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.
How to Provide Care
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.
- Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc.
- Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc.
- Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse.
- If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR.
Two-Responder CPR Technique for Children
Responder one:
- Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum. With smaller children, it may help to draw an imaginary line across the nipples.
- Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them. Remember: Use only one hand when performing chest compressions on smaller children.
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.
- Conduct compressions that go 2 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
- Perform 15 chest compressions.
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:
- Grab the rescue mask and seal it over the victim's face and nose.
- Lift the victim's chin and tilt his or her head back slightly. (When using the bag valve mask, remember not to push down on the mask, but rather, lift the mandible up into the mask – using the CE form to seal the mask – and incorporate the proper head-tilt, chin lift as you do. Also, remember that with children, the head-tilt, chin lift is less pronounced than it is during adult CPR.)
- Compress the bag on the bag valve mask and wait for the chest to rise and fall before administering the next breath.
Responder one:
Go right back into your 15 chest compressions.
Responder two:
- Go right back to delivering two rescue breaths.
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.
A Word About Ventilations
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 mask using a one-way valve
- Using a bag valve mask with or without supplemental oxygen
- Mouth to mouth
- Mouth to nose
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.
Mouth to Mouth Ventilation Steps
- Open the patient's airway past neutral using the head tilt, chin lift maneuver.
- Pinch the patient's nose shut. Create a seal over the patient's mouth using your mouth, or over the mouth and nose for an infant.
- Blow air into the patient's mouth. Break the seal slightly on the inhale and reseal before administering the next breath.