3 - lifesaving procedures

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S.E.P. MANUAL CHAPTER 3 LIFESAVING PROCEDURES Chapter: 3 Page: 1 Rev: 5 Date: 15 JUL 09 ETIHAD AIRWAYS – UNITED ARAB EMIRATES 3.1. LIFE SAVING PROCEDURES ................................................................... 3 3.2. RESUSCITATION PLAN (ADULT) ............................................................ 4 3.3. RESUSCITATION PLAN (CHILD) ............................................................. 5 3.4. RESUSCITATION PLAN (INFANT) ........................................................... 6 3.5. UNCONSCIOUS CASUALTY (RECOVERY POSITION) .......................... 7 3.6. CARDIAC ARREST (C.P.R.)...................................................................... 8 3.6.1. Alternative methods of CPR...................................................................... 10 3.6.2. C.P.R Technique (Children) ...................................................................... 10 3.6.3. CPR Technique (Infants) .......................................................................... 11 3.6.4. Alternative Methods of Rescue Breathing................................................. 11 3.7. DEFIBRILLATION .................................................................................... 12 3.8. GUIDELINES FOR RESUSCITATION ..................................................... 15 3.9. CHOKING ................................................................................................. 16 3.9.1. Management (Conscious Adult)................................................................ 16 3.9.2. Choking Management (Children) .............................................................. 19 3.9.3. Choking Management (Infants)................................................................. 21

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  • S.E.P. MANUAL CHAPTER 3

    LIFESAVING PROCEDURES

    Chapter: 3 Page: 1 Rev: 5 Date: 15 JUL 09

    ETIHAD AIRWAYS UNITED ARAB EMIRATES

    3.1. LIFE SAVING PROCEDURES................................................................... 3

    3.2. RESUSCITATION PLAN (ADULT) ............................................................ 4

    3.3. RESUSCITATION PLAN (CHILD) ............................................................. 5

    3.4. RESUSCITATION PLAN (INFANT) ........................................................... 6

    3.5. UNCONSCIOUS CASUALTY (RECOVERY POSITION) .......................... 7

    3.6. CARDIAC ARREST (C.P.R.)...................................................................... 8 3.6.1. Alternative methods of CPR...................................................................... 10 3.6.2. C.P.R Technique (Children)...................................................................... 10 3.6.3. CPR Technique (Infants) .......................................................................... 11 3.6.4. Alternative Methods of Rescue Breathing................................................. 11

    3.7. DEFIBRILLATION.................................................................................... 12

    3.8. GUIDELINES FOR RESUSCITATION..................................................... 15

    3.9. CHOKING................................................................................................. 16 3.9.1. Management (Conscious Adult)................................................................ 16 3.9.2. Choking Management (Children) .............................................................. 19 3.9.3. Choking Management (Infants)................................................................. 21

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  • S.E.P. MANUAL CHAPTER 3

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    ETIHAD AIRWAYS UNITED ARAB EMIRATES

    3.1. LIFE SAVING PROCEDURES Oxygen is essential for life. The airway should always be considered your first priority over anything else when dealing with the casualty. If at anytime the airway becomes blocked or closed, and/or there is no breathing, it only takes minutes for the human body to become dangerously compromised. Without Oxygen 3 - 5 minutes Irreversible brain damage can occur 7 - 8 minutes Brain death may occur It is essential that crew recognise when a casualty becomes unconscious and the airway has become compromised.

  • S.E.P. MANUAL CHAPTER 3

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    ETIHAD AIRWAYS UNITED ARAB EMIRATES

    3.2. RESUSCITATION PLAN (ADULT)

    Danger Check scene safety; look for hazards to yourself or casualty (Chapt.2, p.3)

    Response Gently shake casualtys shoulders and call to him to see if he responds

    Shout for Help 2nd crew AED 3rd crew Oxygen, pocket mask, communicate

    Treat for fainting Perform Secondary Survey

    Remove hazards

    Airway Head tilt, Clear if necessary, Chin lift

    Breathing Assess Breathing

    Recovery Position Chap 3-3.5

    YES

    YES

    NO

    NO

    YES

    NO or Abnormal

    CPR 30 Compressions: 2 Breaths

    Defibrillation Apply AED ASAP

  • S.E.P. MANUAL CHAPTER 3

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    Chapter: 3 Page: 5 Rev: 5 Date: 15 JUL 09

    ETIHAD AIRWAYS UNITED ARAB EMIRATES

    3.3. RESUSCITATION PLAN (CHILD)

    Danger Check scene safety; look for hazards to yourself or casualty (Chapt.2, p.3)

    Response Gently shake casualtys shoulders and call to him to see if he responds

    Shout for Help 2nd crew AED 3rd crew Oxygen, pocket mask, communicate

    Treat for fainting Perform Secondary Survey

    Remove hazards

    Airway Head tilt, Clear if necessary, Chin lift

    Breathing Assess Breathing

    Recovery Position Chap 3-3.5

    YES

    YES

    NO

    NO

    NO or ABNORMAL

    YES

    Defibrillation Apply AED ASAP

    CPR 5 initial Breaths 30 Compressions: 2 Breaths

  • S.E.P. MANUAL CHAPTER 3

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    ETIHAD AIRWAYS UNITED ARAB EMIRATES

    3.4. RESUSCITATION PLAN (INFANT)

    Danger Check scene safety; look for hazards to yourself or casualty (Chapt 2, p.3 )

    Response Gently tap/pinch infants arm/earlobe and call to him to see if he responds

    Shout for Help 2nd crew AED 3rd crew Oxygen, pocket mask, communicate

    Perform Secondary Survey (Parents to be asked questions)

    Remove hazards

    Airway Clear if necessary and open (chin lift)

    Breathing Assess Breathing

    Hold infant on its side Chap 3-3.5

    YES

    YES

    NO

    NO

    YES

    NO or ABNORMAL

    CPR 5 initial Breaths 30 Compressions: 2 Breaths

    Defibrillation Only on direction of MedLinks doctor or on board doctor

  • S.E.P. MANUAL CHAPTER 3

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    ETIHAD AIRWAYS UNITED ARAB EMIRATES

    3.5. UNCONSCIOUS CASUALTY (RECOVERY POSITION) Unconsciousness - prolonged state of collapse. Recognition

    No response to crew members attempts to waken Breathing present

    Management 1. Recovery position. 2. Monitor Airway and breathing continuously. 3. Contact MedLink. 4. Administer oxygen. 5. Keep warm, cover with a blanket. 6. Give nothing by mouth. 7. Perform Secondary Survey to identify any possible causes of Condition. Recovery position Before placing into the recovery position, attempt to determine the cause of the illness or injury and take necessary precautions if a spinal injury is suspected. Reasons For Placing The Casualty Into The Recovery Position

    a. To keep the airway open and prevent the tongue from blocking he airway b. To allow fluid to drain from the mouth, reducing the risk of the casualty inhaling

    stomach contents. c. To keep the head, neck and back in a straight line (correct anatomical

    alignment) Before turning a casualty, remove their eye glasses, if worn.

  • S.E.P. MANUAL CHAPTER 3

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    ETIHAD AIRWAYS UNITED ARAB EMIRATES

    Technique (Recovery Position) 1. Kneeling beside the casualty, open the airway by tilting the head and lifting the chin.

    Straighten the legs. Place the arm nearest you at right-angles to the body, elbow bent and with the palm of the hand facing upwards.

    2. Bring the arm furthest from you across the chest, and hold the back of the hand

    against the casualty's nearer cheek. 3. With your other hand, grasp the leg furthest from you and pull the knee up, so that

    the foot is flat on the floor. 4. Keeping the hand pressed against the cheek, pull at the knee to roll the casualty

    towards you and onto the side. 5. Tilt the head back to make sure the airway remains open. Adjust the hand under the

    cheek, if necessary, so that the head stays in a tilted position. 6. Adjust the upper leg, if necessary, so that both the hip and the knee are bent at right

    angles. Note: Check casualtys breathing every one minute for 10 seconds.

    If the casualty has to be kept in the recovery position for more than 30 minutes, he should be turned to the opposite side, every 30 minutes.

    Recovery Position - Children Use the same technique as for the adult. Recovery Position - Infants Hold the baby on their side, supporting the babys head and neck, tilting the baby slightly head downwards to prevent inhalation of vomit and stop the tongue blocking the airway.

    3.6. CARDIAC ARREST (C.P.R.) Sudden stoppage of the heartbeat and cardiac function, resulting in the loss of effective circulation. Recognition

    Sudden collapse No response No breathing Skin bluish, grey in colour Possible complaining of chest pain prior to collapse

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    Causes

    Massive heart attack Abnormal heart rhythm e.g. ventricular fibrillation Complication of serious medical condition e.g. shock

    Management CPR (Cardio-Pulmonary Resuscitation) & Defibrillation Technique (CPR) 1. Position the casualty on their back on a flat, hard surface; kneel by the side of the

    casualty 2. Place the heel of one hand in the centre of the casualtys chest 3. Place the heel of your other hand on top of the first one, interlock the fingers of your

    hands and ensure that pressure is not applied over the casualtys ribs

    4. Lean over the casualty, with your shoulders directly above their chest 5. Keeping your arms straight and locked, compress the chest 1/3-1/2 of the casualtys

    chest diameter (approximately 4-5 cm) Release the pressure without removing your hands Give 30 regular, smooth compressions at a rate of 100 compressions / minute Count out loud to keep time and rhythm

    6. Give two effective rescue breaths

    Pinch the soft part of the nose closed using the index finger and thumb of the hand on the forehead

    Allow the mouth to open but maintain a chin lift Take a normal breath and place your lips around the mouth making sure you

    have a good seal

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    Blow steadily into the mouth while watching for the chest to rise, taking

    approximately 1 second as in normal breathing (this will ensure an effective rescue breath is given)

    Maintaining head tilt and chin lift, take your mouth away from the casualtys mouth and watch for the chest to fall as air passes out

    Take another breath and blow into the victims mouth once more to achieve a total of 2 effective breaths

    7. Continue cycle of 30 chest compressions and two rescue breaths

    (Do not attempt more than 2 breaths each time before returning to chest compressions)

    8. As soon as the AED arrives, turn on machine, place pads on the casualtys chest,

    and follow machine prompts

    Adult CPR Ratio - 30 Compressions : 2 Rescue breaths

    CPR should continue while the AED is being set up and the pads are placed on the casualtys chest.

    3.6.1. Alternative methods of CPR CPR in pregnancy If a woman in the later stages of pregnancy requires CPR:-

    Position her on her back Place pillows under her right buttock to tilt the pelvis to the left

    CPR in confined spaces In confined spaces, over the head CPR may be considered. For example, if you are unable to move the casualty from between seats.

    3.6.2. C.P.R Technique (Children) 1. Give 5 initial rescue breaths before starting chest compressions 2. Continue with 30:2 ratio (same as per adult technique) One or two hand technique may be used in order to depress the chest by approximately 1/2 to 1/3 of its depth

    Child CPR Ratio - 30 Compressions : 2 Rescue breaths

    Attach the AED as soon as it arrives on the scene, using the paediatric pads in the appropriate locations.

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    3.6.3. CPR Technique (Infants) 1. Lay the infant on his back on a firm, flat surface. 2. Hold the infants head with one hand. 3. Seal the nose and mouth of the infant with your mouth. 4. Give 5 initial rescue breaths. 5. Draw an imaginary line between the infants nipples. 6. One finger space below this line, place index and middle fingers, on chest.

    7. Compress the chest, 1/3 -1/2 of the infants chest diameter 8. Release the pressure without removing your fingers from the infants chest 9. Give 30 regular, smooth compressions, at a rate of 100 compressions per minute,

    without removing your fingers from the chest throughout the compressions 10. Give two effective breaths 11. Continue cycles of 30 compressions and two breaths

    Infant CPR Ratio - 30 Compressions : 2 Rescue breaths

    The AED is only to be used on an infant if directed by MedLink to do so or in the absence of contact with MedLink, a Doctor of Medicine

    travelling as a passenger onboard recommends its use.

    3.6.4. Alternative Methods of Rescue Breathing Mouth To Nose Breathing If the casualty has a mouth or jaw injury, it may not be possible to seal their mouth, so rescue breathing must be performed via the nose.

    Seal your mouth over the casualtys nose and blow in as per normal technique Hold the casualtys mouth closed After each breath, remove your mouth and hand to allow air out of the casualtys

    lungs Mouth To Stoma Breathing If a casualty has had an operation to remove his voice box or open the windpipe, he will breathe through a hole (stoma) in his neck. If he were to stop breathing, rescue breathing must be performed via the stoma.

    Hold the casualtys nose and mouth closed with one hand. Seal your mouth over the stoma to make an airtight seal. Deliver breaths into the stoma. After giving each breath, lift your mouth away to allow air to escape from the

    casualtys lungs.

  • S.E.P. MANUAL CHAPTER 3

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    3.7. DEFIBRILLATION The AED should only be attached to the casualtys chest when there is unresponsiveness and absence of normal breathing.

    Paediatric pads should be used on children from 1-8 years old (less than 25 kg), however do not delay defibrillation to determine exact age/weight. The defibrillator should only be used on infants if directed by MedLink or on board medical professional to do so.

    Technique For Use Of The Defibrillator (CPR in progress) 1. Clear the area around the casualty. 2. Press the On/Off button to turn the Heartstart FR2+ on. 3. Ensure that the casualtys chest is exposed and prepared for pad placement (dry,

    free of excess hair, medication patches, jewellery and undergarments are removed). 4. Follow the instructions provided by the FR2+ voice and screen prompts. 5. Apply pads to patients bare chest; plug in connector

    i. Open defibrillator pads package ii. Remove pads from protective backing one at a time (to reduce risk of pads

    sticking to each other) 6. Place each pad on the casualtys bare chest.

    i. One pad just below the right collarbone ii. Second pad over the casualtys ribs in line with the armpit, below the left breast

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    7. Plug in pads connector to the FR2+ by inserting firmly into the connector socket (top

    left of AED where flashing light is seen). 8. FR2+ - Analyzing heart rhythm, do not touch the patient

    As soon as the defibrillator detects that pads are connected properly, it automatically begins analyzing the casualtys heart rhythm. Do not touch the casualty during rhythm analysis and ensure no other crew members are touching casualty at this time AED Operator must shout Stop CPR - Stand clear

    Note: If the casualtys heart is not in a shockable rhythm, the FR2+ will prompt No

    shock advised, Check for signs of circulation, if needed begin CPR, and the AED operator should direct person administering CPR to check breathing and continue CPR as required.

    9. If the casualtys heart is in a shockable rhythm, the FR2+ will state Shock advised,

    charging 10. AED Operator must shout - All clear, defibrillating and visually reconfirm that no

    one is touching the casualty or pads. 11. FR2+ prompt - Press the orange button now.

    Press flashing button to deliver shock to casualty. 12. After the first shock has been delivered, the AED will re-analyse the casualtys

    cardiac rhythm. FR2+ prompt - Analyzing heart rhythm, do not touch the patient AED Operator - Stand clear.

    13. If a shockable rhythm is detected, the AED will charge again and prompt to deliver a

    further shock. Continue following the FR2+ prompts. If required, the FR2+ will run through a cycle of 3 shocks, then prompt to perform CPR if required for one minute.

    Note: The FR2+ continues to analyse when charging for a shock if it detects a

    rhythm change and a shock is no longer appropriate, the FR2+ will cancel the charge.

    Adult Pad Placement

    Paediatric pad placement

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    14. After one minute of CPR, the voice prompt will say:

    Analyzing heart rhythm, do not touch the patient. If a shockable rhythm is again detected the AED will run through additional shocks if required (in cycles of three), followed by one minute of CPR.

    REMEMBER TO ALWAYS FOLLOW THE INSTRUCTIONS GIVEN TO YOU BY THE AED

    This sequence should continue until:

    Medical assistance (either MedLink or an on board medical volunteer) advises you to cease.

    The aircraft diverts and medical staff on ground takes over physically from you. There is no diversion, no medical advice is available and you have been

    attempting resuscitation for 30 minutes for an adult, 60 minutes for a child/infant. The casualty shows signs of life.

    Precautions

    Do not touch or move the casualty while the AED is analysing or delivering a shock.

    Never place the AED pads directly on top of medication pads such as nitro glycerine. Patches should always be removed and the skin wiped dry prior to placing the pads.

    If the casualty has a pacemaker or internal defibrillator with battery pack (visible as a lump under the skin about 2 inches (5 cm long), place the defibrillator pads at least one inch (2.5cm) away from the implanted medical device.

    Do not use the AED within 2 metres of electronic equipment e.g. video compartment (VCC) should be suspended by the Cabin Manager if within 2 metres of resuscitation site.

    The AED should be operated in an area large enough to prevent the casualty touching anything e.g. in the galley, not aircraft aisle

    Keep the area as dry as possible. Move oxygen bottles, face masks away from the casualty when the AED prompts

    a shock. Ensure all people assisting are clear of the casualty prior to defibrillation by

    shouting Stand clear. Confirm no-one is touching the casualty when about to deliver a shock by then shouting All clear - defibrillating

    After Use

    Check the status indicator is Flashing Black Hourglass. If the indicator is showing a red flashing cross (X) with a chirping sound carry out

    a BIT. If it continues document and report to Engineering on return to AUH for replacement battery.

    Complete relevant documentation. Check that additional equipment is replenished and ready to use. Place any other soiled equipment (and used pads if removed by medical

    personnel) into a plastic bag and arrange for disposal.

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    Reseal the AED with a BLUE seal (RED seal if the machine is unserviceable and therefore potentially faulty).

    Documentation The following documentation should be completed as soon as possible:- 1. Medical Incident Report 2. AED form 3. Death on board form (as appropriate) 4. MedLink Patch check list form 5. Cabin Maintenance Log 6. Aircraft Maintenance Log (Flight Deck) See Chapter 6-6.5 for detailed information about the Heartstart FR2+ Automated External Defibrillator machine Debriefing of Crew following Resuscitation The Cabin Manager should contact NOC following an incident involving resuscitation. NOC will contact Cabin Crew Management who will arrange for a crew debriefing of the incident, for the purposes of crew support and an opportunity for crew to express any concerns. A representative from Management, Training and the Critical Incident Stress Management team will be involved in this debriefing on return to AUH.

    3.8. GUIDELINES FOR RESUSCITATION Diversion In the case where a diversion is possible, crew will not stop resuscitating until the aircraft comes to a stop and medical personnel take over on the ground. In case of diversion, one crew member should stay out of their jump seat and continue resuscitating even after the command comes for crew to take their seats for landing. No Diversion Possible In a situation where:-

    No diversion is possible, MedLink cannot be contacted, and/or No Medical Volunteer available on board

    Recommended guidelines for Resuscitation attempt time limits are - 30 minutes (Adult); 60 minutes (Child/infant) A decision will then be made in conjunction with the Captain and Cabin Manager to cease resuscitation.

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    If CPR and defibrillation have been continuing for this time without any signs of life, resuscitation has been unsuccessful.

    3.9. CHOKING Partial or total obstruction of the airway by food, fluid or foreign objects. Recognition

    Clutching the throat Coughing, wheezing, gagging Difficulty speaking or swallowing Making violent attempts to breathe Face, neck, lips, ears, fingernails turning blue Making a whistling or crowing noise Collapsing or becoming unconscious

    Causes

    Eating or drinking too quickly Swallowing small bones Not chewing food sufficiently Tablets or capsules Talking or laughing at the same time as eating/drinking

    3.9.1. Management (Conscious Adult) 1. Reassure casualty and confirm that they are choking 2. Encourage casualty to cough and do nothing else If the casualty is unable to dislodge object through coughing :-

    a. Administer up to 5 Back Blows b. Check to see if each back blow has relieved the obstruction c. If back blows do not dislodge obstruction, administer up to 5 Abdominal

    Thrusts d. Give 5 more back blows, if necessary e. Keep alternating between back blows and abdominal thrusts until the

    obstruction is removed f. If casualty collapses, revert to management for unconscious choking casualty

    (over page) Use chest thrusts instead of abdominal thrusts for obviously pregnant women or obese casualties.

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    Back Blows

    Stand to the side and slightly behind the casualty Support his chest with one hand and lean him well forwards, so that when the

    object is dislodged, it comes out the mouth rather than going further down the airway

    Give up to 5 sharp blows to the back between the shoulder blades, with the heel of your other hand

    Abdominal Thrusts

    Stand behind the casualty, bend the casualty well forward Place both arms around the upper part of the abdomen just below the rib cage

    (area between the navel and the bottom of the breast bone) Clench your fist and grasp it with your other hand Pull sharply inwards and upwards Repeat up to 5 times

    Note: Abdominal thrusts can cause internal injuries; therefore a casualty that had

    abdominal thrusts administered to them should be examined for injury by a doctor as soon as possible afterwards.

    Chest Thrusts

    Stand behind the casualty and put both arms around the chest Clench your fist in between the nipples and grasp it with your other hand Pull sharply inwards Give up to 5 chest thrusts

    If casualty becomes unconscious:- 1. Support the casualty carefully to the ground, Shout for help, and apply the AED as

    soon as possible 2. Commence 30 chest compressions 3. Check the airway, for any obvious object. If an object is seen, make an attempt to

    remove it with a single finger sweep 4. Open airway and attempt 2 rescue breaths 5. Continue with cycles of 30 chest compressions, followed by a mouth check and two

    rescue breaths (as per procedure Chapter 3-3.6) See Flowchart over page - Collapsed Choking Adult

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    Unconscious Choking Adult

    30 Chest Compressions

    Check mouth for object/Open

    Airway

    30 Chest Compressions

    2 Rescue Breaths

    Check mouth for object/Open

    Airway

    Continue cycles as per CPR procedure

    (chap 3-3.6),

    If object visible, try single finger

    sweep to remove

    If object visible, try single finger

    sweep to remove

    Note Apply and operate the AED as soon as possible

    Keep Checking Airway before attempting the

    Rescue Breaths

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    3.9.2. Choking Management (Children) 1. Reassure casualty and confirm that they are choking. 2. Encourage casualty to cough. If unable to dislodge object through coughing:-

    a. Hold the child in a face down position and try to position the head lower than the body

    b. Perform up to five back blows c. If unable to dislodge the obstruction, perform up to five abdominal thrusts d. Repeat the cycle until the object is clear or the child becomes unconscious

    If child becomes unconscious:- 1. Support the casualty carefully to the ground, Shout for help, and apply the AED as

    soon as possible 2. Check the mouth for any obvious object. If an object is seen, make an attempt to

    remove it with a single finger sweep 3. Open the airway and attempt 5 Rescue breaths 4. If there is no response (moving, coughing, spontaneous breathing) proceed with 30

    chest compressions as per CPR procedure, Chapter 3-3.6.2 5. Check the mouth for any obvious object. If an object is seen, make an attempt to

    remove it with a single finger sweep 6. Open the airway and attempt 2 rescue breaths 7. Continue with cycles of 30 chest compressions, followed by a mouth check and two

    rescue breaths (as per CPR procedure, Chapter 3-3.6.2) See Flow Chart over page Unconscious Choking Child

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    Unconscious Choking Child or Infant

    Check mouth for object/Open

    Airway

    If object visible, try single finger

    sweep to remove

    30 Chest Compressions

    5 Initial Rescue Breaths

    Check mouth for object/Open

    Airway

    Continue cycles as per CPR procedure

    (chap 3-3.6.2/3.6.3)

    If object visible, try single finger

    sweep to remove

    Note Children: Apply and operate the AED as soon as possible Infant: AED only on direction of MedLinks doctor or onboard doctor

    Keep Checking Airway before attempting the

    Rescue Breaths

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    3.9.3. Choking Management (Infants) 1. Lay infant face down across your lap or down your forearm 2. Support infants head by placing thumb of one hand at the angle of the lower jaw and

    1-2 fingers from the same hand at the same point on the other side of the jaw 3. Position infants head, lower than its body 4. Deliver up to 5 sharp back blows with the heel of hand in the middle of the back

    between the shoulder blades If these do not dislodge the obstruction;

    5. Turn infant into a face up/head down position (place free arm along infants back and with the same hand, cup the back of its head)

    6. Support infant down your arm, which is placed down (or across) your thigh 7. Identify the same landmark used for Chest compressions on an infant 8. Deliver 5 Chest thrusts with 2 fingers 9. Repeat the cycle until the object is clear or the infant becomes unconscious If the choking infant becomes unconscious:- Follow the same procedure as for child (Chapter 3-3.9.2) The AED to be used on an infant if directed by MedLink to do so or in the absence of contact with MedLink, a Doctor of Medicine travelling as a passenger onboard recommends its use

    END OF CHAPTER

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    3.1. LIFE SAVING PROCEDURES3.2. RESUSCITATION PLAN (ADULT)3.3. RESUSCITATION PLAN (CHILD)3.4. RESUSCITATION PLAN (INFANT)3.5. UNCONSCIOUS CASUALTY (RECOVERY POSITION)3.6. CARDIAC ARREST (C.P.R.)3.6.1. Alternative methods of CPR3.6.2. C.P.R Technique (Children)3.6.3. CPR Technique (Infants)3.6.4. Alternative Methods of Rescue Breathing

    3.7. DEFIBRILLATION3.8. GUIDELINES FOR RESUSCITATION 3.9. CHOKING3.9.1. Management (Conscious Adult)3.9.2. Choking Management (Children)3.9.3. Choking Management (Infants)