Short Version Bls -Cpr 2012 (Infant&Child) Outline
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FACTS
• Children < 1yr –Falls & burns @ home
• 1-4 yrs old – Inhale or ingest foreign bodies
• 5- yrs old –Traffi! & s!hool a!!ident
• "-#$ years old –%i!tim of hysi!al assult
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'( )ATT*+ ,AT T* CA.S*///
• ,hen the heart has stoed andthe 0i!tim is not breathing C2+is the ans3er
• ,ithout a !onstant suly of
blood !ells of the body3ill start to die
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NO MATTER WHAT THE CAUSE………
• rain damage begins 3ithin 4 to6 minutes after !ardia! arrest
• ,ithin " to 1$ minutes thedamage may be irre0ersible
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Clinical Death
$-1 min 7 Cardia! Irritability 1-4 min - rain damage - not li8ely
4-6 min - rain damage - ossible
Biological Death
6-1$ min 7 rain damage - 0ery li8ely(0er 1$ min7 Irre0ersible brain
damage
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'( )ATT*+ ,AT T* CA.S*///
• Cardioulmonary resus!itation
3ill hel to !ir!ulate o9ygenatedblood until more ad0an!edmedi!al !are !an be erformed
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Why the need for CPR training?
• )ost eole die of heart atta!8before they e0er rea!h a
hosital• (ther situations !an lead to C2
arrest
CP arrest can occuranytime & anywhere
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Emergency Action Principe !
2lan of a!tion for anyemergen!y to ensure theres!uer:s safety and that of the0i!tim and bystanders and
in!rease the 0i!tim:s !han!esof sur0i0al
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Emergency Action Principe
1 Sur0ey the S!ene
# A!ti0ate medi!al assistan!e
; Initial assessment of the 0i!tim4 Se!ondary assessment of the
0i!tim
5 +eferral for further e0aluation andmanagement
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1 Sur0ey the S!ene
)a8e sure that the s!ene of theemergen!y is safe for you the 0i!timand the bystanders
!onsider - S!ene safety
- )e!hanism of in=ury or nature of
illness - >etermine the number of ersons ?
0i!tim and additional resour!es
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"# Acti$ate Medica
A%%i%tance• Call First “ : If adult reuires
emergen!y !are
• Care First” : for infant and
!hild
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Information to be gi0en in a!ti0itingmedi!al assistan!e
• ,hat haened B
• o!ation B
•
'umber of ersons in=uredB• *9tent of in=ury and First Aid gi0enB
• The telehone number from 3here youare !alling?
• Identity of the erson !alling
• Drop the phone last
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; >o rimary sur0eyof 0i!tim
• Che!8 resonsi0eness
• 2erform !omression
• 2erform res!ue breathing• (en the Air3ay
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4 >o Se!ondary Assessment of the %i!tim
• A systemati! method of gatheringadditional information about in=uries or!onditions that may need !are
a Inter0ie3 the %i!tim DSA)2*E b Che!8 0ital signs e0ery 15 minutes
if stable !ondition and e0ery 5
minutes if unstable
! ead to toe e9amination
D>CA2TSE
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4 a Inter0ie3 the 0i!tim
S – signs and symptoms A - Allergies
M - )edi!ines
P – Past Medical History
L - Last oral intake
E - events prior to injury,
incident or illness
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4! ead to toe e9amination
D : Deformity
C : Contusion
A : Abrasions P : Puncture
B : Burn
T : TendernessL : Laceration
S : Swelling
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5 +eferral of %i!tim for further
*0aluation and )anagement
• refers to the transfer of a
0i!tim to hosital or health!are fa!ility for a definiti0etreatment
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ody Substan!e Isolation
Are re!autions ta8en to isolateor re0ent ris8 of e9osure from
any other tye of bodilysubstan!e using ersonalrote!ti0e euiment D22*E
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asi! 2re!autions & 2ra!ti!es
• 1 2ersonal ygiene
# 2rote!ti0e *uiments
; *uiments for !leaningand disinfe!ting
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olden +ules in i0ing *C
D ! S : Do obtain consent wen possible
Do tink o! te worst
Do remember to identi!y yoursel!
Do provide com!ort and emotional
support Do respect te victim
"modesty and privacy#
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>( G S
&o 'e a% cam and direct a%po%%i'e
&o care for the mo%t %erio(%in)(rie% *r%t
&o a%%i%t the $ictim on medication
&o +eep on oo+er% a,ay from thein)(red per%on
&o hande the $ictim to theminim(m
&o oo%en tight cothing
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>(':Ts •
>o not let the 0i!tim see his ?her in=uries
• >o not lea0e the 0i!tim alone
e9!et to get hel• >o not assume that the 0i!tim:s
ob0ious in=uries are the only one
• >o not ma8e any unrealisti! romises
• >o not trust the =udgment of
a !onfused erson
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-ife S(pport
• The cardiop(monaryre%(%citation ! %erie% of
emergency ife %a$ingproced(re% that are carried o(tto proong the ife of a per%on
,ith ife threateningemergencie%
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Type%.%tage% of ife %(pport
1 asi! ife Suort DSE
# Ad0an!ed Cardia! ife Suort
DACSE
; 2rolonged ife Suort
D2SE
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Stage of -ife S(pport
1. Basic Life Support
- an emergen!y ro!edure that!onsists of re!ogniHing resiratoryor !ardia! arrest or both and theroer ali!ation of C2+ tomaintain life until a 0i!tim re!o0ers
or ad0an!ed life
suort is a0ailable
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Stage% of -ife S(pport
1. Basic Life Support
a. CAB Stes
Comression D!ir!ulationE
Air3ay
Breathing D0entilationE
b .se of sulementary
te!hniues
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Stage% of -ife S(pport
2. Advanced cardiac Life Support(ACLS)
/ The (%e of %pecia e0(ipment tomaintain 'reathing.circ(ation for the$ictim of cardiac emergency#
/ A %et of cinica inter$ention% for the
(rgent treatment of cardiac arre%t
and other ife threateningemergencie% and the
1 2 S to depoy tho%e inter$ention%
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Stage% of -ife S(pport
a# Denitive therapy 3 dr(g%4de*'riation
'# Cardiac monitoring %ta'ii5ationc# Tran%portation
d# Comm(nication
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Stage of -ife S(pport
6# Prolonged Life Support(PLS)
- 7or po%t re%(%citati$e and ongterm re%(%citation ,ith the (%e ofad)(ncti$e e0(ipment %(ch a%$entiator4 cardiac monitor4 p(%e
o8imeter4 etc#
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9a%ic -ife S(pport
• the "oun#ation !or saving
lives !ollowing cardiac
arrest$
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7(ndamenta A%pect% of 9-S !
:mmediate recognition of %(ddencardiac arre%t ;SCA< and acti$ation
of emergency re%pon%e %y%tem Eary cardiop(monary
re%(%citation ;CPR<
Rapid de*'riation ,itha(tomated e8terna de*'riator;AE&<
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Cardiop(monaryRe%(%citation ;CPR<
• An emergency procedure usedfor a person who is not breathing
and whose heart has stoppedbreathing ( cardiac arrest
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Cardiop(monary Re%(%citation ;CPR<• !s a series of assessments and
inter"entions using techni#ues andmaneu"ers made to bring "ictims of
cardiac and respiratory arrest bac$to life%
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When to Start CPR
• CPR %ho(d 'e %tarted on a non/'reathing4 p(%ee%% patient%4 (ne%%
they are o'$io(%y dead or ha$e a&NR order#
;Re%ponder% ,i need to %ee a $aidcopy of the order to honor it#<
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When to Start CPR
• :t i% 'etter to %tart CPR on a per%onthat i% ater decared dead 'y a
phy%ician than to ,ithhod CPR from%omeone that co(d ha$e 'een %a$ed#
hen in Dou!t"#e$u$citate%
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Criteria for not %tarting CPR
• All patient$ in cardiac arre$t receivere$u$citation unle$$&
=#The patient ha% a $aid > &o notRe%(%citate >
; &NR< order
"# Patient ha% %ign% of :rre$er%i'e &eath;rigor morti%4 decapitation4 or dependenti$idity4
decompo%ition<
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Sign% of &eath
Decapitation The head is
searated from the rest of the
body
Rigor mortis Temorary
stiffening of mus!les o!!urs
se0eral hours after death
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Sign% of &eath
'vidence of ti$$ue decopo$ition !Act(a
e%h decay occ(r% ony after a per%on ha%'een dead for more than one day#
Dependent lividity ! Red or p(rpecoor
occ(r% on the part% of the patient@% 'ody
that are co%e%t to the gro(nd#
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Criteria for not %tarting CPR
6# No Phy%ioogica 'ene*t can 'e e8pected'eca(%e $ita f(nction% ha$e deterioratedde%pite ma8ima therapy eg# Progre%%i$e%hoc+ or cardiogenic %hoc+
# Withhoding attempt% to re%(%citate inthe dei$ery room i% appropriate forne,y 'orn infant% ,ith!
– Con&rm gestation ') weee$s or birthweight '*++g
– Anencephaly
– Confrimed trisomy ,) or ,-%
B# Attempt% to perform CPR ,o(d pace there%c(er at
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When to %top CPR
S pontaneo(% 'reathing and p(%eha% 'een re%tored
(rned o$er to profe%%iona hep* perator. Re%c(er i% too e8ha(%ted
to contin(e
P hy%ician A%%(me% re%pon%i'iityS cene 'ecome% (n%afe
S igned ,ai$er to %top CPR
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S(mmary of 1ey :%%(e% andMa)or Change%
#
Key issues and major changes in the 2010
AHA Guidelines for CPR and ECCrecommendations for healthcare proiders
include the follo!ing"
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S(mmary of 1ey :%%(e% andMa)or Change%
• Cardiac arre%t $ictim% may pre%ent,ith a %hort period of %ei5(re/i+e
acti$ity or agona ga%p% that mayconf(%e potentia re%c(er%4di%patcher% %ho(d 'e %peci*cay
trained to identify the%e pre%entation%of cardiac arre%t to impro$e cardiacarre%t recognition#
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S(mmary of 1ey :%%(e% andMa)or Change%
• The heathcare pro$ider 'riey chec+% forno 'reathing or no norma 'reathing ;ie4 no
'reathing or ony ga%ping< ,hen thepro$ider chec+% re%pon%i$ene%%#
• The pro$ider then acti$ate% the emergency
re%pon%e %y%tem and retrie$e% the AE& ;or %end% %omeone to do %o<#
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S(mmary of 1ey :%%(e% andMa)or Change%
The heathcare pro$ider %ho(d not %pendmore
than = %econd% chec+ing for a p(%e4 and ifa
p(%e i% not de*nitey fet ,ithin =
%econd%4%ho(d 'egin CPR and (%e the AE& ,hen
a$aia'e#
f d
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S(mmary of 1ey :%%(e% andMa)or Change%
• >-oo+4 i%ten4 and fee for'reathingD ha% 'een remo$edfrom the agorithm#
S f 1 : d
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S(mmary of 1ey :%%(e% andMa)or Change%
• U%e of cricoid pre%%(re d(ring$entiation% i% generay notrecommended#
• Se0(ence change to che%tcompre%%ion% 'efore gi$ing re%c(e
'reath% ;C/A/9 rather than A/9/C<#
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S(mmary of 1ey :%%(e% and Ma)orChange%
:ncrea%ed empha%i% ha% 'een paced on high/
0(aity CPR ;Parameter% of eFecti$e4 high0(aity CPR<
=# Compre%%ion% of ade0(ate rate at ea%t =.min"# Compre%%ion depth of at ea%t =.6 AP diameter
or
" inche%;B cm<
6# Ao,ing compete che%t recoi 'et,eencompre%%ion%
# Minimi5ing interr(ption% in compre%%ion%4
B# A$oiding e8ce%%i$e $entiation
S f 1 : d
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S(mmary of 1ey :%%(e% andMa)or Change%
• eginning C2+ 3ith ;$!omressions rather than #
0entilations leads to a shorterdelay to first !omression
S f 1 : d
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S(mmary of 1ey :%%(e% andMa)or Change%
• Comression rate is modifiedto at least 1$$?min from
approximately 1$$?min
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Ne, Se0(ence
+' *LD #A,*+AL'
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9-S CHANGES Che%tcompre%%ion%4
Air,ay4 9reathing ;C/A/9<Ne, %cienceindicate% the
foo,ing order!=# Chec+ thepatient forre%pon%i$ene%%and no 'reathing#
"# Ca for hepand get the AE&6# Chec+ thep(%e#
# Gi$e 6com %#
Air,ay4 9reathing4Che%t
compre%%ion%;A/9/C<
Pre$io(%y4 afterre%pon%i$ene%%
,a% a%%e%%ed4 aca for hep ,a%made4 the air,ay,a% opened4 the
patient ,a%
chec+ed for'reathing4 and "
'reath% ,eregi$en4 foo,ed 'y
a p(%e chec+ andcom re%%ion%
Atho(gh$entiation% are an
important part ofre%(%citation4
e$idence %ho,%that compre%%ion%
are the criticaeement in ad(tre%(%citation#
:n the A/9/C
%e0(ence4compre%%ion% areoften deayed 'y
changing the
%e0(ence to C/A/9 re%c(er% can
+' *LD #A,*+AL'
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9-S CHANGES Compre%%ion%%ho(d 'e
initiated ,ithin= %econd% ofrecognition of
the arre%t#
Compre%%ion%,ere to 'e
gi$en afterair,ay and'reathing ,ere
a%%e%%ed4
$entiation%,ere gi$en4 andp(%e% ,erechec+ed#
Atho(gh$entiation% are
an importantpart ofre%(%citation4
e$idence %ho,%
thatcompre%%ion%are the critica
eement in
ad(tre%(%citation#Compre%%ion%
are often
deayed ,hie
+' *LD #A,*+AL'
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9-S CHANGES
Compre%%ion%%ho(d 'egi$en at a
rate ofat lea$t =.min#
Each %et of6
compre%%ion%
%ho(d ta+e
Compre%%ion%,ere to 'egi$en at a
rate ofa!out=.min#
Each cyce of6
compre%%ion%
,a% to 'e
7a%ter
compre%%ion%are re0(iredto generate
the pre%%(re%nece%%ary toperf(%e the
coronary and
cere'raarterie%#
+' *LD #A,*+AL'
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9-S CHANGES Compre%%iondepth% are a%
foo,%! Ad(t%! atlea$t " inche%;B cm<
Chidren! atea%t =.6 thedepth of theche%t4
appro8imatey "inche% ;B cm< :nfant%! atea%t =.6 the
depth of the
Compre%%iondepth% ,ere a%
foo,%! Ad(t%! =J to" inche% Chidren! one
third to onehaf thediameter of theche%t
:nfant%! onethird to onehaf thediameter of the
che%t
&eepercompre%%ion%
are re0(ired togenerate thepre%%(re%nece%%ary to
perf(%e thecoronary andcere'raarterie%#
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Rationae 7or Change
• High/0(aity che%t compre%%ion%,ithin CPR contin(e% to 'e a criticafoca point#
• We/performed compre%%ion%increa%e the i+eihood of %(r$i$a#
Chid.:nfant Compre%%ion
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Chid.:nfant Compre%%ionRate
#Push fast$ push at a rate of
at least 100 compressions per minute%&
'(erg) et al% Circulation%
2010$122$*+,2-*+./
2010 Guidelines
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Rationae 7or Change
• :t ha% 'een fo(nd that higher%(r$i$a rate% are a%%ociated ,ithan increa%e in the n(m'er ofcompre%%ion% pro$ided permin(te#
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Chid.:nfant Compre%%ion &epth
Chest !omressions of aroriaterate and deth G2ush fast: ush ata rate of at least 1$$ !omressions
er minute G2ush hard: ush 3ithsuffi!ient for!e to deress at leastone third the anterior-osterior DA2Ediameter of the !hest oraro9imately 1 in!hes D4 !mE ininfants and # in!hes D5 !mE in!hildrenJ '(erg) et al% Circulation. 2010$122$*+,2-
*+./
2010 Guidelines
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9reathing A%%e%%ment
After a!ti0ation of the emergen!yresonse system all res!uers shouldimmediately begin C2+ for adult 0i!tims3ho are unresonsi0e 3ith no breathing orno normal breathing Donly gasingEJ
'(erg) et al% Circulation. 2010$122$*,+/-*.0/
2010 Guidelines
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Highight%
• No more oo+4 i%ten4 and fee#
• K(ic+ >oo+D for no 'reathing or nonorma 'reathing#
• Agona 'reath% remain a concern#
• Appie% to 'oth ay and heathcarepro$ider%#
CPR S HCP
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CPR Se0(ence / HCP
or an unresponsie person !ho is not reathing or
not reathing normally) and has no oious pulse)
actiate E3* and egin CPR !ith 40 compressions
follo!ed y opening the air!ay and giing 2
rescue reaths% Repeat cycles of 40"2 'CA(
method%
'*ummary from (erg) et al% Circulation.
2010$122$*,+/-*.0/
2010 Guidelines
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Highight%
• :nitia a%%e%%ment approach! – A%%e%% re%pon%i$ene%% and 'reathing – Acti$ate EMS – A%%e%% p(%e – Perform CPR
•
CA9 3 'egin CPR cyce% ,ithcompre%%ion%4 foo,ed 'y air,ay and'reathing#
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Rationae 7or Change
• The %cience indicate% the importanceof not deaying che%t compre%%ion%to perform re%c(e 'reath%#
• Eary che%t compre%%ion canimmediatey circ(ate o8ygen that i%
%ti in the 'ood%tream#
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Respiratory Arrest
and
• Rescue Breathing
Re%piratory Emergency and
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Re%piratory Emergency andArti*cia Re%piration
#e$piratory arre$t
3 A condition in ,hich 'reathing
%top% or inade0(ate4 p(%ecirc(ation contin(e for %ometime
Eary Warning %ign% of Re%piratory
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Eary Warning %ign% of Re%piratoryArre%t
• Una'e to %pea+4 'reathe or
co(gh• Clutche$ nec (universal
distress signal)
• 9(i%h coor of %+in 2 ip%
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Cau$e$ of #e$piratory Arre$t
=# *!$truction=#= Anatomica ! ,hen tong(e drop% 'ac+
and o'%tr(ct the throat# Other ca(%e% areac(te a%thma4 diphtheria4 %,eing and
co(gh
=#" Mechanica ! ,hen foreign o')ect%
odge in pharyn8 or air,ay%L (idacc(m(ate% in the 'ac+ of the throat#
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Cau$e$ of #e$piratory
Arre$t
2. Di$ea$e$
• 9ronchiti%• Pne(monia
• COP& and other re%piratory ine%%
C f # i t
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Cau$e$ of #e$piratoryArre$t
. *ther cau$e$
Eectroc(tionCirc(atory Coap%eStrang(ationChe%t Compre%%ion
&ro,ningPoi%oningEpiep%y 4 Aergy
S(Focation or Smo+e inhaation
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Articial #e$piration
(#e$cue Breathing)
/ proced(re of ca(%ing air to o, intoand o(t of the (ng% ,hen hi% nat(ra'reathing cea%ed or i% inade0(ate
/ techni0(e of 'reathing air into aper%on@% (ng% to %(ppy him theo8ygen needed to %(r$i$e
Arti*cia Re%piration
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p ;Re%c(e 9reathing<
• Gi$en to a $ictim ,ho are not'reathing or inade0(ate '(t %tiha$e p(%e#
• Cr(cia too to re$i$e the indi$id(aor +eep him.her (nti hep come%
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*!/ective$ of A#
=#To open air,ay ! head tit.chin
ift method"#To $entiate the (ng%# To re%tore'reathing
Way% to $entiate the (ng%
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Way% to $entiate the (ng%
0. 1outh to outh !reathing& Thi% in$o$e% the re%c(er ma+ing
a %ea 'et,een their mo(th andthe patient@% mo(th and 'o,ing4to pa%% air into the patient@% 'ody
Way% to $entiate the (ng%
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Way% to $entiate the (ng%
"# 1outh to no$e !reathing& :n%ome in%tance%4 the re%c(er may
need or ,i%h to form a %ea ,iththe patient@% no%e
Way% to $entiate the (ng%
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Way% to $entiate the (ng%
6# 1outh to outh and no$e
!reathing! U%ed in infant%; (%(ay
(p to aro(nd = year od<4 a% thi%form%
the mo%t eFecti$e %ea
Way% to $entiate the (ng%
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Way% to $entiate the (ng%
. 1outh to $toa !reathing!U%ed
,hen the mo(th and the no%e
i% inacce%%i'e#
/ U%(ay (%ed in ad(t%
Way% to $entiate the (ng%
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Way% to $entiate the (ng%
B# 1outh to face $hield !reathing!
:n$ention reate% to a de$ice for
performing ife %a$ing mo(th tomo(th
re%piration ,itho(t the operatordirecty
to(ching the mo(th of the patient
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Way% to $entiate the (ng%
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Way% to $entiate the (ng%
# 1outh to a$ !reathing& Mo%t organi5ation% recommend
the (%e of %ome %ort of 'arrier'et,een re%c(er and patient tored(ce cro%% infection ri%+# One
pop(ar type i% the poc+et ma%+
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Way% to $entiate the (ng%
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Way% to $entiate the (ng%
.Bag valve a$ device & A%impe
de$ice man(ay operated 'y there%c(er4 ,hich in$o$e%%0(ee5ing a 'ag to e8pe air into
the patient
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Specia Con%ideration% !
• Re%c(er to a$oid pre%%ing %oft ti%%(e(nder the chin thi% might o'%tr(ctthe air,ay#
• Re%c(er not to (%e the th(m' to iftthe chin
• Re%c(er not to co%e the $ictim@%
mo(th competey ;(ne%% mo(th tono%e i% the techni0(e<
i id i
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Specia Con%ideration% !
• Each re%c(e 'reath %ho(d gi$eeno(gh air to ma+e the che%t ri%eand 'e gi$en at = %econd#
• Re%c(er %ho(d a$oid dei$eringmore 'reath% ;more than the n(m'errecommended< or 'reath% that are
too arge or too forcef(#
S i C id i
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Specia Con%ideration% !
• Re%c(er% %ho(d ta+e a norma'reath ;not a deep 'reath< mo(th tomo(th or mo(th/to/'arrier de$ice
re%c(e 'reath% #
H d Ti Chi -if M h d
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Head Tit Chin -ift Method
=# 1nee near the ca%(aty@% %ho(der%
"# Pace one of yo(r hand% on theca%(aty@% forehead and appy *rm4'ac+,ard pre%%(re ,ith yo(r pam
to tit the ca%(aty@% head 'ac+#
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H d Tit Chi -ift M th d
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Head Tit Chin -ift Method
6# Pace the *ngertip% of yo(r otherhand (nder the tip of the 'ony part
of the ca%(aty@% o,er )a, and iftthe )a, to 'ring the chin for,ard#
The &ngertips should not press deeply intothe soft tissues under the chin since the pressure
could !t interfere with the casualty.s airway%
/se your &ngertips0 not your thumb0 to lift the chin%
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H d Tit Chi -ift M th d
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Head Tit Chin -ift Method
# -ift the chin for,ard (nti the (pper and
o,er teeth are amo%t 'ro(ght together#
The mouth should not be closed as this may bloc$ theairway%
!f needed0 the thumb may be used to
depress the casualty.s lower lip slightlyto $eep his mouth open%
a, Thr(%t Method
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a (% e od
=# 1nee 'ehind the ca%(aty@% headand re%t yo(r e'o,% on the
%(rface on ,hich the ca%(aty i%ying#
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a, Thr(%t Method
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"# Pace one hand on each %ide of theca%(aty@% head and gra%p the
ange% of the o,er )a, )(%t 'eo,the e$e of the teeth
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a, Thr(%t Method
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6# -ift ,ith 'oth hand% to mo$e the )a,for,ard# Thi% action ,i a%o ca(%ethe ca%(aty@% head to tit 'ac+#
$eep the head and nec$ from mo"ing more than
necessary%
!f mouth to mouth resuscitation0 e1orts are
not e1ecti"e0 you may need to increase the
bac$ward tilt of the head slightly
a, Thr(%t Method
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# :f the ca%(aty@% ip% are %ti co%edafter the )a, ha% 'een mo$ed
for,ard4 (%e yo(r th(m'% to retractthe o,er ip and ao, air to enter theca%(aty@% mo(th#
Cardiac Emergency and CPR
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Cardiac Emergency and CPR
Cardiac arre$t
/ Circ(ation %top%L p(%e and
'reathing %top% at the %ame timeor %oon thereafter
N i A t
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N(r%ing Aert
There are ony minor diFerence% in re%c(e'reathing for ad(t%4 chidren and infant%#
Often4 the oder the $ictim the greater the headtit to hep open the air,ay
Adult Child ,nfant*pening of 1a i tilt of +e tral pl $ +e tral po$ition
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*pening ofair3ay (headtilt chin lift
aneuver
1a4iu tilt ofthe head
+eutral plu$ +eutral po$ition
Location forchecing of
pul$e
Carotid pul$e Carotid pul$e Brachial pul$e
1ethod 1outh to outhor outh to
no$e
1outh to outhor outh to
no$e
1outh to outhand no$e
Breath$ 5ull" $lo3!reath (0.6 to 2
$econd$ per!reath)
5ull" $lo3regulated
!reath (0 to 0.6
$econd$ per!reath)
7entle " $lo3!reath
(0 to 0.6$econd$ per
!reath)
A#ventilation8$eco
nd$( 2 in frae)
0& 6(29 cycle$)
0 & ( 9: cycle$ )
0 & ( 9: cycle$ )
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A:RWA AN& 9REATH:NG
9-S CHANGES+' *LD #A,*+AL'
Cricoid :f an Randomi5ed
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9-S CHANGESCricoidpre%%(re i%
no ongerro(tineyrecommended for (%e ,ith$entiation%#
:f anade0(ate
n(m'er ofre%c(er% ,a%a$aia'e4one co(dappy cricoidpre%%(re#
Randomi5ed%t(die% ha$e
demon%tratedthat cricoidpre%%(re %tiao,% fora%piration#
:t i% a%o
dic(t topropery trainpro$ider% to
perform the
9-S CHANGES+' *LD #A,*+AL'
>-oo+4 i%ten4 and >-oo+4 With the ne, che%t
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9-S CHANGESfee for 'reathingDha% 'een reoved
from the %e0(encefor a%%e%%ment of'reathing afteropening the air,ay#
Heathcare pro$ider%'riey chec+ for'reathing ,henchec+ing
re%pon%i$ene%% todetect %ign% ofcardiac arre%t#
After dei$ery of 6com % one re%c(er%
i%ten4 andfee for
'reathingD,a% (%ed toa%%e%%'reathingafter theair,ay ,a%opened#
comp%3*r%t%e0(ence4 CPR i%
performed if the ad(t$ictim i%(nre%pon%i$e and not'reathing or not'reathing normay; ony ga%ping< and'egin% ,ith comp%;CA9<
Therefore4 'reathingi% 'riey chec+ed a%part of a chec+ forcardiac arre%t#
After the *r%t %et of
Reco$ery Po%ition
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Reco$ery Po%ition
:f the $ictim i% (ncon%cio(% '(t 'reathing!
– Ro the patient onto one %ide4 a% yo(
%(pport the patient@% head#
– Pace the patient@% face on hi% or her %ide
%o any %ecretion% drain o(t of the mo(thand the
tong(e ,on@t 'oc+ the air,ay#
Reco$ery Po%ition
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Reco$ery Po%ition• Adult and !hild
end Arm Kee legs straight
2la!e ba!8 of 0i!tim:s hand
against !hee8 and hold there
old 0i!tim:s hand against his
!hee8 to suort head
2ull bent leg and roll 0i!tim
to3ard you
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Reco$ery Po%ition in CPR
ands suorts head
bent 8nee re0ents rolling
ent arms gi0es stability
Po%%i'e Compication%
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Po%%i'e Compication%
Broen ri!$ Chec+ hand pacement andcontin(e
Po%%i'e Compication%
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Po%%i'e Compication%
7a$tric Di$ten$ion (air in the$toach)Can happen if the air,ay i% not open4 re/
tit headMa+e %(re 'reath% are not gi$en too
forcef(y or too fa%t4 gi$e in = %econd eachand ao, for e8haation
Gi$e 'reath% ony (nti the che%t ri%e%9e aert for $omiting and +eep air,ay cear
Po%%i'e Compication%
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Po%%i'e Compication%
Che$t doe$ not ri$eRepo%ition head and try 'reathagain# :f it@% %ti not ri%ing go right
to compre%%ion%
Po%%i'e Compication%
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Po%%i'e Compication%
<icti !reathe$ through a $toa(opening in the nec)
:f the che%t doe% not ri%e ,ith'reath%4 co$er mo(th and no%e forpo%%i'e air ea+age
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:mportant Con%ideration%
AD;L C=,LD ,+5A+*pening the 1a4iu tilt +eutral +eutral
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Air3ay of the head po$ition po$ition
Location of
opre$$ion
Center of the
che$t
Center of the
che$t
*ne (,)
nger 3idth!elo3 the
nipple line
1anner of
opre$$ion
=eel of the
hand" other
hand on top
=eel of the
hand
( 1 handdepending on the
size o the child )
5inger$ (!iddle and ring
"ngertips)
Depth che$t
copre$$ion
2 inche$ (6
c)
2 inche$ (6
c)
0 > inche$
(9c)
# ratio of che$tpre$$ion to
entilation$
2 in frae )
:&2( 6 cycle$) :&2( 6 cycle$) :&2( 6 cycle$)
P# counting 0"2""9"6"?""@""0:"00"02"0"09"06"0?"0"0@"0
"2:"0"2""9"6"?""@" and 0 (2 ventilation$) up
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Se0(ence
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2oreign Body Airway
3bstruction 4anagement
"%&A'#
7 i 9 d Ai O' t ti
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7oreign 9ody Air,ay O'%tr(ction
;79AO< a !ondition 3hen solid material
li8e !hun8ed foods !oins0omitus small toys et! areblo!8ing the air3ay
Ca(%e% of Air,ay O'%tr(ction
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Ca(%e% of Air,ay O'%tr(ction
1 Imroer !he3ing of largeie!es of food
# *9!essi0e Al!ohol Inta8e
a +ela9ation of the tongue ba!8
into the throat
b Asirated 0omitus
Dstoma!h !ontentE
Ca(%e% of Air,ay O'%tr(ction
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y
; The resen!e of loose uer andlo3er dentures
4 For older !hildren 3ho arerunning 3hile eating
5 For smaller !hildren of hand to
mouth stage left unattended
7oreign 9ody Air,ay O'%tr(ctionM t
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Management
3o ype$ of *!$truction
=# Anatomica
"# Mechanica
T T f O' t ti
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T,o Type% of O'%tr(ction
$% Anatomical struction Happens wen te tongue drops
back and obstructs te troat$
'ter causes are acute astma,croup, dipteria, swelling
and coug "wooping#
T,o Type% of O'%tr(ction
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yp
'% Mechanical struction (en !oreign objects lodge in te
paryn) or airways* !luids
accumulate in te back in tetroat$
7oreign 9ody Air,ay O'%tr(ctionManagement
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Management
Cla$$ication of*!$truction
1 )ild# Se0ere
Ca%%i*cation of O'%tr(ction
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Ca%%i*cation of O'%tr(ction
$% Mil# struction
A% Si(ns
+$ ood air e)cange
$ .esponsive and can coug!orce!ully
/$ May wee0e between coug
1$ Has increased respiratory
di!!iculty$
= Mid O'%tr(ction
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=# Mid O'%tr(ction
)% *escuer Actions
As long as good air e)cangecontinues$
a$ 2ourage te victim to continue
spontaneous couging and breating e!!orts
b$ Do not inter!ere wit te victim3s
own attempts to e)pel te !oreign
body, but stay wit im and
monitor is condition$
Ca%%i*cation of O'%tr(ction
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Ca%%i*cation of O'%tr(ction
'% Se+ere struction A% Si(ns
+$ Poor or no air e)cange
$ (eak or ine!!ective coug or no coug at all$
/$ Hig-pitced noise wile
inaling or no noise at all$
1$ 4ncrease respiratory di!!iculty
# Se0ere (bstru!tion
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# Se0ere (bstru!tion A Signs
5$ 2yanotic 6$ 7nable to speak
8$ 2lutcing te neck wit te tumb
and !ingers making te universalsign o! coking
9$ Movement o! air is absent$
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Are yo( cho+ing?
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Are yo( cho+ing?
1ild *!$tructionictim i% a'e to co(gh
or i% gagging
ictim i% a'e to %pea+and 'reath
Enco(rage $ictim toco(gh and monitorthem in ca%e the air,ay
'ecome% 'oc+ed
Severe *!$tructionictim ha% ineFecti$e
co(gh
ictim i% (na'e to %pea+or 'reath
ictim i% di%paying theUni$er%a Sign
for cho+ing
Prepare to hep $ictim
Abdominal Thrust
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• an emergen!y ro!edure forremo0ing a foreign ob=e!t lodgedin the air3ay that is re0enting a
erson from breathing
• ,ote : A: sould not be usedin!ants under + year o! age due tote risk o! causing injury$
Management of 7oreign 9odyAir,ay O'%tr(ction%
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Air,ay O'%tr(ction%
Air,ay o'%tr(ction in an ad(t orchid
:f the $ictim i% con%cio(%4 %tand 'ehind
them and perform a'domina thr(%t%#:f the $ictim i% o'e%e or pregnant4 %tand
'ehind them and perform che%t thr(%t%in%tead of a'domina thr(%t%#
Management of 7oreign 9odyAir,ay O'%tr(ction%
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Air,ay O'%tr(ction%
:f the $ictim 'ecome% (nre%pon%i$e!
En%(re that the EMS %y%tem ha%'een acti$ated#
Perform CPR4 remem'ering to
chec+ the mo(th for foreigno')ect% 'efore each 'reath#
Step% for Managing Air,ay O'%tr(ction in aCon%cio(% Ad(t or Chid
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Co %c o(% d( o C d
=# -oo+ for %ign% ofcho+ing#
"# Pace yo(r *%t,ith the th(m' %ideagain%t the patient@%a'domen4 )(%t
a'o$e the na$e#
6# Gra%p the *%t,ith yo(r otherhand and pre%% intothe a'domen ,ith
0(ic+ in,ard and(p,ard thr(%t%#
5oreign Body Air3ay *!$truction1anageent
Give 5 blowsirway clear!monitor
til h l i
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Give 5 blows
Still choking
Give 5 abdominal
thrusts
Still choking
If obviously pregnant or
known to be pregnant :
give 5 chest thrusts
irway clear!monitor
until help arrives
If victim"patient becomes
unconscious# provide
intervention for unconscious
choking victim
until help arrives
Performing A'domina Thr(%t (nderSpecia Con%ideration% !
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Specia Con%ideration% !
#$viously pregnant and very#$ese victi!
The main di1erence in performing
abdominal thrust on this group of people is the placement of the &sts% instead of using abdominal thrust0
chest thrust are used% the &sts are placed against the middle
of the breastbone and do chest thrust%
Ca(tion ! for pregnant and
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Ca(tion ! for pregnant and
o'e%e $ictim
• if the regnant and obese
be!ome un!ons!ious call "orELP an# per"orm CP*
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:nfant Cho+ing
;9irth to = year<
Recogni5e cho+ing
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Q Cannot cry or ma+e norma%o(nd%
Q Sient co(gh
Q 9reathing ,ith high/pitchednoi%e%
Q May oo+ '(e4 frightened
Management
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7ive 6 !ac $lap$& Hod the infant facedo,n and
%(pport the )a, and head
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Management
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Gi$e 6 che$t thru$t$&urn the infant
o$er ,hie %(pporting the head
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Management
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Aternate 6 !ac $lap$ and6 che$t thru$t$ until
Q O')ect come% o(tor Q :nfant can cry forcef(y
or Q :nfant %top% re%ponding
Management
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g
:f the infant %top% re%ponding
Q 9egin %tep% of CP#
Q Each time yo( open the air,ay4 loo forthe o!/ect (reove it if $een)
Q After B cyce%4 phone EMS
Q Re%(me CPR (nti infant %tart% to mo$eor EMS re%c(er% ta+e o$er
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79AO Management !Ad . Chid . : f
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Ad(t . Chid . :nfant
1 >etermine s!ene safety
# Introdu!e yourself to the 0i!timguardian or bystander
; >etermine le0el of breathing diffi!ultyby !he!8ing
a. Infant : ine!!ective coug, weak orabsence o! cry
% Chil#.a#ult : by asking i! te
victim is coking$
79AO Management !Ad(t . Chid . :nfant
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. .
4 2roerly osition the 0i!tim
a Infant : suort the infant on
the res!uer:s 8nee or la
b Child adult : assume
straddle osition behind
the 0i!tim
79AO Management !Ad(t . Chid . :nfant
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5 o!ate roer site a Infant : gi0e 5 ba!8 slas and
5 !hest thrusts using fingers
te!hniues b Child adult for abdominal
thrust roerly osition balled
fist on the atient roerly erform abdominal thrust
79AO Management ! Ad(t . Chid .:nfant
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:nfant
6 Carefully lay do3n un!ons!ious atient
Call for hel to a!ti0ate )edi!al Assistan!eDfor ediatri!s and adultsE and erformC2+
"Che!8 oral !a0ity for resen!e ofobstru!tion
- Is foreign body is 0isible
erform finger s3ee
- if not 0isible roerly administer first res!ue breathing
79AO Management ! Ad(t . Chid . :nfant
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L If air boun!e ba!8 re-osition 0i!tim:s
head and roerly administer se!ond
+
1$ After # minutes if not yet done
a!ti0ate *)S11 If still un!ons!ious erform C2+ and
aly A*> if a0ailable
1# If 0i!tim be!omes !ons!ious
roerly la!ed in re!o0ery
osition
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#eference$• +,+ !nternational Consensus on
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+,+ !nternational Consensus onCardiopulmonary 5esuscitation and 6mergency
Cardio"ascular Care Science 7ith Treatment5ecommendations
• +,+ American 8eart Association and American5ed Cross !nternational Consensus on 2irst Aid
Science 7ith Treatment 5ecommendations• +,+ American 8eart Association 9uidelines for
Cardiopulmonary 5esuscitation and 6mergencyCardio"ascular Care
• +,+ American 8eart Association and American5ed Cross 9uidelines for 2irst Aid
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