There is an easy read post and infographic at the bottom as well as translations into other languages (at present Mandarin Chinese, Hindi and Spanish)
So how do you know if a baby even needs CPR? You need to check Scene, Safety, Situation, AVPU, C-AB(CDE - we won't get as far as far as these today).
Scene, Safety, Situation is about is it safe? What's happened? Do you need help (almost always yes - phone emergency services, get them on the way!)? As distressing as it may be to see a very young child very unwell, you are absolutely no use to them if you become a casualty as well. If you cannot safely help them, simply phone the emergency services.
AVPU is used to establish their level of consciousness. A is they're Alert (so giggling, crying etc..). V is Voice (so when you speak to them you get some sort of a reaction). P is pain / pressure. What's normally used now is a Trapezium (Trap) squeeze. This is the muscle at the top of the shoulder / collar bone. Just give that a squeeze on both sides and if you get a reaction they are pain responsive. U is unresponsive (note they can be unresponsive and conscious e.g. some types of seizure). If this is the case, move on to assessing the following.
C stands for catastrophic haemorrhage (Cat haem). This is the sort of bleeding where if it's not stopped, they will be dead within minutes and is usually obvious. So it needs dealing with before anything else (I will do a separate post on this).
If there is no Cat haem, you can move on to A which stands for Airway. Think things like choking or anaphylaxis (severe allergic reaction than can cause swelling of the throat). Anything that would obstruct the airway. You can have a look in their mouth. If there is something at the very FRONT of their mouth, you can remove it. DO NOT go fishing - you can push things further down their throat. If they are allergic to something and having a reaction, if they (or another child - not an adult as the dose is too much) have an EpiPen, you can give them this. No-one is allergic to adrenaline as it is naturally occurring in the body, so you don't need to worry about a reaction to this even if the EpiPen belongs to another child. Put their head into a neutral position - this will open up the airway. To do this, put something under their shoulders like a nappy (diaper) or a thin children's book. This should bring their body more level with their head (which is larger in babies) and tilt the head back slightly opening up the airway.
B is breathing - You will check to see if they are breathing. To do this, you put your cheek to their mouth for 10 seconds facing their chest. You are checking 3 things. You are looking for their chest rising, listening for them breathing, and feeling for their breath on your cheek. DON'T mistake agonal breathing for actual breathing. Agonal breathing is taking the very occasion breath rather than regular breathing. So if they take one or two breaths in that 10 seconds - they're NOT breathing.
If after you've opened up their airway and checked their breathing you find they're not breathing, you start CPR. You DO NOT check for a pulse.
CPR - Baby (up to 1 years old) CPR starts with 5 rescue breaths. This is because in children, the problem is FAR more likely to be respiratory (lung) than cardiac (heart) related. And 5 rescue breaths MAY be all they need to get them breathing again. With rescue breaths, you cover BOTH their mouth and nose. You don't need a whole out breath. Just a small amount will do (they're just a baby remember!)
This is then followed by 15 chest compressions then another 2 rescue breaths. The rate is about 2 per second and you want to go about 1/2 to an inch deep. Put the baby on a hard surface like a table or the floor. Best practice is to wrap your hands around the baby (fingers joining at the back). Then use your thumbs to do the chest compressions. These should be in the centre of the chest. HOWEVER, on larger babies, you may not be able to get your hands all the way around them. In this case, it's perfectly acceptable to use 2 fingers to do the chest compressions with.
Do make sure that as soon as you establish this child requires medical assistance (during your scene, safety, situation assessment), you (or someone else if their is someone with you) call for help. In the UK, they will also talk you through CPR if you have to do it.
You keep going with the 15:2 CPR until the ambulance gets there and tells you to stop / takes over, or there is a change in their condition (like they start breathing again, upon which you reassess from the start).
Easy read
- Check Scene, Safety, Situation, AVPU, C-AB (CD and E will be covered another time)
- Scene, Safety, Situation is about is it safe? What's happened? Do you need help (get emergency services on their way!)? DON'T put yourself in danger or become a casualty yourself, this won't help.
- AVPU is used to establish their level of consciousness. A is they're Alert (so giggling, crying etc..).
- V is responses to Voice (so when you speak to them you get some sort of a reaction).
- P is responses to pain / pressure. What's normally used now is a Trapezium (Trap) squeeze. This is the muscle at the top of the shoulder / collar bone. Just give that a squeeze on both sides and if you get a reaction they are pain responsive.
- U is unresponsive.
- C stands for catastrophic haemorrhage (Cat haem). This is the sort of bleeding where if it's not stopped, they will be dead within minutes and is usually obvious. So it needs dealing with before anything else.
- A if for Airway. If there is something at the very FRONT of their mouth, you can remove it. DO NOT go fishing - you can push things further down their throat.
- If they are allergic to something and having a reaction, if they (or another child - not an adult as the dose is too much) have an EpiPen, you can give them this.
- Put their head into a neutral position - this will open up the airway. To do this, put something under their shoulders like a nappy (diaper) or a thin children's book.
- B is breathing - You will check to see if they are breathing. To do this, you put your cheek to their mouth for 10 seconds facing their chest. You are checking 3 things.
- Does their chest rise, can you hear them breathing, and can you feel their breath on your cheek?
- DON'T mistake agonal breathing for actual breathing. Agonal breathing is taking the very occasion breath rather than regular breathing. So if they take one or two breaths in that 10 seconds - they're NOT breathing.
- CPR - Baby (up to 1 years old) CPR starts with 5 rescue breaths. With rescue breaths, you cover BOTH their mouth and nose. You don't need a whole out breath. Just a small amount will do (they're just a baby remember!)
- This is followed by 15 chest compressions then another 2 rescue breaths. The rate is about 2 per second and you want to go about 1/2 to an inch deep. Place the baby on a hard surface.
- If you can, wrap your hands around the baby (fingers joining at the back). Then use your thumbs to do the chest compressions. These should be in the centre of the chest.
- HOWEVER, on larger babies, you may not be able to get your hands all the way around them. In this case, you can use 2 fingers to do the chest compressions.
- Do make sure that as soon as you establish this child requires medical assistance (during your scene, safety, situation assessment), you (or someone else if their is someone with you) call for help.
- You keep going with the 15:2 CPR until the ambulance gets there and tells you to stop / takes over, or there is a change in their condition (like they start breathing again, upon which you reassess from the start).
Mandarin Chinese
- Jiancha changjing, anquan, qingkuang, AVPU, C-AB (CD he E hui zai lingwai yici jieshao)
- Changjing, anquan, qingkuang shi yao panduan: xianzai anquan ma? Fasheng le shenme? Xuyao bangzhu ma (kuaisu rang jinji fuwu renyuan chulai!)? BU YAO rang ziji chuyu weixian zhong, ye buyao rang ziji chengwei shoushang zhe, yinwei zhe mei you bangzhu.
- AVPU yong lai queding tamen de yishi shuiping.
- A = Alert (qingxing) — tamen shi xingzhe de, bijiao ru giggling, kuqi deng.
- V = Voice (duiyinsheng you fan ying) — dang ni gen tamen shuohua shi, tamen hui you mou zhong fan ying.
- P = Pain / pressure (dui tengtong / yali you fan ying) — xianzai tongchang shiyong Trapezium (Trap) squeeze. Zhe shi jianbang / suogu shangfang de naikuai jirou. Zai liang bian qingqing an ya yixia, ruguo tamen you fan ying, jiu shuoming tamen dui tengtong you fan ying.
- U = Unresponsive (wu fan ying) — dui shengyin he tengtong dou mei you fan ying.
- C daibiao catastrophic haemorrhage (yan zhong da chuxue). Zhe shi yizhong ruguo bu zhi zhu, jige fenzhong nei jiu keneng dao zhi siwang de chuxue, tongchang feichang mingxian. Suoyi xuyao zai qita shiqing zhiqian chuli.
- A = Airway (qihudao). Ruguo tamen zui de zui qianfang you dongxi, ni keyi jiang ta qu chu. BU YAO ba shou shen jin qu luan zhao — zhe keneng hui ba dongxi tui de geng shen ru houlong.
- Ruguo tamen dui mou zhong dongxi guomin bingqie zhengzai fasheng guomin fan ying, ruguo tamen (huozhe ling yi ge haizi — bu shi chengren, yinwei chengren de jiliang tai da) you EpiPen, ni keyi gei tamen shiyong.
- Rang tamen de tou chu yu zhongli weizhi — zhe hui bangzhu dakai qihudao. Wei le zuodao zhe yidian, zai tamen de jianbang xiafang fang yige dongxi, liuru niao bu (nappy / diaper) huo yiben bao bao de haizi shu. Dongxi yao zai jianbang xia, bu shi zai tou xia.
- B = Breathing (huxi) — ni xuyao jiancha tamen shi fou zai huxi. Jiang ni de lian kao jin tamen de zui, jiancha 10 miao, bingqie mianxiang tamen de xiongbu. Ni zai jiancha san jian shi:
- Xiongbu hui bu hui shangxia qifu?
- Neng bu neng tingdao tamen huxi?
- Neng bu neng zai ni de lian shang ganjue dao tamen de huxi?
- BU YAO ba agonal breathing (zuihou de ou ran chuchu huxi) dang zuo zhengchang huxi. Agonal breathing shi ou'er cai hui huxi yixia, er bu shi guilv de huxi. Ruguo tamen zai 10 miao nei zhi huxi yi liang ci, jiu bu neng renwei tamen zai zhengchang huxi.
- CPR — ying'er (1 sui yixia) de CPR cong 5 ci renshu huxi kaishi. Zuoren gong huxi shi, yao tongshi gaizhu tamen de zui he bizi. Ni bu xuyao wanquan chu yi kouqi — zhi xuyao shaoliang de qixi jiu keyi (tamen zhishi yige baobao, jide zhe yidian!).
- Jie xia lai shi 15 ci xiong bu yasu, ranhou zai zuo 2 ci renshu huxi. Sudu dagai shi mei miao 2 ci, shendu dagai 1/2 dao 1 yingcun (1–2.5 cm). Jiang baobao fang zai jianying de pingmian shang.
- Ruguo keyi, yong shuangshou ba baobao de xiongbu baozhu (shouzhi zai beihou xiang jie). Ranhou yong liang ge muzhi zuo xiong bu yasu. Yasu yinggai zuo zai xiongbu zhongyang.
- DANSHI, ruguo baobao jiao da, ni keneng wu fa rang shuangshou wanquan baozhu tamen. Zhe zhong qingkuang xia, keyi shi yong liang ge shouzhi zuo xiong bu yasu.
- Dang ni zai changjing, anquan, qingkuang jiancha zhong queding zhe ge haizi xuyao yiliang bangzhu shi, yi ding yao jinkuai jiao ren bangzhu — ni ziji huo zhe ni shenbian de ling yi ge ren dou keyi bo da jinji fuwu dianhua.
- Jixu zuo 15:2 CPR, zhidao jiuhuche dao da bingqie gao su ni tingzhi / jieshou jiji, huozhe tamen de zhuangkuang you le bianhua (liuru tamen kaishi huixi, zhe shi jiu yao cong tou kaishi chongxin pinggu).
Hindi
- Scene, Safety, Situation, AVPU, C-AB ki jaanch karein (CD aur E ko kisi aur samay cover kiya jayega)
- Scene, Safety, Situation ka matlab hai: kya jagah surakshit hai? Kya hua hai? Kya aapko madad ki zaroorat hai (emergency services ko jaldi bulayein!)? Khud ko khatre mein MAT daalein aur khud ko casualty na banayein, kyunki isse koi madad nahi hogi.
- AVPU ka istemal vyakti ke hosh ki sthiti pata karne ke liye kiya jata hai.
- A = Alert (hosh mein) — bachcha jag raha hai; jaise hansna, khilkhilana, rona aadi.
- V = Voice (awaaz par response) — jab aap bachche se baat karte hain, to uski kisi tarah ki reaction milti hai.
- P = Pain / pressure (dard / pressure par response) — ab aam taur par Trapezium (Trap) squeeze ka istemal kiya jata hai. Yeh kandhe / collar bone ke upar wala muscle hai. Dono taraf halka sa squeeze karein; agar bachcha reaction deta hai, to woh pain responsive hai.
- U = Unresponsive (koi response nahi) — awaaz ya pain par koi response nahi.
- C ka matlab catastrophic haemorrhage (bahut gambhir bleeding) hai. Yeh aisi bleeding hoti hai jo agar roki na jaye to kuch hi minutes mein jaan le sakti hai aur aam taur par saaf taur par dikhai deti hai. Isliye ise kisi bhi doosri cheez se pehle treat karna zaroori hai.
- A = Airway (saans ki nali). Agar unke muh ke bilkul saamne ke hisse mein koi cheez hai, to aap use nikaal sakte hain. Muh ke andar ungli daal kar khojne ki koshish NA karein — aap cheez ko aur neeche gale mein dhakel sakte hain.
- Agar bachche ko kisi cheez se allergy hai aur allergic reaction ho raha hai, aur uske paas (ya kisi doosre bachche ke paas — adult ka EpiPen istemal na karein kyunki dose bahut zyada ho sakti hai) EpiPen hai, to aap use de sakte hain.
- Unke sir ko neutral position mein rakhein — isse airway khulne mein madad milegi. Iske liye unke kandhon ke neeche kuch rakhein, jaise nappy/diaper ya bachchon ki patli kitaab. Cheez kandhon ke neeche honi chahiye, sir ke neeche nahi.
- B = Breathing (saans lena) — aap check karenge ki bachcha saans le raha hai ya nahi. Apna gaal unke muh ke paas 10 seconds ke liye rakhein aur unke seene ki taraf dekhein. Aap teen cheezein check kar rahe hain:
- Kya unka seena upar-neeche ho raha hai?
- Kya aap unki saans sun sakte hain?
- Kya aap apne gaal par unki saans mehsoos kar sakte hain?
- Agonal breathing ko normal breathing na samjhein. Agonal breathing mein bahut kabhi-kabhi ek saans aati hai, regular breathing nahi hoti. Agar 10 seconds mein sirf ek ya do saansein aati hain, to woh normal breathing nahi hai.
- CPR — Baby (1 saal tak) ki CPR 5 rescue breaths se shuru hoti hai. Rescue breaths dete waqt bachche ke muh aur naak dono ko cover karein. Puri saans bahar nikalne ki zaroorat nahi hai — sirf thodi si hawa dena kaafi hai (woh sirf ek baby hai, yaad rakhein!).
- Iske baad 15 chest compressions karein aur phir 2 aur rescue breaths dein. Rate lagbhag 2 compressions per second hona chahiye aur depth lagbhag 1/2 se 1 inch (1–2.5 cm) honi chahiye. Baby ko hard surface par rakhein.
- Agar aap kar sakte hain, to apne dono haathon se baby ke seene ko gher lein (ungliyan peeth ke peeche ek doosre se milti hui). Phir apne dono thumbs se chest compressions karein. Compressions seene ke beech mein honi chahiye.
- LEKIN, bade baby mein aap apne haathon ko poori tarah se uske aas-paas nahi le ja pa sakte. Aisi situation mein chest compressions ke liye 2 ungliyon ka istemal karein.
- Jaise hi aap Scene, Safety, Situation assessment ke dauran decide karte hain ki bachche ko medical assistance ki zaroorat hai, turant help bulayein — agar koi aur vyakti saath hai to woh call kar sakta hai.
- 15:2 CPR jaari rakhein jab tak ambulance nahi aa jati aur aapko rukne / CPR sambhalne ke liye nahi kehti, ya bachche ki condition mein badlav nahi hota (jaise bachcha dobara saans lene lagta hai; is situation mein shuru se dobara assessment karein).
Spanish
- Comprobar la escena, la seguridad, la situación, AVPU y C-AB (CD y E se tratarán en otro momento)
- Escena, seguridad y situación significa preguntarse: ¿es seguro? ¿Qué ha ocurrido? ¿Necesitas ayuda (haz que los servicios de emergencia estén de camino!)? NO te pongas en peligro ni te conviertas tú mismo en otra víctima, porque eso no ayudará.
- AVPU se utiliza para establecer el nivel de consciencia.
- A = Alert (alerta) — está despierto, por ejemplo, puede reír, llorar, etc.
- V = Voice (responde a la voz) — cuando le hablas, obtienes algún tipo de reacción.
- P = Pain / pressure (responde al dolor / presión) — actualmente se suele utilizar un pellizco/sujeción del trapecio (Trap squeeze). Es el músculo situado en la parte superior del hombro / clavícula. Haz una ligera presión en ambos lados y, si obtienes una reacción, responde al dolor.
- U = Unresponsive (sin respuesta) — no responde a la voz ni al dolor.
- C significa catastrophic haemorrhage (hemorragia catastrófica). Es un tipo de sangrado que, si no se detiene, puede causar la muerte en cuestión de minutos y normalmente es evidente. Por lo tanto, debe tratarse antes que cualquier otra cosa.
- A = Airway (vía aérea). Si hay algo en la parte MÁS DELANTERA de la boca, puedes retirarlo. NO introduzcas los dedos para buscar a ciegas — puedes empujar el objeto más abajo, hacia la garganta.
- Si el bebé es alérgico a algo y está teniendo una reacción alérgica, y él (o algún otro niño — no un adulto, porque la dosis puede ser demasiado alta) tiene un EpiPen, puedes administrárselo.
- Coloca su cabeza en una posición neutra — esto ayudará a abrir la vía aérea. Para hacerlo, coloca algo debajo de los hombros, como un pañal o un libro infantil fino. Debe estar debajo de los hombros, no debajo de la cabeza.
- B = Breathing (respiración) — comprobarás si está respirando. Para hacerlo, coloca tu mejilla junto a su boca durante 10 segundos, mirando hacia su pecho. Estás comprobando tres cosas:
- ¿Se eleva su pecho?
- ¿Puedes oír su respiración?
- ¿Puedes sentir su respiración en tu mejilla?
- NO confundas la respiración agónica con una respiración normal. La respiración agónica consiste en respiraciones muy ocasionales, en lugar de una respiración regular. Si hace solo una o dos respiraciones durante esos 10 segundos, NO está respirando normalmente.
- RCP — Bebé (hasta 1 año): la RCP comienza con 5 respiraciones de rescate. Al realizar las respiraciones de rescate, cubre tanto la boca como la nariz del bebé. No necesitas realizar una respiración completa; basta con una pequeña cantidad de aire (¡recuerda, es solo un bebé!).
- A continuación, realiza 15 compresiones torácicas y después otras 2 respiraciones de rescate. El ritmo es de aproximadamente 2 compresiones por segundo y la profundidad debe ser de aproximadamente 1/2 a 1 pulgada (1–2,5 cm). Coloca al bebé sobre una superficie dura.
- Si puedes, rodea el cuerpo del bebé con las manos (con los dedos uniéndose por detrás). Después utiliza los dos pulgares para realizar las compresiones torácicas. Estas deben hacerse en el centro del pecho.
- SIN EMBARGO, en bebés más grandes puede que no puedas rodearlos completamente con las manos. En ese caso, puedes utilizar dos dedos para realizar las compresiones torácicas.
- Asegúrate de que, en cuanto determines durante la evaluación de escena, seguridad y situación que el bebé necesita asistencia médica, tú u otra persona que esté contigo llame para pedir ayuda.
- Continúa con la RCP 15:2 hasta que llegue la ambulancia y te diga que pares / se haga cargo, o hasta que haya un cambio en su estado (por ejemplo, que empiece a respirar de nuevo; en ese caso, vuelve a evaluar desde el principio).
