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).

