Frequently asked questions (FAQs)

The rapid bedside evaluation of blood glucose as part of the ABCDE assessment is designed to identify hypoglycaemia as a cause of disordered conscious level, as early as possible in the clinical assessment of a patient. Whilst finger prick capillary blood samples and point of care ("bedside") blood glucose meter/strip readings can be inaccurate in certain clinical situations, waiting for the results of a venous or arterial blood sample takes time. If the patient is hypoglycaemic, this delay risks short and long-term neurological damage. The benefits of a rapid bedside diagnosis and early treatment of hypoglycaemia, even if some inaccuracies in measurement are present, generally outweigh the dangers presented by these inaccuracies. Therefore do not delay the treatment of ‘suspected’ hypoglycaemia whilst awaiting a formal laboratory venous or arterial blood sample result.

All staff using blood glucose test strips and/or meters must understand how to perform the test accurately and must also be aware of the many potential sources of error.

Conditions where there may be inaccuracies with point of care testing with blood glucose meters include hypotension, shock, and severe dehydration. The Medicines and Healthcare Products Regulatory Agency (MHRA) provides detailed advice in Point of Care Testing and Blood Glucose Meters (2011).

February 2013

There has been no change in who should deliver the full paediatric BLS sequence with Guidelines 2015. The full paediatric BLS sequence of 15:2 is still aimed at healthcare professionals with a duty to respond to paediatric emergencies (e.g. Emergency Department staff, paediatric doctors and nurses, paramedics). These people usually work in teams of two or more rescuers.

Lay people should be taught the adult BLS sequence of 30 compressions : 2 ventilations.

Cardiorespiratory arrest occurs less frequently in children and many children do not receive resuscitation because potential rescuers fear causing harm. This fear is unfounded; it is far better to use the adult BLS sequence for resuscitation of a child than to do nothing. Guidelines 2015 reiterate this approach and promote the delivery of BLS by the general public and the use of the same sequence on children who are not responsive and not breathing normally. 

Lay people with responsibility for the care of children (e.g. teachers, lifeguards) should be taught the adult BLS sequence of 30:2 with the following modification that makes it more suitable for use on children:

• Give 5 initial breaths before starting chest compression.
• If on your own, perform CPR for approximately 1 minute before going for help.
• Compress the chest by one-third of its depth, approximately 4 cm for an infant and approximately 5 cm for an older child. Use two fingers for an infant under 1 year; use one or two hands for a child over 1 year to achieve an adequate depth of compression.

There are other potential rescuers such as dentists, general practitioners, health visitors, and school nurses who are healthcare professionals working with children, but they often work alone. Although they may have to resuscitate a child, this would be a very unusual event and they are more likely to have to resuscitate a parent or grandparent. It would be sufficient to teach these groups the adult sequence of 30:2 with the paediatric modifiers unless they expressed a particular wish or interest to learn the full paediatric sequence.

October 2015

The full paediatric BLS sequence is for healthcare professionals with a duty to respond to paediatric emergencies (e.g. Emergency Department staff, paediatric doctors and nurses, paramedics).These people usually work in teams of two or more rescuers.

Lay people with responsibility for the care of children (e.g. teachers, lifeguards) should be taught the adult sequence with the paediatric modifiers (see note below). It is recognised, however, that there are other potential rescuers that fall between these two groups, where it is unclear which sequence is the more appropriate.  The decision as to what should be taught may be made locally (e.g. by the Resuscitation Committee) according to circumstances and available resources. In coming to a decision, it may be helpful to ask the following questions:

1. Are the providers healthcare professionals?  
2. Would they normally be expected to have to resuscitate an infant or child during the course of their work?
3. Do they usually work in a team?

Generally, the full paediatric sequence and compression: ventilation ratio of 15:2 should be taught to those who give a positive answer to all three questions.

General practitioners, health visitors, and school nurses, for example, are healthcare professionals working with children, but they often work alone.  Although they may have to resuscitate a child, this would be a very unusual event and they are more likely to have to resuscitate a parent or grandparent. It would be sufficient to teach these groups the adult sequence of 30:2 with the paediatric modifiers unless they expressed a particular wish or interest to learn the full paediatric sequence.

Mental Health nurses working in child mental health units are healthcare professionals working in teams of two or more.  Although it would be unusual in most such units to have to resuscitate a child, some may treat high-risk children (such as those with severe anorexia nervosa) so it would be reasonable to allow training decisions to be based on local circumstances.

Note
Modifications to the adult BLS sequence of 30 compressions: 2 ventilations that will make it more suitable for use on children:

• Give 5 initial breaths before starting chest compression.
• If on your own, perform CPR for approximately 1 minute before going for help.
• Compress the chest by one-third of its depth, approximately 4 cm for an infant and approximately 5 cm for an older child. Use two fingers for an infant under 1 year; use one or two hands for a child over 1 year to achieve an adequate depth of compression.

October 2015

Yes, the EPALS course uses the simple acronym W E T Fl A G for children over the age of 1 year and up to 10 years old. This equates to:

W     Weight                           (Age + 4)  x  2  (kg)
E      Energy/electricity         4 x weight (kg) = Joules
T      Tube (endotracheal)    Age/4 plus 4 = ID mm (uncuffed tubes)
Fl     Fluids (bolus)                20  x weight (kg) = mL of isotonic fluid (caution in some cases)
A     Adrenaline                      10 mcg kG-1 1:10000 solution = 0.1 mL kg^-1
G     Glucose                           2 mL kg^-1 (10% Dextrose)
 
Example
For a 2 year old child:
W  =  (2 + 4) x 2 = 12 kg
E   =  12 x 4 = 48 J
T   =  2/4 +4 = 4.5 mm ID tracheal tube uncuffed
Fl  =  20 mL x 12 kg = 240 mL 0.9% saline
A   =  10 micrograms x 12 kg = 120 micrograms 1:10,000 = 1.2 mL
G   =  2mL x 12 kg = 24 mL 10% Dextrose

Whilst this is not evidence based, it provides a simple, easy to remember framework in a stressful situation reducing the risk or error.

June 2016

Read the RC (UK)'s updated statement on the Use of airway clearance devices (ACD).