How long should you spend checking for a pulse and normal breathing during pediatric CPR?

Performing CPR on a child in cardiac arrest can be a stressful situation. Knowing what to do and being able to act quickly could mean the difference between life and death. One important question many caregivers have is: how long should I spend checking for a pulse and normal breathing before beginning CPR compressions? In this article, we’ll discuss the American Heart Association’s guidelines for checking a pediatric patient’s pulse and breathing during a cardiac emergency and why it’s so important to act fast.

Check for no more than 10 seconds

The updated 2020 American Heart Association pediatric CPR guidelines recommend spending no more than 10 seconds checking for signs of circulation, such as a pulse and normal breathing in a child during a cardiac emergency. Checking any longer than 10 seconds delays the initiation of life-saving CPR compressions.

Some key things to remember when checking a pediatric patient’s pulse and breathing:

• Feel for a carotid or brachial pulse. Place your first two fingers on the child’s carotid artery or brachial pulse in the arm.
• Check only for up to 10 seconds max before starting CPR if no pulse is detected.
• Open the child’s airway and glance for chest rise/fall. Listen for breath sounds at the child’s mouth and nose, but check for only up to 10 seconds before starting CPR if no normal breathing is seen.
• You don’t need sophisticated medical equipment to check – use simple observation.

The goal is to minimize delays so high-quality compressions can be delivered as soon as possible to circulate oxygenated blood to the child’s brain and vital organs. Prompt CPR initiation is critical for cardiac arrest survival in pediatrics.

FAQ: Why check so quickly during pediatric cardiac arrest?

You may be wondering – why the urgency to check pulses and breathing for only 10 seconds maximum during a pediatric cardiac emergency? There are a few key reasons:

Brain damage can start as soon as 4-6 minutes without oxygen. A child’s brain is much more sensitive to a lack of oxygen than an adult’s. Irreversible brain damage and death can occur if oxygen deprivation lasts too long.

Every second counts. Delivering high-quality chest compressions gets oxygenated blood flowing to the brain and tissues again as fast as possible. Even a brief pause in compressions hurts survival odds.

It’s hard to tell if there’s a pulse. In stressful situations, it can be difficult for lay rescuers to accurately feel a weak pulse in a child [4]. Starting compressions is favored over delaying.

Focus should be on high-quality CPR. Spending excessive time on checks means fewer compressions are delivered. The guidelines emphasize the importance of good chest compressions over other interventions.

In summary, with pediatric cardiac arrest the mantra is “look and go” – check pulses and breathing very briefly before focusing efforts on delivering the most effective CPR possible as quickly as possible. Time lost is brain lost, so don’t delay compressions.

Maintaining compression quality

Once CPR has been initiated on a pediatric patient, keeping compressions consistent and of high quality is vital. Some tips for maintaining compression quality include:

• Chest depth: Compress at least one-third the depth of the chest, or about 2 inches (5 cm) for infants and 1 1⁄2  to 2 inches (4 to 5 cm) for children.
• Rate: Compress the chest at a rate of 100 to 120 compressions per minute for all pediatric patients. Use a metronome app if available.
• Allow full recoil: Release all pressure on the chest in between compressions to allow return to the normal position.
• Minimize interruptions: Limit interruptions of chest compressions to less than 5-10 seconds for things like changing rescuers or applying an AED.
• Use two hands: To achieve proper depth and maintain quality, use two hands on the lower half of the breastbone for all pediatric CPR.

High-quality compressions are critical because they provide blood flow and circulation, even in the brief windows between interruptions. Proper technique is key to maximizing the brief moments oxygenated blood is circulating until ROSC or more advanced life support arrives.

FAQ: Checking airway and breathing during pediatric CPR

In addition to a pulse check, rescuers are also directed to briefly check for normal breathing during the initial 10 seconds of a pediatric cardiac emergency assessment. What specifically should you look for?

• Open the airway: Gently tilt the head back and lift the chin to open the airway.
• Look, listen, feel: Look down at the child’s chest to see if it rises on inspiration. Listen to the child’s mouth and nose for breath sounds. Feel for airflow by placing your cheek near the child’s mouth.
• Assess for no more than 10 seconds: Checking these signs of breathing should take no more than 10 seconds before initiating CPR if you find no normal breathing effort.

Absence of breathing qualifies the need to start rescue breaths as part of CPR. Some children may be taking erratic, gasping or noisy breaths that are not effective enough to support circulation. In these cases, high-quality CPR including rescue breathing is still needed. Don’t delay starting compressions based on abnormal or marginal breathing efforts. Act promptly based on the guidelines.

Special considerations: Infants less than 1 year old

For infants less than 1 year old, there are a couple special considerations when checking pulses and breathing during pediatric CPR:

• Feel for brachial pulse only: Due to the infant’s size, feel for a pulse in only one brachial artery at the inner aspect of the upper arm.
• Use two fingers: Use only two fingers to feel for the brachial pulse, overlapping the fingers.
• Check rate: Check for only 10 seconds max before starting compressions if no brachial pulse is felt.
• One-hand technique: Use a modified one-hand technique to compress the lower third of the breastbone during infant CPR. Two thumbs are preferred over two fingers for compressions.
• Special airway considerations: Take extra care when opening an infant’s airway, and use caution giving rescue breaths due to their small lung volumes and mouth size.

Remember that for infants, the emphasis is the same – minimize any pulse and breathing checks to 10 seconds or less before starting CPR and high-quality compressions if needed based on assessment findings.

Responding to a pediatric cardiac emergency

Here is a quick outline of the key steps to follow when responding to a pediatric cardiac emergency such as suspected cardiac arrest:

1. Check for responsiveness by gently tapping and shouting.
2. Call for help and have someone activate 911 as soon as possible.
3. Check breathing normally and pulse for no more than 10 seconds.
4. If there is no normal breathing or pulse, start chest compressions immediately.
5. Compress at a rate of 100-120/minute to a depth of 2 inches (5 cm) for infants or 11⁄2-2 inches (4-5 cm) for children.
6. Minimize interruptions and limit pulse/breathing checks to 5-10 seconds when changing rescuers.
7. Continue high-quality CPR until an AED arrives or advanced life support takes over care.
8. Follow all AED/ALS prompts and instructions while continuing CPR.

Following these steps will give the child the best chance of survival from sudden cardiac arrest. Prompt action based on the pediatric CPR guidelines could mean the difference in life or death.

Conclusion

Checking a child’s pulse and breathing for signs of circulation is an important initial step during any suspected cardiac emergency. However, the updated 2020 pediatric CPR guidelines emphasize minimizing these assessments to 10 seconds or less before starting chest compressions and CPR, if needed. Every second counts when it comes to oxygen delivery to the pediatric brain. By acting quickly based on the mantra “look and go,” lay rescuers and medical providers can optimize survival outcomes from cardiac arrest in children through prompt initiation of high-quality CPR. Don’t delay – start chest compressions immediately if no signs of a pulse or normal breathing are detected within 10 seconds.

This information is based on the 2020 American Heart Association pediatric CPR guidelines. Always seek professional medical training for proper CPR certification.