Fractures are quite rare in children because of the flexibility of the chest wall. A sudden significant rise in end-tidal carbon dioxide level, usually to a value greater than 30 mm Hg, or a palpable pulse during pause in compressions, indicates restoration of spontaneous circulation.Д¬ostochondral separation and fractured ribs often cannot be avoided because it is important to compress the chest enough to produce sufficient blood flow. While there is limited evidence supporting specific numbers in physiologic monitoring, it is generally accepted that an end-tidal carbon dioxide level of 10 to 20 mm Hg is associated with adequate CPR. Quantitative end-tidal carbon dioxide monitoring may provide a better estimate of cardiac output during chest compressions patients with inadequate perfusion have little venous return to the lungs and hence a low end-tidal carbon dioxide (as do those with hyperventilation). However, palpation of pulses during chest compression is difficult, even for experienced clinicians, and often unreliable.

Ideally, external cardiac compression produces a palpable pulse with each compression, although cardiac output is only 20 to 30% of normal. The recommended chest compression depth for adults is about 5 to 6 cm. read more, laryngeal mask airway Laryngeal Mask Airways (LMA) If no spontaneous respiration occurs after airway opening and no respiratory devices are available, rescue breathing (mouth-to-mask or mouth-to-barrier device) is started mouth-to-mouth ventilation. Unless highly experienced rescuers are available, endotracheal intubation may be delayed in favor of ventilation with a bag-valve-mask Bag-Valve-Mask Devices If no spontaneous respiration occurs after airway opening and no respiratory devices are available, rescue breathing (mouth-to-mask or mouth-to-barrier device) is started mouth-to-mouth ventilation. However, chest compression and defibrillation take precedence over endotracheal intubation. A breath is given every 6 seconds (10 breaths/minute) without interrupting chest compression in adults infants and children are given breaths every 2 to 3 seconds (20 to 30 breaths/minute). When qualified rescuers are present, an advanced airway (endotracheal tube or supraglottic airway) is placed without interruption of chest compressions after initial CPR and defibrillation attempts, as described under Airway Establishment and Control Airway Establishment and Control Airway management consists of Clearing the upper airway Maintaining an open air passage with a mechanical device Sometimes assisting respirations (See also Overview of Respiratory Arrest.) read more. If the initial rhythm is pulseless electrical activity or asystole, an initial dose of epinephrine 1 mg IV/IO (intravenous/intraosseous) should be administered as soon as possible after recognition of cardiac arrest. If the cardiac arrest is witnessed and a defibrillator is on the scene, a person in VF or VT should be immediately defibrillated, with compressions immediately resumed after shock is delivered early defibrillation may promptly convert VF or pulseless VT to a perfusing rhythm. read more (VT) is given an unsynchronized shock (see also Defibrillation Defibrillation Cardiopulmonary resuscitation (CPR) is an organized, sequential response to cardiac arrest, including Recognition of absent breathing and circulation Basic life support with chest compressions. Symptoms depend on duration and vary from none to palpitations to hemodynamic collapse and death. read more (VF) or pulseless ventricular tachycardia Ventricular Tachycardia (VT) Ventricular tachycardia is в‰Ґ 3 consecutive ventricular beats at a rate в‰Ґ 120 beats/minute. It causes immediate syncope and death within minutes.

When a defibrillator (manual or automated) becomes available, a person in ventricular fibrillation Ventricular Fibrillation (VF) Ventricular fibrillation causes uncoordinated quivering of the ventricle with no useful contractions.

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