Advanced Life Support (ALS) Level 3 (VTQ)
Course Content
- ALS Introduction
- Initial Care and PPE
- Pre-shift checks
- Privacy and Dignity
- Chain of infection and universal precautions
- How to use gloves
- Scene safety
- Primary Survey
- National Early Warning Score - NEWS2
- NEWS2 Escalation
- Chain of Survival
- Chain of communication
- When communication breaks down
- Respiration and Breathing
- Pulse Points
- Recovery Position
- Infant Recovery Position
- ABCDE Approach
- Heart Rhythms
- Airway Management
- ECG's
- Pulse Oximetry
- Pharmacology ,Drugs and Medications
- Advanced CPR
- Non-traumatic chest pain
- First Aid vs BLS Healthcare Professionals
- When to call for assistance
- Advanced CPR Overview
- CPR Introduction
- Adult CPR Theory
- Ethics of resuscitation
- Bag Valve Masks
- Pocket Mask - Advanced
- Adult CPR
- CPR Breaths
- Compression only CPR
- CPR Seizures and agonal gasps
- Using an AED
- AED Pad Placement
- CPR Cycle - 1 person
- Effective CPR
- Improving compressions
- The Precordial thump
- Improving breaths
- The hospital resuscitation team
- Child and infant CPR overview
- Infant CPR practical (first aid guidelines)
- Child and infant CPR Theory
- Post resuscitation care
- Defibrillation
- Oxygen
- When Oxygen is Used
- Hazards of using oxygen
- Contra Indications Of Oxygen
- Oxygen and COPD
- Hypoxia
- Storage Of Oxygen
- Transport of Cylinders
- Standard oxygen cylinder
- PIN INDEX cylinder
- Oxygen Regulators
- BOC Oxygen Kit
- How long does an Oxygen cylinder last?
- Oxygen Giving Set
- Venturi Mask
- Non Rebreather mask
- Nasal Cannula
- DNR's and When to Stop Resuscitation
- CPR Scenarios
- Choking
- Medical Emergencies
- ALS Summary
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We are now going to look at the practicalities of carrying out basic life support on a child and an infant patient. It is important to remember at this stage that it is quite an emotive situation to be in, dealing with a child in a cardiac arrest. It is emotive for us as practitioners, it is also emotive for the parents of the child that you are dealing with. Now even if attempts at CPR seem futile, we must continue to carry out basic life support and have that child transported to the hospital. We must also consider the long-term effects of your attempts on the parents and relatives. You need to approach this in a confident yet calm manner. If everything else fails, at least the parents will know that their child had the best attempt at being resuscitated.We will now go on to have look at the practicalities of the initial assessment, identifying cardiac arrest and managing the CPR process in a child and in an infant. By a child, we mean any person who is in a pre-pubescent stage, so nobody hair, small voice box and clearly looks like a child. In the sequence leading up to a child cardiac arrest, it is often secondary to hypoxia. This may be choking, it may be drowning, it may be some airway, upper or lower airway disease.Once we have established that the patient is in a cardiac arrest, we need to go through a similar process of seeing what that patient's levels of response are. Once we identify that the child is in a collapsed state, we need to establish what that child's levels of response are. And we will do that by shaking, "Hello, hello, can you hear me? Can you hear me?" There is no response. So we will look inside the child's mouth. If the airway is clear, we can tip the head back and wait for one second to see if the child starts to breathe. If the child does not breathe, then we can give five inflations using the bag valve mask or mouth-to-mouth ventilations. Each ventilation lasting one second in, one second out, and then we commence chest compressions.To identify the landmarks on a child, we go between the nipples and the center of the chest using, on a child this size, the heel of our hand to depress the chest approximately one-third of its anterior-posterior diameter, and we will do this for 15 compressions at a rate of 100 to 120 per minute. After we have done the 15 compressions, we come back to do two inflations, and back to alternate between compressions and inflations.While we are physically managing the airway of a child, we need to be aware of certain things in that the airways are much smaller and therefore they occlude much quicker, and also that the soft tissue around the neck and the jaw is very easy to compress. A damaged tissue swells further causing an obstruction. So keep your fingers on the firm bony part of the jaw. And when we inflate the chest, what we are looking for is adequate rise and fall. We would normally ventilate at 5 to 7 mL/kg, but actually what we are really looking for is, is the chest going up and down? If it is, then we know that air is going in and out, and then we need to make sure that we pump air around the body.On an infant, which we defined as being less than 1 years old, the principles of identifying that the child needs basic life support are just the same. The child becomes unresponsive. We check for levels of response, "Hello, hello." On a child or an infant, if you clap above the face so the waft of air and the noise may stimulate the child. We can also flick the heel, and we look for the legs being pulled away, a good method of assessing for a pain response in a child. As you can see on this particular infant at this age, there is a large occiput and it is important that we pad underneath the shoulders to make sure that the airway is in neutral alignment.So when we ventilate the child this size, there is no need to pull the head back because the airway is open in that position. Any hyperextension or flexion, just like a hosepipe in the garden, will kink and stop the air going in and out. So neutral alignment is important. Here again when we place the mask over the face, over the bridge of the nose, roll down and be very, very careful here not to compress any soft tissues around the neck. I am going to give five inflations, looking for an adequate rise and fall of the chest.On an infant this size, we will probably find that compressing the chest with two fingers is adequate. Between the nipples, middle of the chest and here again, compressing approximately one-third of the depth of the chest. As a child gets smaller, it is tempting to go faster but actually, the rate remains the same throughout for adults, children or infants. We are compressing at a rate of 100 to 120 per minute, one-third the depth of the chest. As with all patients, we must allow for the total recoil of the chest in between compressions, and we must be particularly aware of that in the infant, that we do not leave the weight of our fingers over the chest, we must allow it to fully recoil. This will give the ventricles of the heart a maximum chance of filling. And we do this for 15 compressions, and then two inflations without tilting the head back on this infant. As with an adult patient, we continue doing CPR until we see signs of life or until help arrives and senior medical help can take over.
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The hospital resuscitation team
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Infant CPR practical (first aid guidelines)
Effective Pediatric Basic Life Support
Providing Vital Support in Child and Infant Emergencies
Compassionate and Skilled Care for Young Patients
- Emotive Nature of Child Cardiac Arrest: A Challenging Situation
- Continuous Basic Life Support: Ensuring Immediate Action
- Long-Term Considerations: Supporting Parents and Relatives
Initial Assessment and CPR Management
Identifying Cardiac Arrest and Administering CPR in Children and Infants
- Child Definition: Pre-Pubescent Stage
- Common Causes of Child Cardiac Arrest: Hypoxia and Other Factors
- Assessing Levels of Response: Shaking and Airway Check
- Effective Chest Compressions: Proper Technique and Rate
- Safe Airway Management: Special Considerations for Children
- Infant Definition: Less Than 1 Year Old
- Assessing Infant Responsiveness: Clapping and Pain Response
- Optimal Airway Alignment: Avoiding Obstruction
When dealing with child and infant cardiac arrests, it's essential to approach the situation with empathy and competence. This guide covers the identification of cardiac arrest, levels of response assessment, proper chest compressions, and safe airway management for pediatric patients, including children and infants.