A Systematic Approach
It is difficult to find the cause of illness when you encounter an unresponsive child or infant. You will need to act quickly and decisively in applying solutions to fit the present needs of the patient. In order to achieve this, PALS was designed so that rescuers could employ a comprehensive rescuing framework.
A child or infant can be unresponsive for various reasons, and no matter what, it is always important to keep the blood pumping through the vasculature (perfusion) while making sure that enough oxygen is being supplied to the lungs (oxygenation). When the patient is experiencing either poor perfusion and/or oxygenation, CPR becomes the best alternative in sustaining the heart and the lungs. If the perfusion and oxygenation have been stabilized and the patient remains unresponsive, initial assessment and treatment may be done without CPR.
Figure 6
Normal breathing and agonal breathing should be differentiated from each other. Gasping or agonal breathing cannot be considered as normal breathing.
Likewise, not all pulses can be considered adequate. Sixty beats per minute are required to maintain adequate perfusion in a child or an infant.
The diagnosis must be carried out urgently. There is a low threshold for providing ventilation and/or compressions if there is evidence that the child or infant cannot sustain these on their own.
If the problem appears to come from respiratory complications (e.g., ineffective breathing with normal pulses), then rescue breathing should be started immediately. If breathing is ineffective and pulses are inadequate, perform high-quality CPR as soon as possible. It is crucial to acknowledge that any case can change at any time, so the rescuer must be prepared to change approaches whenever necessary. Perform CPR to support breathing and circulation until the problem has been clearly determined and treated.