Public Health, safety

34. Basic CPR and Management of Choking for Children of All Ages

When an infant or child suddenly needs CPR, knowing what to do can be lifesaving. The steps for resuscitating infants and children are outlined below:

ONE. Always make sure the area is safe for you and the victim.

TWO. Assess the need for CPR:

Check for Response: Gently tap the victim and ask loudly, “Are you okay?”

Call the child’s name if you know it. If the child is responsive, he or she will answer, move, or moan. If the child is unresponsive, shout for help.

Check for Breathing: If you see regular breathing, the victim does not need CPR.

If you are alone and the child is breathing, leave the child to phone 911, but return quickly and recheck the child’s condition frequently.

Children with respiratory distress often assume a position that keeps the airway open and optimizes ventilation. Allow the child with respiratory distress to remain in a position that is most comfortable.

If there is no evidence of trauma, you can turn a breathing child onto the side (recovery position), which helps maintain a patent airway and decreases risk of aspiration.

THREE. Begin CPR

If the victim is unresponsive and not breathing (or only gasping), begin CPR. See TABLE with comprehensive CPR instructions at the end of this post.

Sometimes victims who require CPR will gasp, which may be misinterpreted as breathing. Treat the victim who is gasping as though there is no breathing and begin CPR.

FOUR. Open the Airway and Give Ventilations.

For infants and children, two rescue breaths can be given before starting chest compressions. If a known respiratory problem has caused a child to become unresponsive, CPR should begin with rescue breathing. For unresponsive adults, CPR should begin with chest compressions.

Open the airway using a head tilt–chin lift maneuver for both injured and non-injured victims. For trauma victims, be careful not to manipulate the spine when opening the airway.

Make sure the breaths are effective (i.e. the chest rises). Each breath should take about 1 second. In an unresponsive infant or child, the tongue may obstruct the airway and interfere with ventilations. If the chest does not rise, reposition the head, make a better seal, and try again. It may be necessary to move the child’s head through a range of positions to provide optimal airway patency and effective rescue breathing.

FIVE. Start Chest Compressions

Move the victim to a hard surface before starting chest compressions if possible. Allow FULL RECOIL of the chest while doing compressions!

SIX. Coordinate Chest Compressions and Breathing: After giving 2 breaths, immediately give 30 compressions. The lone rescuer should continue this cycle of 30 compressions and 2 breaths for approximately 2 minutes (about 5 cycles) before leaving the victim to activate the emergency response system and obtain an automated external defibrillator (AED) if one is nearby.

When to use an automated external defibrillator, or AED: If a child (or adult) collapses suddenly for unknown reasons, he may be suffering from a treatable cardiac arrhythmia. In this case, apply an AED to the chest wall as quickly as possible if one is available. Follow the prompts issued by the AED. Make sure no one (including yourself) is touching the victim while administering shocks. Ideally, for children who weigh < 55 pounds, an AED with pediatric pads should be used. For infants, a manual defibrillator should be used by emergency medical providers.

HOW TO MANAGE A CHOKING CHILD:

ONE. Choking but still breathing:

If a child is choking and having some breathing difficulties—but is still able to speak or has a strong cough—do nothing yourself; the child’s cough is better than any back blows or abdominal thrusts (Heimlich maneuver). Call 911 so that the child can be transported to an emergency department, since a partial blockage of the airway could turn into a complete one.

TWO. Conscious but not breathing, or cough is very weak:

Have someone call 911.

Perform the Heimlich maneuver with the child lying, sitting, or standing:

For a conscious child who is sitting or standing, position yourself behind the child and wrap your arms around the waist. Place the thumb side of your fist on the middle of the abdomen, well below the lower tip of the breastbone. Then grab that fist with your free hand, press inward with rapid, upward thrusts. Repeat the thrusts five times until the object is coughed up or the child begins to breathe or cough.

If this doesn’t work, you can also administer five back blows to help dislodge the object.

THREE. Choking and unconscious:

Try to clear the airway

Lower the child to the floor on her back and try using the tongue-jaw lift. Open the child’s mouth, with your thumb held over her tongue, and your fingers wrapped around the lower jaw; as this draws the tongue away from the back of the throat, you may be able to clear the airway. If you can see the foreign object, try removing it with a sideways sweep of a finger; use this approach carefully, however, since it could push the object even farther down the airway, causing additional blockage. Don’t do a finger sweep blindly, as this can push obstructing objects further into the airway.

Give two rescue breaths if breathing still has not resumed. Tilt the child’s head back gently and lift her chin. Then place your own mouth over the child’s mouth and, pinching the nose shut, give two slow breaths, each lasting one and a half to two seconds.

If rescue breathing is not successful, return to the Heimlich maneuver. Kneeling at the child’s feet, place the heel of one of your hands in the midline between the navel and rib cage. Then place your other hand on top of the first one. Next, press firmly but gently into the abdomen, using six to ten rapid inward and upward thrusts.

If the child remains unresponsive, continue basic CPR until help arrives, alternating chest compressions with rescue breathing.

HOW TO MANAGE A CHOKING INFANT:

ONE. Assume a seated position and hold the infant face down on your forearm, which is resting on your thigh. Support the infant’s head and neck with your hand, and place the head lower than the trunk.

TWO. Thump the infant gently but firmly five times on the middle of the back using the heel of your hand. Keep your fingers pointed up to avoid hitting the infant in the back of the head.

THREE. Turn the infant faceup on your forearm, resting on your thigh with the head lower than the trunk if the infant still isn’t breathing. Using two fingers placed at the center of the infant’s breastbone, give five quick chest compressions. Press down about 1 1/2 inches, and let the chest rise again in between each compression.

FOUR. Provide two rescue breaths.

FIVE. Repeat the back blows and chest thrusts if breathing doesn’t resume. Call for emergency medical help.

SIX. Begin infant CPR, alternating rescue breathing with chest compressions, if the infant doesn’t resume breathing.

 

COMPREHENSIVE INSTRUCTIONS FOR CPR IN ALL AGE GROUPS

 

  INFANTS CHILDREN

(age 1-puberty)

When to call

  911

CPR X 2 minutes, then call 911 CPR X 2 minutes, then call 911
Ventilation or compression first? 2 rescue breaths first

 (because unresponsiveness in infants is often caused by breathing issues)

start with breathing or compressions

 (breathe first for a known respiratory problem)

Compression-

Ventilation

Ratio

30 : 2 (lone rescuer)

15 : 2 (two rescuers)

30 : 2 (lone rescuer)

15 : 2 (two rescuers)

How to administer

compressions

 

Use 2 – 3 fingers Use heel of 1 or 2 hands
Depth 1/3 depth chest (about 1/2 inch) 2 inches
Location Center of chest below nipples Center of chest below nipples
Rate compressions 100 – 120 per comp/min

(push 1-2 times per second)

100 – 120 comp/min
Rate rescue breathing 1 breath every 3 – 5 seconds, 1 second per breath 1 breath every 3 – 5 seconds, 1 second per breath
Breathing technique Mouth over nose and mouth; or pinch nose and breath into mouth

 

Pinch nose, mouth to mouth

 

 

  ADULT
When to call

  911

Call 911, then start CPR
Ventilation or compression first? compressions first
Compression-

Ventilation

Ratio

30 : 2 (one or two rescuers)
How to administer

compressions

 

Use 2 hands
Depth 2 – 2.4 inches max
Location Center of chest below nipples
Rate compressions 100 – 120 comp/min
Rate rescue breathing 1 breath every 5 seconds, 1 second per breath
Breathing technique Pinch nose, mouth to mouth