Assessment and Management of the Critcally Ill and Injured Infant and Child (APLS, PALS)

Cardiopulmonary arrest in infants and children is rarely a sudden event. Instead, it is often the result of progressive deterioration in respiratory and circulatory function. The epidemiology of cardiopulmonary arrest is different from that of adults. Sudden primary cardiac arrest in infants and children is uncommon. More commonly, injury or disease causes respiratory or circulatory failure, which progresses to cardiopulmonary failure with hypoglycemia and acidosis culminating in cardiopulmonary arrest.

Intact survival from endothermic systolic or pulse less cardiac arrest is uncommon.
In contrast, respiratory arrest alone is associated with a survival exceeding 50% when prompt resuscitation is provided.

Pediatric cardiopulmonary arrest occurs most commonly at either end of the age spectrum - in children younger than one year and in adolescence.

When cardiopulmonary failure is detected, initial priority is given to ventilation and oxygenation. If circulation and per fusion fail to improve rapidly, therapy for shock is provided.

Below is the path of various disease states leading to cardiopulmonary failure in infants and children (APLS).

MANY CAUSES

                         RESPIRATORY FAILURE                          SHOCK

                                            CARDIOPULMONARY FAILURE

                        DEATH                                             CARDIOVASCULAR RECOVERY

                                                                  NEUROLOGICAL                              NEUROLOGICAL
                                                                    IMPAIRMENT                                         RECOVERY 

Summary of BLS Man oeuvres in Infants and Children

          MAN OEUVRE                     INFANT (<1 YEAR)                           CHILD ( 1 TO 8 Y)

    AIRWAY                                Head tilt/chin lift(if trauma               Head tilt/chin lift(if trauma
                                                            present, use jaw thrust)                     present, use jaw thrust)

           BREATHING

            Initial                                         Two breaths at 1-                                 Two breaths at 1-
                                                                  2 secs/breath                                          2 secs/breath

       Subsequent                                      20 breaths/min                                      20 breaths/min
                                                                (approximate)                                       (approximate)

        CIRCULATION
           Pulse check                                 Bronchial/femoral                                           Carotid

            Compression area                   Lower half of sternum                  Lower half of sternum

           Compression with                           2 or 3 fingers                                     Heel of one hand

               Depth                               Approximately one third to             Approximately one third to
                                                          one half the depth of the                 one half of the depth of the
                                                                         chest                                                 chest

                Rate                                        At least 100/min                                        100/min

       Compression ventilation            5:1 (pause for ventilation)           5:1 (pause for ventilation)
                  ratio

           Foreign body                              Back blows/chest thrusts                   Heimlich man oeuvre
         airway obstruction