Airway Obstruction in Unconscious Persons 3

Airway Obstruction

• The tongue is the most common airway obstruction in an unconscious person.
• The tongue can fall back into the throat when the person is not conscious enough to prevent it.

Opening the Airway

• Use the head tilt/chin lift method for non-trauma victims to open the airway.
• Place one hand on the forehead and the other hand underneath the chin.
• Gently push down on the forehead while lifting the chin to open the airway.
• Be cautious not to lift the chin too hard, as it can close the child's mouth, and tilting the head too far back can occlude the airway.

Rescue Breathing

• The rescue breathing portion of child/infant CPR is highly recommended.
• If not properly trained, "fast-n-hard" chest compressions at a rate of 100 to 120 per minute are appropriate.
• However, rescue breathing must be conducted properly to be effective.

Child CPR Technique

• After opening the airway, pinch the nose shut and deliver the first rescue breath slowly and evenly until the chest visually rises.
• Chest compressions can begin after the first rescue breath.
• Use one-handed or two-handed compressions depending on the child's size and your strength.
• Press straight down on the child's chest hard enough to compress the sternum 2 inches (5 cm) or approximately 1/3 the depth of the child's chest.
• Deliver chest compressions at a rate of 100 to 120 per minute.

CPR Cycle

• Deliver 30 "hard-n-fast" chest compression cycles, followed by 2 rescue breaths.
• Continue CPR cycles until an AED or EMS arrives, the victim shows obvious signs of life, or the scene becomes too unsafe to continue care.

Infant CPR

• Cardiac arrest in infants is uncommon but can occur due to asphyxia or respiratory ailments.
• Most non-traumatic infant cardiac arrests respond favorably to rescue breathing.
• All unresponsive infants should receive CPR, including rescue breathing, until reaching the hospital if possible.

Universal Precautions

• Minimal universal precautions for CPR include:
  • Protective exam gloves
  • Barrier device when using mouth-to-mouth rescue breathing

Infant CPR Protocol

• Conduct CPR on infants under the age of one year.
• Follow the National CPR Standards: Compressions - Airway - Breathing - Defibrillation (CABD).
• Check for consciousness by tapping or tickling the infant's foot and making noise.
• If unresponsive, position the infant on a flat surface, with the face up, and begin compressions.

Compression Technique

• Proper placement for chest compressions is just below the nipple line.
• Place three fingers in the center of the infant's chest, with the top finger between the nipples, to find the correct placement.

Keys to Successful CPR

• High-quality, "fast-n-hard" CPR, including rescue breathing, gives the infant the greatest chance of survival.
• Continue CPR until:
  • The infant shows signs of life (breathing or moving).
  • Another person with higher training takes over.
  • Physical exhaustion or injury prevents continuation.
  • It becomes too dangerous to continue.

Defibrillation

• Most newer model AEDs deliver normal defibrillation energy levels to adults or children, depending on the size pad selected.
• Pediatric pads are designed for children and deliver lower energy levels to infants and children up to eight years old/less than 55 pounds.

Infant CPR

• Infant CPR should be conducted on any child under the age of one year.
• To check for consciousness, tap or tickle the bottom of the infant's foot and make noise.

Compressions

• Proper placement for chest compressions on an infant is just below the nipple line, at the center of the infant's sternum.
• To find the correct placement, place three fingers in the center of the infant's chest with the top finger between the nipples.
• If the notch at the bottom of the infant's sternum is felt with the compression fingertips, move them up slightly toward the head.
• Administer 30 chest compressions on an infant at 1.5 inches deep (1/3 their chest diameter).
• Compressions should be delivered "fast-n-hard" at a depth that maximizes blood flow without causing injury.
• Ensure compressions are delivered smoothly, not with stiff, rigid, or spastic motions.

Airway

• Opening the infant's airway is safely accomplished by applying a gentle head-tilt/chin-lift maneuver.
• The airway must be open so that air can enter and exit the lungs.
• The tongue is the most common airway obstruction in any unconscious victim and can prevent adequate airflow during CPR.

Breathing

• Once the victim's airway is properly open, ensure the barrier device is in place before delivering the first rescue breath.
• To properly deliver a breath to an infant, simultaneously cover their nose and mouth with your mouth.
• It should take about a second to fill the victim's lungs and about a second for exhalation to occur naturally.
• Repeat the rescue breath once more before proceeding with the next cycle of 30 chest compressions.

General

• The minimal universal precaution requirements for conducting CPR on any person of any age consist of protective exam gloves and the use of a barrier device when mouth-to-mouth rescue breathing is used.
• Employ C, A, B, D: Compressions - Airway - Breathing - Defibrillation.