Assessment:
Determine unresponsiveness. Shout for help.
Action:
Position the infant on his or her back.
Tap or gently shake victim's shoulder. Call out "Help!" If help arrives, send someone to activate the EMS system.
Turn the infant as a unit, supporting head and neck. Place the infant on a firm surface. If the infant's head or neck has possibly been injured, turn the infant carefully, holding the head and neck as a unit to avoid bending or turning the neck.
You do not want to begin CPR unnecessarily if the infant is sleeping. A call for help will summon persons nearby but allow you to begin CPR if necessary.
For CPR to be effective, the infant must be flat on his or her back on a firm surface. CPR cannot be performed if the infant is face down.
Action:
Open the airway
(head tilt–chin lift).
Assessment:
Determine breathlessness.
Lift the chin up and out gently with one hand while pushing down on the
forehead with the other to tilt the head back into a neutral position. Don't
close the mouth. If
trauma is suspected, use the jaw thrust to open the airway.
Maintain an open airway. Turn your head toward the infant's chest with your ear directly over and close to the infant's mouth.
Look at the chest for movement.
Listen for the sounds of breathing.
Feel for breath on your cheek.
The airway must be opened to determine whether the infant is breathing. Infants may be unable to breathe because the tongue is obstructing the airway.
Hearing and feeling are the only true ways of determining the presence of effective breathing. If there is chest movement but you cannot feel or hear air, the airway may still be obstructed.
Rescue breathing should not be performed on someone who is breathing effectively.
If the victim is not breathing, provide rescue breathing. Give 2 slow rescue breaths (1 to 1½ seconds per breath). Observe the rise of the chest with each breath.
Maintain pressure on the infant's forehead to keep the head tilted. With the other hand lift the chin, open your mouth wide and take a deep breath. Cover the infant's mouth and nose with your mouth, making a tight seal. Breathe into the infant's mouth and nose twice, completely refilling your lungs between breaths. Watch for the infant's chest to rise.
Each rescue breath is given over 1 to 1½ seconds, allowing the infant's lungs to deflate between breaths. If the rescue breaths do not cause the infant's chest to rise, the airway is obstructed. Reposition the head, lift the chin, and try again. If the chest still does not rise with the rescue breath, start the relief of obstructed airway sequence.
It is important to get as much oxygen as possible into the infant. If your rescue breathing is effective, you will
- Feel air going in as you blow
- Feel the air leaving your own lungs
- See the infant's chest rise and fall
The most common cause of an obstructed airway is that the airway has not been properly opened.
Place 2 or 3 fingers on the inside of the infant's upper arm, between the elbow and shoulder. Press gently on the inside of the arm with your index and middle fingers. Maintain head tilt with the other hand. Feel for the brachial pulse.
- If pulse is present and breathing has not resumed, breathe for the infant at the rate of 20 times per minute.
- If there is no pulse, start chest compressions.
Begin the first cycle of chest compressions.
To begin the first cycle, imagine a line drawn between the infant's nipples. Place 2 or 3 fingers on the breastbone (sternum) about 1 finger's width below that line. Because of wide variations in the relative sizes of rescuers' hands and infants' chests, these instructions are only guidelines. After finding the position for compressions, make sure your fingers are not over the bottom of the sternum (xiphoid). Compress the infant's chest downward approximately one third to one half the depth of the chest (about ½ to 1 inch, but these measurements are not precise) at least 100 times per minute.
Compress smoothly and
evenly, and release pressure between compressions to allow the chest to
return to its normal position. Do not lift your fingers
off the chest.
To achieve a proper rate and ratio, count aloud: "one-two-three-four-five-breathe . . . ."
Proper finger placement is important to maximize the effectiveness of compressions and minimize the risk of injury to the infant.
With each compression, you want to squeeze the heart and increase pressure within the chest so that blood moves to the vital organs.
Give 5 compressions and 1 breath.
1 breath.
Action:
Activate the EMS system at the end of 20 cycles or 20 rescue breaths (approximately
1 minute).
After EMS notification, resume CPR, beginning with chest compressions.
Check every few
minutes for return of pulse.
Know your local EMS telephone number. If a second person is available, he or she should telephone the local EMS immediately while you continue CPR. If you are alone, perform CPR for approximately 1 minute before activating the EMS system.
- If the pulse returns, check for spontaneous breathing.
- If there is no breathing, give 1 rescue breath every 3 seconds (20 breaths per minute) and monitor the pulse.
- If breathing resumes, maintain an open airway and monitor breathing and pulse.
- If pulse and breathing resume and are regular and there is no evidence of trauma, turn the infant on his or her side, continue to monitor breathing and pulse, and await rescue personnel.