Infant STEP 1 ASSESS UnRESPOnSIvEnESS · Chest compressions in an infant consist of serial,...
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CARDIO-PULMONARY RESUSCITATION (CPR) Infant Module 7 INFANT CARDIO-PULMONARY RESUSCITATION (CPR) 7.1 INTRODUCTION An infant is a child who is up to 1 year old. Infants rarely collapse because of a primary heart problem. Cardiac arrest is usually secondary to other events, such as major trauma or respiratory problems. Therefore, rescuers must detect and promptly treat early signs of respiratory failure to prevent cardiac arrest. STEP 1 ASSESS UNRESPONSIVENESS • Quickly assess and determine whether the infant is responsive by tapping gently on the infant’s shoulders. • Avoid violent shaking and unnecessary movements of the infant’s head and neck as this might result in injury. • If the infant does not respond, he/ she is likely to be unconscious. • Possible causes of unconsciousness may be: – an airway that is obstructed (blocked) by food, secretions or a tongue that has fallen backwards. – breathing that has stopped. – a heart that has stopped beating. BCLS Programme 31 30 BCLS Programme
Transcript of Infant STEP 1 ASSESS UnRESPOnSIvEnESS · Chest compressions in an infant consist of serial,...
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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