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David OlleyPaediatricA practical guide to paediatric rst aid6thEdition

                              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:- Deal with conditions which are immediately or potentially life-threatening.- Provide First Aid for conditions which may not be life-threatening but will requiretreatment to prevent further harm, before the emergency medical services arrive.- Provide First Aid response in cases where injuries are minor and the treatment may be allthe child requires.- Provide reassurance to the patient as well as other children in the vicinity.- Record all actions and interventions and pass this information on when handing over tobetter qualified persons.- Be aware of the location and contents of emergency first aid kits.- Be aware of the need for and competent in, raising the alarm or calling emergency servicesin a timely manner.- Make themselves aware of any pre-existing conditions suered by children in their care.- Display the personal skills needed, including composure, competence and self-confidence,while understanding their limitations.- Be prepared to do what is necessary to maintain their knowledge and skills to the requiredlevel.- Work only within the scope of their training and competence.- A neonate is birth to one month- An infant is one month to one year- A child is one year to puberty.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.- Where appropriate, attempt to minimise these hazards. Use others at the scene if appropriate.- Are there multiple casualties? Is there help available at the scene if required?- Is there equipment available that you might need (First Aid Kit/AED) and can you sendsomebody to bring it?- Do you need to call emergency services immediately?The Aftermath- When emergency medical services have been involved, they usually take responsibility forcleaning and making the area safe afterwards.- In the event of more minor injury you may have to ensure that potential hazards such asbloodstained dressings are disposed of safely and appropriately and the area made safe.- If a First Aid Kit or equipment has been in use this will need to be checked and replenished andput back into service.Handover the Casualty to Medical Help- When emergency medical services arrive, introduce yourself as the First Aider on scene.- Tell them what you have seen, what you have done and what aect, if any, your actions havehad. Be brief but accurate.- Where possible, take written notes and always try to record the time when events occurred orchanges took place.- Make sure the EMS on scene have your personal contact details in case they need to be in touchor require further information.Assess and Treat the Casualty or Casualties- Quickly assess their condition using ABC (Primary Survey).- Treat potentially life-threatening conditions first.- Look for and treat other problems in order of priority (Secondary Survey).- Stay with them, reassure them continuously, make them as comfortable as possible and continueto 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 yourspecific requirements. The plan should cover all situations thatmight occur when you have children in your care.Points to consider- Access to a telephone, with a backup should the telephone be out of action.- The services of someone to care for the remaining children whilst you deal with theemergency.- Access to the following telephone numbers for you or someone else who may need totake action in an emergency:- Access to children’s individual record forms to take to hospital with the child or forsomeone else to use to contact the parents.- First aid kit. This should be properly labeled and quick and easy for others to find.- Have you completed an appropriate first aid course and do you have the knowledge andskills to react appropriately in an emergency?- Are parents aware of your emergency plan and what to expect if there is an emergency?- Are they aware of what would be expected of them?* Child’s parents (home and work numbers).* Child’s doctor and your own doctor.* Local health centre and local hospital.* Emergency backup person.* Social services.

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:- How many patients there are.- Their current condition.- Will you need assistance and is assistance available?- Will you need equipment and is it available?- What resources are available to call for help?- Do any patients that appear in imminent danger of death?- What or who are your priorities?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

Approach with care▪ Be aware of potential danger to yourself, bystanders or the child.▪ Think about infection control procedures,Assess response▪ Do they open their eyes to speech?▪ Do they open their eyes to a gentle movement or a tap?▪ If unresponsive, shout for help and request an AED if one is available.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.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.Maintain care▪ Ensure professional help has been called.▪ Continue to monitor their condition.▪ Reassure them continuously.▪ Perform first aid procedures as necessary.▪ Hand over to an appropriate practitioner.The steps for primary survey can be remembered by using D.R.A.B.C.DANGER – RESPONSE – AIRWAY – BREATHING – CIRCULATIONSecondary 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 Survey

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- Have a good look at the child from top to toe looking for obvious signs of bleeding.- Look for signs of hidden bleeding such as bruising or swelling.- Pale, cold skin or signs of shock?- Have they got blood on their clothing?- Control any serious bleeding as a priority.Head and Neck- Are there any signs of injury to the head such as lumps, bruising or bleeding?- Swelling or bruising around the eyes?- Blood, or pale coloured liquid leaking from ears or nose?- Does the accident suggest a neck injury? If so, assume it.Torso and Limbs- Are there any obvious signs of injury?- Does the casualty seem to have trouble breathing?- Do they experience pain on breathing or coughing?- Does the history of the incident suggest a blow or crushing injury to the torso?- Are their arms and legs the correct shape and pointing in the right direction?- Are they showing signs of bleeding or shock with no obvious external bleeding?Any child or baby who is unconscious is in danger, due to the threat of a blocked airway. Theairway could become blocked by food, blood, saliva, vomit or their own tongue.The level of consciousness my be estimated using the AVPU scale:AALERTAwake with eyes open. Reacts normally if you speak to them or touch them.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.A child with a level other than ‘A’ will require emergency medical attention.The Unresponsive Child

Approach with CAREIf they RESPOND- If the child responds by opening their eyes, speaking or trying to move:keep them in the position that you find them.- Check for other injuries and treat any conditions that are immediately lifethreatening.- Send for help or raise the alarm.Make sure that there is no danger to yourself, the child or bystanders.Check for RESPONSE- Speak loudly to the child, ask them to open their eyes.- Gently stimulate them by tapping them on the shoulder.- Never forcefully shake the child.- Watch their face for signs of eye opening or movement.If there is NO RESPONSE- Shout loudly for help.- If someone is nearby ask them to bring an AED.- If you are alone, shout for help loudly to try to attract attention, but do not leaveOpen the AIRWAY- Place one hand on their forehead and press gentlydownward.- Place the tips of the fingers under the bony part ofthe jaw to lift and support the chin.- Rotate the head gently backward.Check for NORMAL BREATHINGKneel 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- Treat any immediately life threatening injury.- Turn them into the recovery position as soon as it ispractical to do so.- Continue to monitor until the arrival of help.If they are NOT BREATHING NORMALLY- Give five 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-check their mouth and remove any obvious obstruction- Make sure the head is tilted and the jaw is lifted properly.- Make sure you are making a good seal around the mouth.- Repeat up to five attempts to give eective inflations.- If unsuccessful move on to chest compressions.Start CHEST COMPRESSIONS- The objective of chest compression is to use the child’s own heart as a mechanical pump.- As you compress it blood is forced out, when pressure is released the elastic nature of theheart means that blood is drawn back into it.- The child should be on a firm 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.- In larger children or with small rescuers this may be done with both hands, as in adultchest compression.- Repeat at a rate of 120 compressions a minute.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- After 30 chest compressions stop and give two more rescue breaths.- Alternate 30 compressions with two rescue breaths.- If there is no response after one minute, and nobody has called for help, stop and dial999 for an ambulance.- When you know that help is coming, continue with rescue breathing/chest compressionsat a ratio of 30 to 2 until help arrives and someone takes over.- If there is more than one rescuer present, change over every two minutes.- Try to keep the chest compressions at a regular speed and depth.- Keep pauses or stoppages as short as possible.Approach with CARE- Make sure that there is no danger to yourself, the baby or bystanders.Check for RESPONSE- Gently stimulate the baby by speaking loudly to them andby moving a limb or tapping them on the foot.- Never shake a baby!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 there is NO RESPONSE▪  “HELP”   A.B.C.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

- If someone else is available send them to dial112/999 to call an ambulance.- If you are on your own start rescue breathing andchest compressions and continue for around oneminute before calling the ambulance.- Deliver ve eective rescue breaths- Ensure the airway is open.- Take a breath and place your lips around thebaby’s nose and mouth ensuring that you have agood seal.- Blow out gently into the baby’s mouth until you see the chest rise.- Lift your head away from the baby while maintaining head tilt – chin lift and allow theair to come out of the baby’s mouth.- Repeat this sequence five times.If the baby IS BREATHING NORMALLY- Treat any immediately life-threatening injury.- Turn them onto their side as soon as it is practical to do so.- Continue to monitor until the arrival of help.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-check the baby’s mouth and remove any obvious obstruction- Make sure that the head is tilted and the jaw is lifted properly.- Make sure that you are making a good seal around the baby’s mouth.Repeat up to 5 attempts to give eective inflations. If still unsuccessful move on to chestcompressions.CHEST COMPRESSIONS - Infant- Place the tips of two fingers over the lowerthird of the baby’s breastbone.- Press down on the breastbone to a depth ofone third of the depth of the baby’s chest.- Release the pressure keeping your fingers incontact with the baby’s chest.- Give 30 compressions at a speed of 120compressions a minute.PAEDIATRIC FIRST AIDBasic Life Support - Infant

Combine CHEST COMPRESSIONS with RESCUE BREATHINGCombine rescue breathing with chestcompressions at a ratio of 30 chestcompressions to 2 rescue breaths.Maintain CPR until:- The baby shows signs of recovery.- The AED arrives- Someone else takes overWhen to go for HELP- It is vital to raise the alarm as soon as possible.- If there is more than one rescuer, one should start CPR whilst the other goes for help.- If you are on your own, perform 5 sets of 30:2 CPR before going for help.- It may be possible to take the baby with you to the telephone.De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:- They should be placed on their side with the mouth lower than the chest, to allow forfree drainage.- There should be no pressure on the chest.- The position should be stable and allow easy access to the airway.- It should be possible to return the child onto their back easily.Method- Before attempting to move them make sure that there is nothing in the immediate areawhich may be dangerous.- Have a good look at them checking for obvious injuries, these may not prevent you frommoving them but they may modify the way it is done.- Remove their spectacles if worn and any sharp or bulky items from their pockets.- Kneel beside them.- Open their airway with head tilt/chin lift.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