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Now in this training segment, we're going to cover how to incorporate two rescuers for a child in CPR for the healthcare professional. We're still gonna make sure the scene is safe, our gloves are on. Whether we have a rescue mask with a one way valve or whether we're using a full BVM. We have a partner with us that's going to help us with the rescue breathing. And in this case, Jody will be using the Bag Valve Mask. Now, we're still gonna call out to the patient. Hey, child are you okay? Are you all right? They don't respond, so we tap and shout. Are you okay? Can you hear me? They still don't respond. Now's the time we call 911, activate EMS, call the code, or send a bystander to go call 911 and come back with an AED if they have one. It's now at this time I'm going to access for regular breathing and a pulse. Jody, this patient is not breathing normally and there is no pulse. I'm gonna begin CPR. I draw an imaginary line between the nipples and place the palm of one hand on the sternum. If this is a large child, I'm gonna use two hands. If it's a small child, I'm gonna use one hand. That's a variation from the adult to the child in CPR compressions. In this case, he's probably big enough. I'm gonna use two. Now I'm gonna do one-third the depth of the chest compressions at a rate of between 100 and 120 per minutes. But we're gonna change to 15 compressions for every 2 rescue breaths because we have 2 rescuers doing the CPR. So I'm gonna do that now. 1 and 2 and 3 and 4 and 5 and 6 and 7 and 8 and 9 and 10 and 11 and 12 and 13 and 14 and 15. Now hear's where we're approaching the two minute mark. And remember with two rescuers, we're gonna be switching out compressors approximately every two minutes so that we have a fresh compressor on the chest able to ensure that third of the depth of the compression at a rate of 100 to 120 times per minute. So at the last set before we reach that two minute mark, I'm gonna say we need to switch. And 2 and 3 and 4 and 5 and 6 and 7 and 8. 9 and 10, 11 and 12, 13, 14, 15. He delivers the two more rescue breaths as I situate myself to the head of the bed. I take over the rescue breaths while Jody jumps right on doing chest compressions. He does 15 compressions. Speaker 2: 10, 11 and 12, 13, 14, 15. Speaker 1: I give two rescue breaths. One in. Two rescue breaths in. He continues. Speaker 2: 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15. Speaker 1: Now let's say two minutes has gone by again. He'll yell out the switch. I'll finish with the two rescue breaths. He takes back over on the Bag Valve Mask and I come back around and jump right back into doing chest compressions. So there's this minimization of pause between the switch, the rescue breaths, and chest compressions so that we never leave too much time without somebody's hand on the chest doing a deep compression. This helps to bring the pulse pressures up. It helps to keep the blood pressure high as we can with this artificial compression of the heart muscle. And it allows for us to ensure that this child has the best chance at survivability with the least amount of chance of brain damage that we can give them. It's this kind of teamwork that brings the high quality chest compressions that we're looking for to give our patients their best chance and a second chance at life.
In this section, we're going to cover two-responder child CPR for the healthcare professional using a bag valve mask. (If you don't have a bag valve mask, a simple mask with a one-way valve will suffice.)
Much of what was covered in the last section – Adult CPR with Two Responders – will apply in this section – Child CPR with Two Responders. There will, however, be some subtle but crucial differences that are highlighted below.
Pro Tip #1: When performing chest compressions on a large child, use two hands as you would for an adult. But when performing compressions on a smaller child, use just one hand to assure you're not compressing with too much force.
Pro Tip #2: The rate of compressions to rescue breaths changes during child CPR when two responders are present. Instead of performing 30 compressions to two rescue breaths, reduce the number of compressions to 15 for every two rescue breaths.
It's worth mentioning again – The assessment phase is similar to one-responder situations, however, while one of you is assessing the scene and patient, the other can get the equipment ready to perform CPR, try to locate an AED if one isn't present, call 911 or a code, etc. Once chest compressions begin, that's when the efforts of each responder will begin to coordinate, including the important switch at the two-minute mark.
The importance of having a fresh compressor cannot be overstated. Performing high-quality compressions will help bring the pulse pressure up as well as keeping the blood pressure as high as possible. Having two responders working together as a coordinated team will ensure the highest quality CPR gets delivered, which will give the patient the greatest chance of survival.
After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve (or bag valve mask when there are two responders), begin calling out to the victim to assess whether or not the child is responsive.
Are you OK? Can you hear me?
If you don't get an initial response, place your hand on the child's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps.
Responder one:
Make sure you're directly over the victim's chest to maximize cardiac output, and not off to one side. If you're not directly over the chest, you may not adequately compress the heart.
Remember that counting out loud is even more important when two responders are working together. It allows the other responder to anticipate the delivery of rescue breaths and the all-important switching of duties.
Responder two:
Go right back into your 15 chest compressions.
Once you reach the two-minute mark, the responder performing chest compressions will call out switch, or the agreed upon word or phrase you'll be using to coordinate a switching of duties.
Responder two, after delivering two more rescue breaths, will hand the bag valve mask to responder one, walk around the patient and get into proper position, and begin performing chest compressions, while responder one prepares to administer rescue breaths using the bag valve mask.
Continue to perform 15 chest compressions to two rescue breaths – while switching duties every two minutes – until help arrives, an AED arrives, or the victim is responding positively and breathing normally.
Artificial ventilation is the method of forcing air into the lungs of a patient who is not breathing on their own. The oxygen in the ventilated air will be absorbed by blood flowing through the lungs and carried to the body's tissues and vital organs.
There are several ways to provide this ventilation, including:
Mouth to nose ventilation may be required if no ventilation equipment is present and if you are unable to create a proper seal over the patient's mouth.