Paediatric basic and advanced life support — formative SAQs

SAQ 1 — Basic life support sequence and high-quality CPR (10 marks)

A 2-year-old is found unresponsive and not breathing after a short seizure. You are the registrar first on scene with a skilled nurse. The child has no signs of life. ^{[1] [4]}

Questions

1. Outline the basic life support sequence from arrival at the scene to ongoing compressions, including the compression-to-ventilation ratio. (5 marks) ^[1]
2. State the five quality parameters of high-quality paediatric CPR and explain why each matters. (5 marks) ^[4]

Model answer

BLS sequence (5). First ensure the scene is safe, then check responsiveness by tapping and shouting. If unresponsive, shout for help and send a specific person to fetch the defibrillator and call the arrest team. Open the airway with a head tilt and chin lift, and look, listen and feel for normal breathing for no more than ten seconds. If the child is not breathing normally, give five rescue breaths, each about one second, with enough volume to produce gentle chest rise. Then begin chest compressions at a ratio of fifteen compressions to two ventilations, because two rescuers are present. Cycle every two minutes, swapping compressors, and attach the defibrillator as soon as it arrives. ^[1]

High-quality CPR parameters (5). First, push hard — compress one third of the anteroposterior chest depth, about 4 cm in an infant and 5 cm in a child, because adequate depth generates coronary and cerebral perfusion. Second, push fast — 100 to 120 per minute, because this rate optimises flow. Third, allow full chest recoil between compressions, because recoil allows the heart to refill. Fourth, minimise interruptions to keep the chest compression fraction above 0.8, because every pause longer than ten seconds drains the aortic pressure the cycle just built. Fifth, avoid excessive ventilation — two breaths of one second each — because over-ventilation raises intrathoracic pressure and lowers cardiac output. ^[4]