 10 seconds. If there are no visible signs of normal breathing, assume cardiac arrest.

Checking for a Pulse

• It may be difficult to detect a pulse in small-bodied victims, so if a pulse is not detected within 10 seconds, begin CPR immediately.

Checking for a Pulse in a Child

• Locate the trachea using two or three fingers.
• Slide your fingers into the groove between the trachea and the muscles at the side of the neck, where the carotid pulse can be felt.
• Feel for at least 5 seconds but no more than 10 seconds. If no pulse is detected, begin CPR.

Checking for a Pulse in an Infant

• Place two fingers on the inside of the upper arm, midway between the elbow and shoulder.
• Press gently to attempt to feel the pulse for at least 5 seconds but no more than 10 seconds.

Rescue Breathing (If Pulse is Present, But No Normal Breathing)

Rescue breathing provides assisted breaths to an unresponsive victim who has a pulse but is not breathing.

• Provide 1 breath every 3–5 seconds (about 12 to 20 breaths per minute).
• Each breath should be given over 1 second and should result in visible chest rise.
• Recheck the pulse approximately every 2 minutes.

When to Begin CPR

If the victim is not breathing and has no pulse, begin CPR immediately.

Child Chest Compressions

1. Ensure the child is lying face up on a firm, flat surface.

   If you need to move or roll them over, do so with extreme caution, especially if a head or neck injury is suspected.

2. Position yourself correctly:

   Stand or kneel at the child’s side.

3. Hand Placement and Body Positioning:
   • Place the heel of one hand in the center of the child’s chest, on the lower half of the breastbone (sternum).
   • Position the second hand on top of the first, interlocking your fingers (or use one hand for very small children).
   • Straighten your arms and position your shoulders directly over your hands for maximum force.
4. Begin Chest Compressions:
   • Perform compressions at a rate of 100 to 120 per minute (think of the rhythm of the song “Staying Alive”).
   • Push hard and fast, at least 1/3 of the chest diameter (about 2 inches or 5 cm).
   • At the end of each compression, allow the chest to fully recoil before beginning the next compression.

Infant 2-Rescuer Chest Compressions

1. Ensure the infant is lying face up on a firm, flat surface.

   If you need to move or roll them over, do so with extreme caution, especially if a head or neck injury is suspected.

2. Hand Placement:
   • Place both hands side by side in the center of the infant’s chest on the lower half of the breastbone (sternum).
   • Encircle the infant’s chest with both hands, using your fingers to support the back.
   • Use both thumbs to depress the breastbone.
3. Begin Chest Compressions:
   • Perform compressions at a rate of 100 to 120 per minute.
   • Compress at least 1/3 of the chest diameter (about 1.5 inches or 4 cm).
   • At the end of each compression, allow the chest to fully recoil.
4. Rescue Breaths:
   • After every 15 compressions, pause for no more than 10 seconds to allow the second rescuer to open the airway using the head tilt-chin lift technique.
   • Give 2 breaths, each lasting 1 second. The chest should visibly rise with each breath.
5. Continue 15:2 Compression-to-Breath Ratio:
• Continue performing compressions and breaths at a ratio of 15:2.
• Switch positions every 5 cycles or 2 minutes to avoid fatigue.