infant step 1 assess unresponsiveness · chest compressions in an infant consist of serial,...
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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.
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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.
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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.
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• 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.
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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.
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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.
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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.
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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).
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