Paediatric Life Support

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Paediatric Life Support

• A Computer-based Learning Program
• (please wait for the presentation to start)
• We gratefully acknowledge the use of the
  Australian Resuscitation Council (ARC) Guidelines
  in the development of this program. Please note
  that there may be a delay between the publication
  of updated guidelines and their
  incorporation into this program. The ARC website
  can be accessed to check for updates
  at http//www.resus.org.au/

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Paediatric Life Support

• Welcome to this interactive CPR (cardio-pulmonary
  resuscitation) learning module
• It should not take longer than 25 minutes to
  complete
• You can navigate through this program by clicking
  on the arrows below in order to get to the next
  slide
• ...or to see the previous slide

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Paediatric Life Support

• Sometimes you may be asked to click on so-called
  hyperlinks, they will look
  something like this
• Now click on the hyperlink in order to get to the
  next slide

4
Paediatric Life Support

• This is the way it works!
• If you want to exit the program at any stage,
  press Esc on your keyboard
• To return to the list of contents click on the
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• Alternatively scroll down the bar on the right
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• Now, click on the next slide arrow to begin the
  teaching program

5
List of ContentsClick on the topic
you want to access. If visiting the program for
the first time simply move on to the next page by
clicking on the next page arrow

• Pathways leading to cardiac arrest
• Basic life support (BLS)
• BLS Airway and Foreign Body
• BLS Breathing
• BLS Circulation

• Code Blue
• Advanced Airway management
• Vascular access and Fluids
• Drugs
• Defibrillation

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Paediatric Life Support

• Objectives of this presentation are
• Revise assessment and interventions for airway,
  breathing and circulation
• Revise the systematic approach for paediatric
  life support featuring emergency interventions,
  including intubation, IV access, drugs and
  defibrillation

7
Definitions

• For the purpose of resuscitation, children are
  divided -somewhat arbitrarily- into 3 age groups
• Infants under one year of age
• Small children 1 to 8 years of age
• Older children/adults 9 years and over

8

• Let us have a look at the pathways that lead to
  cardiac arrest in children

9
Pathways Leading to Cardiac Arrest
FLUID LOSS
FLUID MALDISTRIBUTION Septic shock Cardiac
disease Anaphylaxis
RESPIRATORY DISTRESS
RESPIRATORY DEPRESSION Convulsions Raised
ICP Drug induced
Blood loss Gastroenteritis Burns
Bronchiolitis Asthma Croup Foreign Body
CIRCULATORY FAILURE
RESPIRATORY FAILURE
CARDIAC ARREST
10
Pathways Leading to Cardiac Arrest
FLUID LOSS
FLUID MALDISTRIBUTION Septic shock Cardiac
disease Anaphylaxis
RESPIRATORY DISTRESS
RESPIRATORY DEPRESSION Convulsions Raised
ICP Drug induced
Blood loss Gastroenteritis Burns
Bronchiolitis Asthma Croup Foreign Body
Note that there are quite a few different
conditions, all leading to circulatory failure!
CIRCULATORY FAILURE
RESPIRATORY FAILURE
CARDIAC ARREST
11
Pathways Leading to Cardiac Arrest
FLUID LOSS
FLUID MALDISTRIBUTION Septic shock Cardiac
disease Anaphylaxis
RESPIRATORY DISTRESS
RESPIRATORY DEPRESSION Convulsions Raised
ICP Drug induced
Blood loss Gastroenteritis Burns
Bronchiolitis Asthma Croup Foreign Body
CIRCULATORY FAILURE
RESPIRATORY FAILURE
CARDIAC ARREST
12
Pathways Leading to Cardiac Arrest
FLUID LOSS
FLUID MALDISTRIBUTION Septic shock Cardiac
disease Anaphylaxis
RESPIRATORY DISTRESS
RESPIRATORY DEPRESSION Convulsions Raised
ICP Drug induced
Blood loss Gastroenteritis Burns
Bronchiolitis Asthma Croup Foreign Body
CIRCULATORY FAILURE
RESPIRATORY FAILURE
CARDIAC ARREST
13
Pathways Leading to Cardiac Arrest
FLUID LOSS
FLUID MALDISTRIBUTION Septic shock Cardiac
disease Anaphylaxis
RESPIRATORY DISTRESS
RESPIRATORY DEPRESSION Convulsions Raised
ICP Drug induced
Blood loss Gastroenteritis Burns
Bronchiolitis Asthma Croup Foreign Body
Note that not only conditions primarily affecting
airways or breathing can lead to respiratory
failure!
CIRCULATORY FAILURE
RESPIRATORY FAILURE
CARDIAC ARREST
14
Pathways Leading to Cardiac Arrest
FLUID LOSS
FLUID MALDISTRIBUTION Septic shock Cardiac
disease Anaphylaxis
RESPIRATORY DISTRESS
RESPIRATORY DEPRESSION Convulsions Raised
ICP Drug induced
Blood loss Gastroenteritis Burns
Bronchiolitis Asthma Croup Foreign Body
CIRCULATORY FAILURE
RESPIRATORY FAILURE
CARDIAC ARREST
15
Pathways Leading to Cardiac Arrest

• The primary cause for arrest in children is
  respiratory or less commonly- circulatory
  failure
• Prevention of arrest is infinitively preferable
  to treatment and outcome is likely to be far more
  satisfactory
• It is important to anticipate such emergencies
  and ensure all staff including you- are
  proficient in paediatric resuscitation

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Pathways Leading to Cardiac Arrest
FLUID LOSS
FLUID MALDISTRIBUTION Septic shock Cardiac
disease Anaphylaxis
RESPIRATORY DISTRESS
RESPIRATORY DEPRESSION Convulsions Raised
ICP Drug induced
Blood loss Gastroenteritis Burns
Bronchiolitis Asthma Croup Foreign Body
CIRCULATORY FAILURE
RESPIRATORY FAILURE
Appropriate resuscitation draws the line here!
CARDIAC ARREST
17
Basic Life Support

• Check for DANGER, stop and look
• Check RESPONSE, verbal and tactile but do not
  shake and shout
  If conscious, assess carefully, patient may still
  need urgent medical review
• Continue to assess and manage
• Airway
• Breathing
• Circulation

D
R
A
B
C
18
Basic Life Support Flowchart
Check for DANGER
Check for RESPONSE
UNCONSCIOUS Alert assistance Clear airway Apply
head tilt and jaw support Check for breathing
CONSCIOUS Make comfortable Observe ABC
NOT BREATHING 2 rescue breaths Check for
pulse Look for signs of life
BREATHING Lateral position Observe ABC
INADEQUATE PULSE No signs of life Commence CPR
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Basic Life Support Flowchart
Check for DANGER
Check for RESPONSE
CONSCIOUS Make comfortable Observe ABC
BREATHING lateral position Observe ABC
20
Basic Life Support Flowchart
Check for DANGER
Check for RESPONSE
UNCONSCIOUS Alert assistance Clear airway, Apply
head tilt and jaw support, Check for breathing
NOT BREATHING 2 rescue breaths Check for
pulse Look for signs of life
INADEQUATE PULSE No signs of life Commence CPR
21
Basic Life Support

• The following slides will introduce you to some
  practical aspects of basic life support

22
Basic Life Support

• Airway
• Breathing
• Circulation

23
Airway

• Observe for secretions and clear (suction)
• Do not attempt a blind finger sweep
• Open the airway
• chin lift / jaw thrust
• neutral position in infants
• sniffing position in children

Small amounts of secretions will affect the
airway Always suction under direct vision using
a Yankauer sucker
24
Airway Opening ManoeuvresChin lift/head tilt
Infants Neutral head position with chin lift
Smaller children Sniffing position with chin lift
25
Airway Opening ManoeuvresChin lift/head tilt
Older children/adults Backward head tilt with
pistol grip
26
Airway Opening ManoeuvresJaw thrust
Use when concerned re cervical spine injury May
also facilitate bag and mask ventilation
Jaw thrust
27
Foreign Body
Assess Severity
Effective Cough
Severe airway obstruction
Mild airway obstruction
Ineffective Cough
Unconscious
Conscious
Encourage coughing Continue to check victim until
recovery or deterioration Call for help
Call for help Commence CPR
Call for help Give up to 5 back blows If not
effective Give up to 5 chest thrusts
28
Foreign Body
Assess Severity
Effective Cough
Mild airway obstruction
Encourage coughing Continue to check victim until
recovery or deterioration Call for help
29
Foreign Body

• If there is an effective cough (mild
  obstruction)
• Encourage coughing
• Continue to check victim until recovery or
  deterioration
• Call for help
• Do not attempt any manoeuvres to remove unless
  this is very easily done

30
Foreign Body
Assess Severity
Severe airway obstruction
Ineffective Cough
Unconscious
Conscious
Call for help Commence CPR
Call for help Give up to 5 back blows If not
effective Give up to 5 chest thrusts
31
Foreign Body

• If there is an ineffective cough (severe
  obstruction)
• Unconscious
• call for help, commence CPR
• Conscious
• call for help
• give up to 5 back blows firm blows between the
  shoulder blades using the heel of the hand

32
Back blows small child
Back blows infant
33
Foreign Body

• If 5 back blows unsuccessful
• Chest thrusts
• identify same compression point as for CPR
• give up to 5 chest thrusts
• similar to compressions but sharper and delivered
  at a slower rate
• check to see if each thrust has relieved the
  airway obstruction
• Infant
• place in a head down supine position across
  rescuers thigh
• Child/ older child / adult
• may be placed in sitting or standing position
• Note this is not the same as a Heimlich
  manouvere this manouvere is on the chest

34
Hand position is lower half of the sternum
Chest thrusts infant
Chest thrusts small child
35
Basic Life Support

• Airway
• Breathing
• Circulation

36
Breathing

• Look, Listen Feel for Breathing for 10 seconds

37
Breathing

• If breathing is absent or inadequate
• Give 2 rescue breaths allowing about 1 second
  per inspiration
• Sufficient breath to achieve gentle rise
  and fall of chest, this means
• puffs for an infant
• breaths for a child
• full breaths for an older child/adult

38
Bag and Mask
Correct mask size cover mouth and nose only
C
Holding the mask C-grip
39
Bag and Maska few technicalities...

• Mask size
• Bridge of nose to cleft of chin and sufficiently
  wide to cover mouth
• If too big you may get an air leak and also
  potential damage especially with pressure applied
  to the eyes
• Self inflating bag
• Connect to oxygen 10L/Min
• Once reservoir bag full, delivering 95-100
  oxygen
• Pressure release valve prevents too high pressure
• Self-inflating, so can be used to deliver room
  air

40
Self Inflating Bag Sizes
Preterm Infant (240ml) lt2.5kg
Adult (1600ml) gt25kg

• Child (500ml) 2.5 25kg

41
Checking Self Inflating Bags

• Check that the self inflating bag compresses
  and reinflates quickly and air is felt from
  patient outlet
• Check the one way valve opens when self
  inflating bag is compressed
• Occlude patient outlet with hand and compress
  bag, listen for the pressure release value to
  release
• Take off oxygen reservoir bag and place over
  the patient outlet. Inflate the reservoir bag
  checking for holes

42
Basic Life Support

• Airway
• Breathing
• Circulation

43
Pulse Checkthe smallprint

• Do not check the pulse for longer than 10 seconds
• Research has shown that pulse check is an
  unreliable indicator and is now de-emphasised.
  Recommendation health care personnel may use
  pulse palpation in their assessment but valuable
  time should not be wasted. If the patient shows
  no sign of life and a pulse cannot be palpated in
  10 seconds presume it to be absent!
• Brachial is recommended in the infant as carotid
  pulse is difficult to find and extension of the
  neck may compromise the airway
• Carotid pulse locate thyroid cartilage and feel
  to side, dont feel too high due to the risk of
  inadvertently massaging the carotid sinus,
  inducing bradycardia and hypotension

44
Pulse Check

• Check pulse for
• up to 10 seconds
• infants - brachial
• small or older child -carotid

45
Look for signs of life

• No signs of life
• unconscious
• unresponsive
• not moving
• not breathing normally
• No signs of life commence external cardiac
  compressions

46
Circulation

• Assess for pulse and signs of life
• If no pulse, inadequate pulse or no signs of life
  
• commence ECC

47
Circulation

• ECC is compression of the heart and major vessels
  between the sternum and vertebral column. This
  increases intrathoracic pressure causing a
  pressure gradient, resulting in blood flow
• Patient should be on a hard surface eg. cardiac
  board
• Rhythmic action, equal time for compression and
  relaxation
• Aim for a rate of 100 compressions per minute

48
CPR Ratio
The ratio describes the number of compressions in
relation to breaths, the rate is the number of
compressions/breaths given per minute.
CIRCULATION
INFANT
OLDER CHILD
SMALL CHILD
Hand Position

• Lower half of sternum

Depth of Compression
1/3 depth of chest
30 compressions 2 breaths 5 cycles / 2 min
Ratio and Rate 1 rescuer
Ratio and Rate 2 rescuers
15 2 5 cycles/min
30 2 5 cycles/2 min
49
CPR Infant

• Infant
• Locate the lower half of the sternum
• Two fingers one operator CPR
• Two thumbs / two fingers if two operators
• Ratio
• Lone health care provider/ lay rescuer
• 30 compressions 2 breaths (5 cycles per 2
  minute)
• Two health care providers
• 15 compressions 2 breaths (5 cycles per 1
  minute)
• Aim for a rate of 100 compressions per minute

50
CPR Infant
Finger/Thumb position lower 1/2 of the sternum
Compression depth 1/3 of the depth of the chest
51
CPR Ratio
CIRCULATION
INFANT
OLDER CHILD
SMALL CHILD
Hand Position

• Lower half of sternum

Depth of Compression
1/3 depth of chest
30 compressions 2 breaths 5 cycles / 2 min
Ratio and Rate 1 rescuer
Ratio and Rate 2 rescuers
15 2 5 cycles/min
30 2 5 cycles/2 min
52
CPR Small Child

• Child Up to 8 years
• Use the heel of one hand
• Locate lower half of sternum
• Ratio
• Lone health care provider/ lay rescuer
• 30 compressions 2 breaths (5 cycles per 2
  minute)
• Two health care providers
• 15 compressions 2 breaths (5 cycles per 1
  minute)
• Aim for a rate of 100 compressions per minute

53
CPR Ratio
CIRCULATION
INFANT
OLDER CHILD
SMALL CHILD
Hand Position

• Lower half of sternum

Depth of Compression
1/3 depth of chest
30 compressions 2 breaths 5 cycles / 2 min
Ratio and Rate 1 rescuer
Ratio and Rate 2 rescuers
15 2 5 cycles/min
30 2 5 cycles/2 min
54
CPR Older Child/Adult

• Older child/adult i.e.gt9years
• Use two hands
• Locate lower half of sternum
• Ratio
• Lone health care provider/ lay rescuer or two
  health care providers
• 30 compressions 2 breaths (5 cycles per 2
  minute)
• Aim for a rate of 100 compressions per minute
• Pressure is exerted through the heel of the hand,
  with arm/s straight, using body weight as the
  compression force

55
CPR(Small and older child)
1/3
CPR older child/ adult
CPR small child
Compression depth 1/3 of chest
56
CPR

• ARC recommend minimum interruptions of ECC and
  CPR should not be interrupted to check for signs
  of life
• Ineffective CPR
• too gentle
• too slow
• incorrect hand position
• too many interruptions

57
Basic Life Support Flowchart A last overview
before we move to something else
Check for DANGER
Check for RESPONSE
UNCONSCIOUS Alert assistance Clear airway Apply
head tilt and jaw support Check for breathing
CONSCIOUS Make comfortable Observe ABC
NOT BREATHING 2 rescue breaths Check for
pulse Look for signs of life
BREATHING Lateral position Observe ABC
INADEQUATE PULSE No signs of life Commence CPR
58
For PMH Staff Medical Emergency Team (MET)

• It is important to anticipate medical
  emergencies. The Medical Emergency Response Team
  at PMH has been put in place to deal with these
  situations
• If you have a child on the ward whose condition
  you are concerned about but do not need to call a
  code blue, LAN page 8165 request a MET review,
  ward you are on and extension number to ring back
  on. The ICU coordinator will call you back
  before coming the review the patient on the ward.
• Medical and Nursing staff from PICU will attend
  in lt 5minutes to review the patient.
• Note they will not bring the resus trolley or any
  drugs
• Any call made via switchboard will be treated as
  a Code Blue.

59
For PMH Staff Code Blue/Calling for help
Code Blue Medical Emergency

• By calling switchboard on extension 55 a code
  blue can be activated
• State type of emergency (Code Blue), location of
  the emergency (e.g.PMH, ward 6A, room 5) and your
  name.

60
For PMH Staff Code Blue

• Person 1
• Call for help and note time
• Check for danger
• Establish unresponsiveness
• Commence basic life support
• Once 2nd person available continue airway
  management, bag and mask ventilation 100 O2

61
For PMH Staff Code Blue

• Person 2
• Dial 55, state type and location of emergency
• Return to patient with Ward Resus Trolley
• Connect O2 and give Laerdal Bag and Mask to
• Person 1
• Remove head of bed and position for access
• Place cardiac board under patient
• Take over ECC (as appropriate)

62
For PMH Staff Code Blue

• Person 3
• Delegate someone to direct Code Blue team
• Commence drawing up resus drugs and IV
• Commence resus record documentation, once team
  has arrived continue as delegated scribe
• Delegate someone to look after child's parents,
  ensure privacy and clear room
• Delegate someone to collect patients notes

63
For PMH Staff Who attends a Code Blue

• Out of hours
• ICU registrar
• ICU Consultant on call
• ICU RN x 2
• (coordinator and runner)
• ED Registrar
• Hospital Coordinator
• Anaesthetic Registrar
• Medical Registrar/ Night Resident
• Orderly

• In hours
• ICU registrar
• ICU consultant
• ICU RN x 2
• (coordinator and runner)
• ED Registrar
• Hospital Coordinator
• Chief orderly

64
And finally...

• The more advanced resuscitation techniques...

65
Oropharyngeal AirwaysUse to keep the airway
open in an unconscious patient and to facilitate
bag and mask ventilation

• Use with caution
• If airway is able to be maintained with head
  positioning and jaw support dont use an
  oropharyngeal airway
• Use of oropharyngeal airways
• size is imperative measure from centre of
  teeth/mouth to angle of the jaw layed across the
  face
• In the infant and small child insert the concave
  side over the tongue under direct vision. This
  avoids damage to the palate

66
Oropharyngeal Airways

• Potential problems
• Trauma
• Obstruction
• Illicit a gag reflex causing aspiration
• Laryngospasm
• Vagal response

67
IntubationSome children may need a definitive
airway this slide shows the equipment needed

• ETT correct size and ½ size smaller (age/4) 4
• Laryngoscope and blade
• Introducer
• McGills forceps
• Suction Yankauer and suction
  catheters
• Nasogastric tube

68
Intubation

• The following points are important in relation to
  endotracheal intubation
• Pre-oxygenation with 100 oxygen is essential
• ETT size chart on side of resus trolley
• Generally un-cuffed ETT is used lt 8years of age
  as the narrowest portion of the airway is at the
  level of the cricoid creating a physiological
  cuff
• Be familiar with equipment
• Assisting with Intubation
• Intubation is a left handed procedure, therefore
  position yourself on the right on the person
  performing the intubation
• Pass equipment as requested ready to be inserted
  directly into patients mouth

69
Intubation

• Cricoid pressure
• Place two fingers on the level of the cricoid
  cartilage and apply pressure (gently!)
• Closes the oesophagus and straightens trachea
• Dont release pressure until instructed or if the
  patient actively vomits

70
Vascular Access

• Peripheral IV access may be difficult in the
  shutdown patient
• Intraosseous access consider if no venous
  access achieved within 1.5 minutes of
  resuscitation
• easy, quick and can be used for all fluids and
  drugs
• CVC (central venous catheter)
• difficult and time consuming, more appropriate in
  a controlled situation once the patient is
  stabilised

71
Vascular Access

• Intraosseous
• sites proximal tibia, distal femur and anterior
  iliac spine
• tibia preferred
• ensure firm surface
• insert perpendicular to bone using a firm
  twisting action
• stop immediately when loss of resistance is felt
• aspirate bone marrow can be used for blood
  tests (absence of aspirate does not necessarily
  mean unsuccessful positioning of I/O)
• change to peripheral line or CVC once stabilised

72
Fluids

• When?
• Should be given when perfusion is compromised
• How much?
• Guided by the clinical response
• 20ml/Kg is the amount of one fluid bolus
• Which?
• Crystalloid or colloid
• Normal saline in most cases is first choice
• Consider blood if more than half of the
  circulating volume has been replaced

73
Fluids

• Fluid boluses
• Circulating volume is around 80ml/Kg
• Children usually compensate well until they lose
  at least 25 of their circulating volume due to
  blood loss, re-distribution etc.
• Therefore
  25 of 80ml/Kg
  20ml/Kg
  
  
  the
  amount of one fluid bolus

74
Drugs

• Adrenaline 110 000 (0.1ml/kg)
• increases heart rate
• improves myocardial contractility and systemic
  vascular resistance thus increasing BP
• Sodium Bicarbonate (1mmol/kg)
• corrects acidosis
• Calcium Gluconate (20mg/kg)
• used to correct electrolyte imbalances
  hypocalcaemia
• not as irritating to small veins as Calcium
  Chloride
• Normal Saline
• necessary to flush line between administration of
  
• drugs

75
Phillips Biphasic Defibrillator

• Features
• Monitoring
• HR
• RR
• BP
• SaO2
• ETCO2
• Biphasic defibrillation
• External Cardiac Pacing

76
Phillips Biphasic Defibrillator

• Features
• Monitoring
• HR
• RR
• BP
• SaO2
• ETCO2
• Biphasic defibrillation
• External Cardiac Pacing

77
Phillips Biphasic Defibrillator

• Features
• Monitoring
• HR
• RR
• BP
• SaO2
• ETCO2
• Biphasic defibrillation
• External Cardiac Pacing

78
Phillips Biphasic Defibrillator

• Features
• Monitoring
• HR
• RR
• BP
• SaO2
• ETCO2
• Biphasic defibrillation
• External Cardiac Pacing

79
Phillips Biphasic Defibrillator

• Features
• Monitoring
• HR
• RR
• BP
• SaO2
• ETCO2
• Biphasic defibrillation
• External Cardiac Pacing

80
Phillips Biphasic Defibrillator

• Features
• Monitoring
• HR
• RR
• BP
• SaO2
• ETCO2
• Biphasic defibrillation
• External Cardiac Pacing

81
Defibrillation

• Important issues
• Rarely used in paediatrics
• Performed by medical staff at PMH
• Safety is paramount
• Correct paddle/ pad placement
• Select unsynchronised
• Energy selection First
  shock 2j/kg then subsequent shocks4j/kg

82
Defibrillation
Safety is paramount!

• Fibrillation is uncommon, children generally
  arrest into asystole
• Used in Pulseless VT and VF
• For an unwitnessed arrest first shock 2j/kg
  followed by 2 minutes of CPR, subsequent shocks
  4j/kg.
• For witnessed monitored arrest (change seen on a
  ECG monitor) give up to 3 stacked shocks (2,4,4
  J/Kg) at first defibrillation attempt, if further
  shocks are needed these should be single shocks
  4J/kg.

83
Defibrillation

• Safety aspects
• correct pad/paddle placement
• ensure good contact
• dry skin
• dry floor
• shout all clear and ensure all rescuers are
  clear
• do not wave paddles in air
• do not discharge paddles in air

84
Can you identify 10 Things wrong with this resus?
85

• Incorrect size bag mask

86

• Incorrect size bag mask
• Incorrect mask bag technique

87

• Incorrect size bag mask
• Incorrect mask bag technique
• No cardiac board

88

• Incorrect size bag mask
• Incorrect mask bag technique
• No cardiac board
• Chair in way

89

• Incorrect size bag mask
• Incorrect mask bag technique
• No cardiac board
• Chair in way
• Monitor not on or connected

90

• Incorrect size bag mask
• Incorrect mask bag technique
• No cardiac board
• Chair in way
• Monitor not on or connected
• Incorrect pad placement

91

• Incorrect size bag mask
• Incorrect mask bag technique
• No cardiac board
• Chair in way
• Monitor not on or connected
• Incorrect pad placement
• Incorrect hand placement

92

• Incorrect size bag mask
• Incorrect mask bag technique
• No cardiac board
• Chair in way
• Monitor not on or connected
• Incorrect pad placement
• Incorrect hand placement
• No scribe

93

• Incorrect size bag mask
• Incorrect mask bag technique
• No cardiac board
• Chair in way
• Monitor not on or connected
• Incorrect pad placement
• Incorrect hand placement
• No scribe
• No drugs prepared

?
94

• Incorrect size bag mask
• Incorrect mask bag technique
• No cardiac board
• Chair in way
• Monitor not on or connected
• Incorrect pad placement
• Incorrect hand placement
• No scribe
• No drugs prepared
• No oxygen tubing

95
The End

• If you feel you would like to go over certain
  aspects of this program again, click on the links
  below. Press the Esc button on the keyboard at
  any time to leave the presentation
• Pathways leading to cardiac arrest
• Basic life support
• Foreign body
• The list continues on the following page

96

• If you feel you would like to go over certain
  aspects of this program again, click on the link
  below. Press the escape button on the keyboard at
  any time to leave the presentation.
• CPR
• Intubation and advanced life support

97
Evaluation Form
Well done! You have completed the tutorial. We
recommend you now practice on a resuscitation
manikin to achieve competence in these skills. We
value your questions and comments. Please click
on the relevant link to email either Melanie
Cairns or Tracey Maron, Resuscitation Training
Coordinators, PMH or Pam Nicol, Clinical
Educator, School of Paediatrics and Child Health,
UWA
To help us develop this and other tutorials
please complete the Evaluation Form
98

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