Pediatric Basic Life Support Algorithm – Two Rescuers

🩺 Pediatric Basic Life Support (BLS) Algorithm – 2 Rescuers

The Pediatric BLS Algorithm for two or more rescuers provides a structured, step-by-step approach to managing pediatric cardiac arrest. It emphasizes safety, early recognition, high-quality CPR, rescue breathing, AED use, and prompt activation of emergency medical services (EMS).

🔹 Step 1: Ensure Scene Safety
Before approaching the victim, verify that the scene is safe for both rescuers and the child. Do not proceed if hazards are present.

🔹 Step 2: Check Responsiveness and Call for Help
Tap the child gently and shout to assess responsiveness. If there is no response, one rescuer should stay with the victim while the second activates the emergency response system and retrieves the AED and emergency equipment.

🔹 Step 3: Assess Breathing and Pulse (Simultaneously – within 10 seconds)
Look for normal breathing or gasping. At the same time, check for a pulse:

• Infants (under 1 year): Check the brachial pulse.
• Children (over 1 year): Check the carotid or femoral pulse.

🔸 If the child is breathing normally and has a pulse:
Monitor and wait for EMS to arrive.

🔸 If there is a pulse but abnormal or no breathing:
Begin rescue breathing:

• Provide 1 breath every 2–3 seconds (20–30 breaths per minute).
• Reassess the pulse every 2 minutes.
• If the pulse drops to ≤60 bpm with signs of poor perfusion, begin chest compressions.

🔸 If there is no pulse:
Start CPR immediately.

🔹 Step 4: Begin High-Quality CPR
Start chest compressions at a rate of 100–120 compressions per minute at a depth of approximately one-third of the chest’s depth:

• Infants:
  • One rescuer: Use 2 fingers in the center of the chest.
  • Two rescuers: Use the 2 thumb–encircling hands technique.
• Children:
  • Use 1 or 2 hands based on the child’s size and rescuer’s strength.

Compression-to-ventilation ratios:

• Before second rescuer returns: 30 compressions to 2 breaths.
• Once both rescuers are present: 15 compressions to 2 breaths.

🔹 Step 5: Use the AED
As soon as the AED is available, power it on and follow the prompts.

• If a shockable rhythm is detected:
  • Clear the patient.
  • Deliver shock (2 J/kg).
  • Immediately resume CPR for 2 minutes (starting with compressions).
• If no shock is advised:
  • Immediately resume CPR (starting with compressions).

💡 Important: Do not interrupt chest compressions for more than 10 seconds. Continue CPR and follow AED prompts until:

• Advanced Life Support (ALS) providers arrive, or
• The child shows signs of life (movement, breathing, response).

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