Infant STEP 1 ASSESS UnRESPOnSIvEnESS · Chest compressions in an infant consist of serial, rhythmic applications of pressure over the lower half of the sternum (breastbone). ...

CARDIO-PULMONARYRESUSCITATION(CPR)

Infant

Module 7 InFAnT CARDIO-PULMOnARY RESUSCITATIOn (CPR)

7.1 InTRODUCTIOn

Aninfantisachildwhoisupto1yearold.Infantsrarelycollapsebecauseofaprimary

heartproblem.Cardiacarrestisusuallysecondarytootherevents,suchasmajortrauma

orrespiratoryproblems.Therefore,rescuersmustdetectandpromptlytreatearlysigns

ofrespiratoryfailuretopreventcardiacarrest.

STEP 1 ASSESS UnRESPOnSIvEnESS

• Quicklyassessanddeterminewhethertheinfantisresponsivebytappinggentlyon

theinfant’sshoulders.

• Avoidviolentshakingandunnecessarymovementsoftheinfant’sheadandneckas

thismightresultininjury.

• Iftheinfantdoesnotrespond,he/sheis

likelytobeunconscious.

• Possiblecausesofunconsciousnessmaybe:

– anairwaythatisobstructed(blocked)

byfood,secretionsoratonguethathas

fallenbackwards.

– breathingthathasstopped.

– aheartthathasstoppedbeating.

BC

LSP

rog

ram

me

3130

BC

LSP

rog

ram

me

STEP 2 ACTIvATE EMERGEnCY MEDICAL SERvICE (EMS)

Whentheinfantdoesnotrespond:

• Ifyou arealone, immediatelycommenceCPR30:2forapproximately2minutes

beforecalling995foranambulance.

• Ifasecond rescuer is present,askhim/hertoactivatetheEMSsystembydiallingthe

ambulancenumber995.

WhencallingEMS995,state:• Locationofinfant.• Thetelephonenumberyouare

callingfrom.• Whathappened• Numberofvictims.• Immediateambulancerequired.• Hanguponlyafterinstructedtodo

sobythedispatcher.

STEP 3 POSITIOn ThE InFAnT

• ForCPRtobeeffective,theinfant

mustlieonafirmflatsurface,theleg

straightenedandthearmsplaced

alongsidethebody.

STEP 4 OPEn ThE AIRWAY

Performaheadtilt-chinliftmanoeuvretoopentheairway.Inanunconsciousinfant,

muscletoneisimpairedresultinginthetonguefallingbackandobstructingtheairway.

Asthetongueisattachedtothelowerjaw,movingthelowerjawforwardwillliftthe

tongueawayfrombackofthethroatandopentheairway.

Perform a head tilt-chin lift manoeuvre :

• Placeonehandontheinfant’sforeheadand

applyfirmbackwardpressure

withyourpalmtotiltthe

headback.

• Placethefingersof

yourotherhandunder

thebonypartofthe

lowerjawtoliftthejaw

forward.

Check the airway :

• Opentheinfant’smouthgentlyand

checkforanyvisibleforeignbodies.

• Useahookedlittlefingerand

removeanyobviousobstructing

foreignbodies.

Caution

• Donotpressdeeplyintothesofttissuesunderthechinoroverextendtheinfant’sneck

becausethismayblocktheairway.

• Donotperformblindfingersweepasthismaypushobjectsbackintothethroatorfurther

intotheairway.

• Performagentlechinliftifheadorneckinjuryissuspected.

32

BC

LSP

rog

ram

me

BC

LSP

rog

ram

me

33

STEP 5 ChECK FOR BREAThInG

• Placeyourearandcheek

overtheinfant’smouthand

noseandassessfor

breathing(upto10seconds):

– Lookfortheriseandfallof

thechest.

– Listenforairescaping

duringexhalation.

– Feelfortheflowofairfrom

theinfant’smouthand

nosemovingpastyour

cheeks.

STEP 6 MOUTh TO MOUTh & nOSE BREAThInG

Ifthereisnospontaneous

breathing,performmouth to

mouth & nose breathing.

• Maintainaheadtilt-chinlift.

• Sealyourmouthoverthe

infant’smouthandnoseand

give2shortbreathsinquick

successiononeafterthe

other.

• Eachrescuebreathshould

makethechestrise.

• Thedurationforeachbreath

is1second.

• Ventilationvolumeisapproximately30mlperbreath.

• Allowexhalationbetweenbreaths.

STEP 7 ASSESS FOR PULSE / SIGnS OF CIRCULATIOn

• Maintainheadtiltandlocate

thebrachialpulse(whichis

ontheinneraspectofthe

upperarm)withtheindex

andmiddlefingers.

• Applygentlepressureand

feelforthebrachialpulse

for10secondsandlook

for‘signsofcirculation’

(consciousness,movement,

breathingorcoughing).

• Iftheinfanthasnopulse(if

unsureofpulseandinfant

hasno‘signsofcirculation’),startchestcompressions.

STEP 8 LOCATE LAnDMARK FOR ChEST COMPRESSIOn

Chestcompressionsinaninfantconsistofserial,rhythmicapplicationsofpressureover

thelowerhalfofthesternum(breastbone).Tolocatethecorrectlandmarkforchest

compression:

• Maintainheadtiltwithonehand.

• Drawanimaginarylinebetweenthe

infant’snipplesusingyourindexfinger

oftheotherhand.

• Placetheindexfingeron the imaginary

line.

34

BC

LSP

rog

ram

me

BC

LSP

rog

ram

me

35

• Placeyourmiddleandring

fingersnexttotheindexfinger.

• Movethe3fingerstothe

centreofthesternum

(breastbone)

• Positionthefingersupright.

• Liftofftheindexfingerbut

maintainthemiddleandring

fingerscontactonthesternum

(breastbone).

STEP 9 PERFORM ChEST COMPRESSIOn

• Leanforwardandplaceyour

cheekneartheinfant’smouth

andnose.

• Useyourmiddleandring

fingerstocompressthesternum

(breastbone)2cm.

• Countyourcompressions:

1and2and3and4and5and

1and2and3and4and10and

1and2and3and4and15 and

1and2and3and4and20and

1and2and3and4and25and

1and2and3and4and30.

• Performchestcompressionsatarateof100perminute.

• Theratioofcompressionsandventilationsis30compressions:2breaths.

• Perform5cyclesof30compressionsand2breathsforapproximately2minutes.

Note :

Tofacilitateventilationwithoutdelaystore-positionthehead,useonehandtomaintain

theheadtiltpositionwhileperformingchestcompressions.

36

BC

LSP

rog

ram

me

BC

LSP

rog

ram

me

37

DOnT’s

DO’s

• Maintainyour2fingersonthesternum(breastbone)duringeach

upstroke.

• Releasethepressureonthechestaftereachcompressiontoallow

bloodtoflowintothechestandheart.

• Compressatrateof100perminute.

• Donotliftthefingersfromthesternum(breastbone),otherwise

correctfingerpositionmaybelost.

• Donotbounceorjerkduringcompressionsasthesemovementsmay

causeinjuries.

GUIDELInES FOR PROPER COMPRESSIOn Module 8 InFAnT RECOvERY POSITIOn

8.1 InTRODUCTIOn

Therecoverypositionisusedinthemanagementofinfantswhoareunresponsive

butarebreathingandhavesignsofcirculation.Whenanunresponsiveinfantislying

supine,theairwaymaybecomeobstructedbythetongueormucusandvomit.These

problemsmaybepreventedwhentheinfantisplacedintherecoveryposition,because

fluidcandraineasilyfromthemouth.

Therecoverypositionforaninfantdiffersfromtheadultposition.Theinfantisput

onthelateral(side)positionwhenpulseandbreathinghaveresumed.

Thispositionkeepstheairwayopen.Thefollowingstepsarerecommended:

STEP 1 POSITIOn ThE InFAnT

STEP 10 RE-ASSESSMEnT

• Assesstheinfantforpulse,

’signsofcirculation’and

breathingafterevery5cycles

ofCPR30:2

• Ifpulseisabsent(ifunsureof

pulseandinfanthasno‘signs

ofcirculation’,assumecardiac

arrest),continueCPR30:2.

• Ifpulseispresent,checkinfant

forbreathing.

• Ifbreathingisabsent,perform

rescuebreathingatarateof

20breathsperminute(one

breathevery3seconds)bycounting ‘2-a-thousand, 3-a-thousand aftereachbreath.

Repeatthesequenceuntilyouhavecompletedatotalof20breaths.

• Ifboththepulseandbreathingarepresent,positiontheinfantintherecovery

position.

• Continuetomonitortheinfant’spulse,‘signsofcirculation’andbreathingeveryfew

minutesasthesecanstopsuddenly.

• Placetheinfant’sarmsalongsidethebody.

• Straightentheinfant’slegs.

38

BC

LSP

rog

ram

me

BC

LSP

rog

ram

me

39

STEP 3 FInAL RECOvERY POSITIOn

• Supporttheinfant’sback

withasoftpillow/cushion

• Ensurethattheinfant’shead

isnotoverextendedor

flexed.

• Staywiththeinfantand

continuetomonitorthe

pulse,‘signsofcirculation’

andbreathingeveryfew

minutesasthesecanstop

suddenly.

Module 9 InFAnT FOREIGn BODY AIRWAY OBSTRUCTIOn (FBAO)

9.1 InTRODUCTIOn

Airwayobstruction(choking)isacommoncauseofinfantdeathanddisability.

Completeairwayobstructionindicatesthatthebreathingpassagesaretotallyblocked.

Theinfantisunabletospeak(makenoises),breatheorcough.Chokingininfantsis

commonestduringeatingorplayingwithsmallobjects.

Inawitnessedchokingevent,thechanceofsurvivalincreasesiftherescuerisable

tointervenewhentheinfantisstillconscious.Theobstructedairwaycanbecleared

usingacombinationofbackblowsandchestthrusts.

COMMOn CAUSES OF FBAO

Airwayobstructioncanresultfromeitherintrinsic,orextrinsiccauses.

InTRInSIC CAUSES

• Thetonguefallingbackwardintothepharynxinanunconsciousinfant.

• Bloodfromheadandfacialinjuriestricklingintotheairway.

• Regurgitatedstomachcontentsgoingintotheairway.

EXTRInSIC CAUSES

• Foreignbodiese.g.food,smallobjectsortoysetc.

RECOGnITIOn OF FBAO

Incompleteairwayobstruction,theinfantmayexhibitthefollowingsigns:

• Suddenonsetofrespiratory/breathingdistress.

• Cyanosis(bluelips,nailorskin)

• Unabletospeak(makenoises).

• Unabletobreathe.

• Unabletocough.

STEP 2 ROLL ThE ChILD TOWARDS ThE RESCUER

• Supporttheinfant’shead

andneckwithonehand.

• Placetheotherhandonthe

infant’ship.

• Gentlyrollorturntheinfant

onthesidetowardthe

rescuer.

40

BC

LSP

rog

ram

me

BC

LSP

rog

ram

me

41

9.2 RELIEF OF FBAO In ThE CONSCIOUS InFAnT

STEP 1 ASSESSMEnT

• Assessforsignsofcompleteairwayobstructione.g.unabletospeak(makenoises),

breatheorcough.

• Ifinfantischoking,attempttorelievetheairwayobstructionimmediately.

STEP 2 SUPPORT ThE InFAnT

• Supportingtheinfant’sheadand

bodybetweenyourhandsand

forearmsusingthe‘Sandwich

Manoeuvre’.

• Holdtheinfant’sfacedownandrestyourforearm

onyourthigh.

• Keeptheheadlowerthanthetrunk.

STEP 3 BACK BLOWS AnD ChEST ThRUSTS

• Deliver5backblowsforcefullybetweenthe

shoulderbladeswiththeheelofyourotherhand.

• Supporttheinfant’sheadandbodybetween

yourhandsandforearmsusingthe‘Sandwich

Manoeuvre’afterdeliveringthe5 back blows.

• Turntheinfantoveronhis/herback,restingon

yourthigh.

• Keeptheinfant’sheadlowerthanthetrunk.

42

BC

LSP

rog

ram

me

BC

LSP

rog

ram

me

43

Note :

Eachbackblowandchestthrustshouldbedeliveredwithsufficientforceandwiththe

intentionofexpellingtheforeignbody.

STEP 4 RE-ASSESSMEnT

• Checkifforeignbodyisexpelledaftereverysetof5backblowsand5chestthrusts

andremoveitwithyourlittlefingeriftheforeignbodyisvisibleinthemouth.

• Iftheforeignbodyisexpelledsuccessfully,assesstheinfantforpulse,‘signsof

circulation’andbreathing.

• Iftheairwayremainsobstructedandtheinfantisstillconscious,repeatthesequence

of5backblowsand5chestthrustsuntiltheforeignbodyisexpelledortheinfant

becomesunconscious.

9.3 RELIEF OF FBAO In ThE UNCONSCIOUS InFAnT

Foranunconscious infant,proceedwiththefollowingsteps:

STEP 1

• PositioninfantonafirmflatsurfaceandimmediatelyactivateEmergencyMedical

Servicesbydialling995foranemergencyambulance,ifasecondrescuerisavailable.

STEP 2

• Opentheinfant’sairwaybyperformingaheadtilt-chinlift.

• Checktheinfant’smouthforvisibleforeignbodies.

• Useahookedlittlefingerandremoveanyobviousobstructingforeignbodies.

STEP 3

• Assesstheinfantforanypresenceofspontaneousbreathingbylook,listenandfeel.

• Ifbreathingisabsent,attempttoventilate.

• Ifairwayisblocked,re-positiontheinfant’sheadandre-attempttoventilate.

STEP 4

• Iftheairwayisblockedagain,perform30chestcompressions.(Thelandmarkand

techniqueisthesameasforinfantCPR).

STEP 5

• Repeatsteps2 to 4 until you are able to give two successful ventilations(Successful

ventilationmeanschestrisingaftereachventilation).

STEP 6

• Assessforpulseand‘signsofcirculation’oncetheairwayiscleared.

• Ifpulseisabsent(ifunsureofpulseandinfanthasno‘signsofcirculation’,assume

cardiacarrest),continueCPR30:2.

• Ifpulseispresent,checkinfantforbreathing.

• Ifbreathingisabsent,performrescuebreathingatrateof20breathsperminute(one

breathevery3seconds)bycounting ‘2-a-thousand, 3-a-thousand aftereachbreath.

Repeatthesequenceuntilyouhavecompletedatotalof20breaths.

• Ifboththepulseandbreathingarepresent,positiontheinfantintherecoveryposition.

• Continuetomonitortheinfant’spulse,‘signsofcirculation’andbreathingeveryfew

minutesasthesecanstopsuddenly.

• ActivateEMSifitisnotdoneearlier.

• Deliver5 chest thrustsoverthelowerhalfofthe

sternum(breastbone)bycountingaloud‘1,2,3,4,5’

(landmarkforchestthrustisthesameasforinfant

CPR).

44

BC

LSP

rog

ram

me

BC

LSP

rog

ram

me

45