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Message PAEDIATRICFIRST AIDApracticalguidetopaediatricrstaid7TH EDITION

                              6thEditionThis handbook is ideal for use insupport of a properly structured firstaid course. It will also prove invaluableas ongoing reference for someonewho has completed the course.PaediatricFirst AidContentsFirst Aid Skills 2AssessmentEmergency Plan 4IntroductionRoles & Responsibilities 3Primary Survey 6Secondary Survey 6Unresponsive Child 7Life Support & ResuscitationBasic Life Support (Child) 8Basic Life Support (Infant) 10AED 13InjuryExternal Bleeding 24Burns40Poisons48Head Injury46Bites & Stings49Spinal Injury44Fractures42Acute IllnessSeizures34Sickle Cell Disease 38Diabetes 37Meningitis28Personal & Scene Safety 5Recovery Position 15Scene Assessment 5Patient Assessment 5Airway Obstruction 16Immersion & Drowning 19Electric Shock 21Circulatory Shock22Internal Bleeding 25Asthma 26Anaphylaxis 31Fifth Disease 39Foreign Bodies52Appendix 1Documentation53Medication Flowchart55Appendix 2First Aid Kit56

PAEDIATRIC FIRST AIDIntroductionFirst AidPaediatric First Aid is, quite simply, the initial treatment given to a baby or childwho suers injury or sudden illness.If the injury or illness is minor then it may be the only help that the child receives or needs. Ifthe condition is more serious then first aid may be given until the child is handed over to abetter qualified person or medical practitioner, who could be a paramedic or doctor.The basic principle of first aid is to keep the child alive, to prevent their condition fromdeteriorating and to hand them over in the best possible condition in the circumstances.The Paediatric First Aider should possess the following skills, and be able to:-Dealwithconditionswhichareimmediatelyorpotentiallylife-threatening.-ProvideFirstAidforconditionswhichmaynotbelife-threateningbutwillrequiretreatment to prevent further harm, before the emergency medical services arrive.-ProvideFirstAidresponseincaseswhereinjuriesareminorandthetreatmentmaybeallthe child requires.-Providereassurancetothepatientaswellasotherchildreninthevicinity.-Recordallactionsandinterventionsandpassthisinformationonwhenhandingovertobetter qualified persons.-Beawareofthelocationandcontentsofemergencyfirst aid kits.-Beawareoftheneedforandcompetentin,raisingthealarmorcallingemergencyservicesin a timely manner.-Makethemselvesawareofanypre-existingconditionssuered by children in their care.-Displaythepersonalskillsneeded,includingcomposure,competenceandself-confidence,while understanding their limitations.-Bepreparedtodowhatisnecessarytomaintaintheirknowledgeandskillstotherequiredlevel.-Workonlywithinthescopeoftheirtrainingandcompetence.-Aneonateisbirthtoonemonth-Aninfantisonemonthtooneyear-Achildisoneyeartopuberty.If you are unsure whether a child may have reached puberty, treat them as an adult.Denition

PAEDIATRIC FIRST AIDRoles & ResponsibilitiesThe First Aider should not be expected to deal with complex casualties or incidents,but to provide an initial response where rst aid is required.In some circumstances such as minor wounds or injuries the first aid given may be the onlytreatment that the casualty receives. Where injuries or illnesses are more serious, first aid may befollowed by treatment from ambulance paramedics, doctors or hospital sta.Assess the Situation- Identify potential hazards to the health and safety of yourself, the casualty and others.-Whereappropriate,attempttominimisethesehazards.Useothersatthesceneifappropriate.-Aretheremultiplecasualties?Istherehelpavailableatthesceneifrequired?-Isthereequipmentavailablethatyoumightneed(FirstAidKit/AED)andcanyousendsomebody to bring it?-Doyouneedtocallemergencyservicesimmediately?The Aftermath-Whenemergencymedicalserviceshavebeeninvolved,theyusuallytakeresponsibilityforcleaning and making the area safe afterwards.-Intheeventofmoreminorinjuryyoumayhavetoensurethatpotentialhazardssuchasbloodstained dressings are disposed of safely and appropriately and the area made safe.-IfaFirstAidKitorequipmenthasbeeninusethiswillneedtobecheckedandreplenishedandput back into service.Handover the Casualty to Medical Help-Whenemergencymedicalservicesarrive,introduceyourselfastheFirstAideronscene.-Tellthemwhatyouhaveseen,whatyouhavedoneandwhataect, if any, your actions havehad. Be brief but accurate.-Wherepossible,takewrittennotesandalwaystrytorecordthetimewheneventsoccurredorchanges took place.-MakesuretheEMSonscenehaveyourpersonalcontactdetailsincasetheyneedtobeintouchor require further information.Assess and Treat the Casualty or Casualties-QuicklyassesstheirconditionusingABC(PrimarySurvey).-Treatpotentiallylife-threateningconditionsfirst.-Lookforandtreatotherproblemsinorderofpriority(SecondarySurvey).-Staywiththem,reassurethemcontinuously,makethemascomfortableaspossibleandcontinueto monitor their condition until the arrival of help.

PAEDIATRIC FIRST AIDEmergency PlanThankfully, when caring for children it is rare to have to give firstaid for anything other than trivial accidents or injuries. However,on occasions accidents may occur or children may become ill andyou may be called upon to oer first aid or even medicaltreatments.It is therefore very important that you plan for these events. Youwill need to develop your own emergency plan which meets yourspecificrequirements.Theplanshouldcoverallsituationsthatmight occur when you have children in your care.Points to consider-Accesstoatelephone,withabackupshouldthetelephonebeoutofaction.-Theservicesofsomeonetocarefortheremainingchildrenwhilstyoudealwiththeemergency.-Accesstothefollowingtelephonenumbersforyouorsomeoneelsewhomayneedtotake action in an emergency:-Accesstochildren’sindividualrecordformstotaketohospitalwiththechildorforsomeone else to use to contact the parents.-Firstaidkit.Thisshouldbeproperlylabeledandquickandeasyforotherstofind.-Haveyoucompletedanappropriatefirst aid course and do you have the knowledge andskills to react appropriately in an emergency?-Areparentsawareofyouremergencyplanandwhattoexpectifthereisanemergency?-Aretheyawareofwhatwouldbeexpectedofthem?*Child’sparents(homeandworknumbers).*Child’sdoctorandyourowndoctor.*Localhealthcentreandlocalhospital.*Emergencybackupperson.*Socialservices.

PAEDIATRIC FIRST AIDScene SafetyInjuries that require First Aid may result from dangerous occurrences. The problems thatcaused the accident may persist and oer a threat to first aiders and subsequent rescuers.It is vital that the rst aider is aware of this when attending an accident scene.First aiders should not knowingly place themselves in a dangerous situation.You cannot help the casualty if you become a casualty yourself.As you approach the scene, look for threats to your own safety. These may be obviousthreats, such as moving traic, fire or unstable structures or they may be much less obvioussuch as escaping gas or electricity. It is essential that you use all of your senses to alert youto danger and remember that although it may be safe to approach now, things can changequickly so remain alert and continue to monitor the situation.Personal and Scene SafetyOnce you have ensured that it is safe then you need to assess the situationfrom a rst aid point of view. You will need to know:-Howmanypatientsthereare.-Theircurrentcondition.-Willyouneedassistanceandisassistanceavailable?-Willyouneedequipmentandisitavailable?-Whatresourcesareavailabletocallforhelp?-Doanypatientsthatappearinimminentdangerofdeath?-Whatorwhoareyourpriorities?Scene AssessmentAssessment of the patient’s condition is usually performed in two parts:The Primary SurveyThe Secondary SurveyThe primary survey is conducted to find and simultaneously treat conditions that arepotentially life-threatening.The secondary survey should take place only after the primary survey and when you aresure that any life threatening conditions have been treated eectively. The objective of thesecond reassessment is to find and, where appropriate, treat other conditions in order ofPatient Assessment

Open the airway▪ Check that their airway is clear and open.▪ If necessary, open the airway with head tilt/chin lift.▪ Consider possible cervical spine injury.If the airway isobstructed▪ Take measures to clear the airway.Disability▪ Assess level of conciousness sing the ACVPU scale.Check for normalbreathing▪ If unresponsive and not breathing normally start CPR.▪ If unresponsive and breathing normally, place them carefully into therecovery position and continue to monitor their condition.▪ Conduct secondary survey and treat serious injury if appropriate.Check for seriousbleeding or blood loss▪ Control serious bleeding with direct pressure.▪ Use elevation if injuries permit.▪ Apply a wound dressing if available.▪ Look for and be prepared to treat, blood loss shock.The steps for primary survey can be remembered by using A.B.C.D.EAIRWAY – BREATHING – CIRCULATION – DISABILITY – EXPOSESecondary SurveyThe secondary survey is undertaken to discover the extent of the child’s injuries or illness,or to assess the eectiveness of treatment given during the primary survey.There are three elements to the secondary survey:▪ History / Mechanism Of Injury (M.O.I.)▪ Signs▪ SymptomsPAEDIATRIC FIRST AIDPrimary Survey & Secondary SurveyExpose▪ Move or remove clothing to expose the area of injury or concern.

PAEDIATRIC FIRST AIDSecondary SurveyExamining the casualty just means looking carefully at themIt is important that the casualty is examined for signs of obvious injury, and for their generalappearance and demeanour. The results of the examination put together with the history andthe symptoms described by the casualty are often enough to suggest what might be wrongwith them and also suggest an appropriate course of action.Bleeding-Haveagoodlookatthechildfromtoptotoelookingforobvioussignsofbleeding.-Lookforsignsofhiddenbleedingsuchasbruisingorswelling.-Pale,coldskinorsignsofshock?-Havetheygotbloodontheirclothing?-Controlanyseriousbleedingasapriority.Head and Neck-Arethereanysignsofinjurytotheheadsuchaslumps,bruisingorbleeding?-Swellingorbruisingaroundtheeyes?-Blood,orpalecolouredliquidleakingfromearsornose?-Doestheaccidentsuggestaneckinjury? If so, assume it.Torso and Limbs-Arethereanyobvioussignsofinjury?-Doesthecasualtyseemtohavetroublebreathing?-Dotheyexperiencepainonbreathingorcoughing?-Doesthehistoryoftheincidentsuggestabloworcrushinginjurytothetorso?-Aretheirarmsandlegsthecorrectshapeandpointingintherightdirection?-Aretheyshowingsignsofbleedingorshockwithnoobviousexternalbleeding?The level of consciousness my be estimated using the ACVPU scale:AALERTAwake with eyes open. Reacts normally if you speak to them or touch them.CCONFUSIONMay appear to be awake , but acting abnormally or making abnormal noises.VVERBALMay appear asleep but will open their eyes to the sound of your voice.PPAINAppears asleep with eyes closed. Will only respond to touch or movement.UUNRESPONSIVEAppears asleep with eyes closed. They do not open their eyes to any stimulus.Achildwithalevelotherthan‘A’willrequireemergencymedicalattention.

Approach with CAREIf they RESPOND-Ifthechildrespondsbyopeningtheireyes,speakingortryingtomovekeep them in the position that you find them.-Checkforotherinjuriesandtreatanyconditionsthatareimmediatelylifethreatening.-Sendforhelporraisethealarm.Make sure that there is no danger to yourself, the child or bystanders.Check for RESPONSE-Speakloudlytothechild,askthemtoopentheireyes.-Gentlystimulatethembytappingthemontheshoulder.-Neverforcefullyshakethechild.-Watchtheirfaceforsignsofeyeopeningormovement.If thereisNO RESPONSE-Callforanambulancestraightawayorgetsomeoneelsetocall-Usethespeaker/handsfreefunctiononyourphone. Ifyoucanusethevideofunctionaswell, then do so-Followthedirectionsofthedispatcher-IfyouaretrainedinPeadiatricBasicLifeSupportcheckbreathingasdescribedbelow,whilst waiting to be connected.Open the AIRWAY and Check for NORMAL BREATHING-Placeonehandontheirforeheadandpressgentlydownward.-Placethetipsofthefingers under the bony part ofthe jaw to lift and support the chin.-Rotatetheheadgentlybackward.Kneel next to the child with your cheek over their noseand mouth looking down the chest towards the toes.▪ Look – for chest movement.▪ Listen – for breath sounds.▪ Feel – for breath on the cheek. Take no more than 10secondsPAEDIATRIC FIRST AIDBasic Life Support - Child

If they are BREATHING NORMALLY-Treatanyimmediatelylifethreateninginjury.-Turnthemintotherecoverypositionassoonasitispractical to do so.-Continuetomonitoruntilthearrivalofhelp.If they are NOT BREATHING NORMALLY-Givefive rescue breathsEnsure that the airway isopen (head tilt – chin lift).Pinch the soft part ofthe nose with the indexfinger and thumb of thehand which is pressingon the forehead.Take a breath and place yourlips around their mouth,ensuring that you have agood seal. Blow steadily intotheir mouth for about onesecond until you see thechest rise.Lift your head away whilst maintaining head tilt – chin lift and allow the air to come out oftheir mouth.Airway ObstructionIf you have diiculty achieving an eective breath it probably means that the airway isobstructed.-Re-checktheirmouthandremoveanyobviousobstruction-Makesuretheheadistiltedandthejawisliftedproperly.-Makesureyouaremakingagoodsealaroundthemouth.-Repeatuptofive attempts to give eective inflations.-Ifunsuccessfulmoveontochestcompressions.Start CHEST COMPRESSIONS-Theobjectiveofchestcompressionistousethechild’sownheartasa mechanicalpump.-Asyoucompressitbloodisforcedout,whenpressureisreleasedtheelasticnatureoftheheart means that blood is drawn back into it.-Thechildshouldbeonafirm flat surface for chest compressions to be fully eective.PAEDIATRIC FIRST AIDBasic Life Support - Child

Place the heel of one hand over the lowerthird of the child’s breastbone.Lift the fingers to ensure that you do notpress on the ribs.-Inlargerchildrenorwithsmallrescuersthismaybedonewithbothhands,asinadultchest compression.-Repeatatarateof120compressionsaminute.Position yourself with your shoulder overthe chest and with your arm straight.Push vertically downward with enoughforce to compress the chest by one thirdof its depth.Combine CHEST COMPRESSION and RESCUE BREATHING-After15chestcompressionsstopandgivetwomorerescuebreaths.-Alternate15compressionswithtworescuebreaths.-Ifthereisnoresponseafteroneminute,andnobodyhascalledforhelp,stopanddial999 for an ambulance.-Whenyouknowthathelpiscoming,continuewithrescuebreathing/chestcompressionsat a ratio of 15 to 2 until help arrives and someone takes over.-Ifthereismorethanonerescuerpresent,changeovereverytwominutes.-Trytokeepthechestcompressionsataregularspeedanddepth.-Keeppausesorstoppagesasshortaspossible.Approach with CARE-Makesurethatthereisnodangertoyourself,thebabyorbystanders.Check for RESPONSE-Gentlystimulatethebabybyspeakingloudlytothemandby moving a limb or tapping them on the foot.-Nevershakeababy!Basic Life Support - InfantPAEDIATRIC FIRST AIDBasic Life Support - Child & Infant

If they RESPONDIf the baby responds by opening their eyes or trying to move:▪ keep them in the position that you found them.▪ check for other injuries and treat any conditions that are immediatelylife-threatening.▪ send for help or raise the alarm.▪ continue to monitor their condition until the arrival of trained help.If thereisNO RESPONSE▪  “HELP”         Open the AIRWAYPlace one hand on the baby’s forehead andpress gently downward to rotate the headbackward.Place the tip of one finger under the bony partof the jaw to lift and support the chin.Be careful not to over extend the neck.The finished position should be with thebaby’s eyes pointing straight upward.Check BREATHINGPlace your ear closely over the nose and mouthof the baby.Look down the chest towards the toes.Look for movement of the chest or abdomen.Listen for breath sounds.Feel for breath on the cheek.Take no more than 10 seconds to check.PAEDIATRIC FIRST AIDBasic Life Support - Infant

-Ifsomeoneelseisavailablesendthemtodial112/999 to call an ambulance.-Ifyouareonyourownstartrescuebreathingandchest compressions and continue for around oneminute before calling the ambulance.-Deliverveeectiverescuebreaths-Ensuretheairwayisopen.-Takeabreathandplaceyourlipsaroundthebaby’s nose and mouth ensuring that you have agood seal.-Blowoutgentlyintothebaby’smouthuntilyouseethechestrise.-Liftyourheadawayfromthebabywhilemaintainingheadtilt–chinliftandallowtheair to come out of the baby’s mouth.-Repeatthissequencefive times.If the baby IS BREATHING NORMALLY-Treatanyimmediatelylife-threateninginjury.-Turnthemontotheirsideassoonasitispracticaltodoso.-Continuetomonitoruntilthearrivalofhelp.If the baby IS NOT BREATHING NORMALLYAirway ObstructionIf you have diiculty achieving an eective breath it probably means that the airway isobstructed.-Re-checkthebaby’smouthandremoveanyobviousobstruction-Makesurethattheheadistiltedandthejawisliftedproperly.-Makesurethatyouaremakingagoodsealaroundthebaby’smouth.Repeat up to 5 attempts to give eective inflations. If still unsuccessful move on to chestcompressions.CHEST COMPRESSIONS -Infant-Usetwothumbsonthebreastbone,encirclingthe chest with the ngers.-Pressdownonthebreastbonetoadepthofone third of the depth of the baby’s chest.-Releasethepressurekeepingyourthumbs incontact with the baby’s chest.-Give15compressionsataspeedof120compressions a minute.PAEDIATRIC FIRST AIDBasic Life Support - Infant

Combine CHEST COMPRESSIONS with RESCUE BREATHINGCombine rescue breathing with chest compressions at a ratio of 15 chest compressions to 2rescue breaths.Maintain CPR until:-Thebabyshowssignsofrecovery.-TheAEDarrives-SomeoneelsetakesoverDebrillation and ChildrenThankfully it is rare to have to use an AED on a child. Their use however can be life-savingin some circumstances. Standard AEDs are suitable for use on children older than eightyears and the rescuer should use the same procedures and techniques as for adults. Specialpaediatric pads that reduce the power delivered are available and should be used if possi-ble. On some AEDs there is a switch for lowering the power output paediatric levels If not,then using adult pads is better than doing nothing.When the AED ArrivesOne person should continue with CPR whilst another prepares the AEDfor use and attaches the pads. In older children, where the chest area islarge enough, the pads can be at-tached with the one pad over theupper right chest and the other padbelow the left armpit on the side ofthe chest. For very small children orinfants then one pad should beplaced centrally on the front of thebaby’s chest and the other padplaced on the back, between theshoulder blades.PAEDIATRIC FIRST AIDBasic Life Support & AEDs

Once the pads are attached, stop CPR and allow the AED to analyse.Do not touch the child whilst the machine is analysing.Listen to and follow the voice prompts.AnalyseCheck electrodesIf “check electrodes” indicated then check pads are properly fixed and making good contactwith the chest wall.No shock indicatedIf no shock is indicated then restart CPR and continue for two minutes.Listen to and follow the voice prompts.Shock indicatedIf shock is indicated then ensure no one else is touching the child.Press the flashing shock button until the shock is delivered.Allow the machine to analyse.Listen to and follow voice prompts.            AED SummaryPAEDIATRIC FIRST AIDUse of AEDs

The aim of the recovery position is to maintain the airway by placing the child in aposition on their side, with the head lower than the chest. This allows the tongue to fallforward and allows drainage of blood, saliva or stomach contents from the mouth, bygravity.If corrosive stomach contents were allowed to enter the windpipe and lungs either bygravity or breathing in, the eect would be to cause a rapid and often fatal inflammationof the lining of the lungs. The inflamed or burnt surfaces produce large amounts of fluidand the child can literally drown in their own body fluids. This problem occurs becausethe muscle (sphincter) at the opening to the stomach relaxes in unconsciousness allowingcorrosive stomach contents to be regurgitated into the mouth.The following criteria should be met:-Theyshouldbeplacedontheirsidewiththemouthlowerthanthechest,toallowforfree drainage.-Thereshouldbenopressureonthechest.-Thepositionshouldbestableandalloweasyaccesstotheairway.-Itshouldbepossibletoreturnthechildontotheirbackeasily.Method-Beforeattemptingtomovethemmakesurethatthereisnothingintheimmediateareawhich may be dangerous.-Haveagoodlookatthemcheckingforobviousinjuries,thesemaynotpreventyoufrommoving them but they may modify the way it is done.-Removetheirspectaclesifwornandanysharporbulkyitemsfromtheirpockets.-Kneelbesidethem.-Opentheirairwaywithheadtilt/chinlift.Take the arm nearest to youand place it at right angles tothe body with the elbow bentand the palm of the handuppermost.Bring the furthest arm acrossthe chest and place the back ofthe hand against their nearestcheek, holding it there with yourhand.With your other hand, grasp thefurthest leg just above the kneeand pull it up, bending the kneebut keeping the foot on thefloor.PAEDIATRIC FIRST AIDThe Recovery Position