Performance Guidelines

Relief of Obstructed Airway: Conscious Infant (younger than 1 year)

Objectives Critical Performance Reason

Assessment:
Determine complete airway obstruction either by observing sudden onset of signs of complete airway obstruction or by the circumstances in which the infant is found.
Rescuer must identify complete airway obstruction by the presence of breathing difficulty, an absent or ineffective cough, dusky color, and an inability to make sounds.

If the infant is able to cough or cry, do not interfere with the infant's attempts to expel the object.

In the conscious infant it is essential to recognize the signs of complete airway obstruction and take prompt action.

If the infant is able to cough or cry, air is getting through the trachea (windpipe) and the obstruction is not complete. In such a situation, you may make things worse by interfering.

If the infant is unable to cry or cough effectively:

Action:
Deliver up to 5 back blows.

Support the infant's head and neck with one hand firmly holding the jaw. Place the infant face down on your forearm, keeping the head lower than the trunk.

With the heel of your free hand, deliver up to 5 back blows forcefully between the infant's shoulder blades.
You must hold the infant's head firmly to avoid injury. The back blows increase pressure in the airway and may help dislodge the object.

Action:
Deliver up to 5 chest thrusts over the lower half of the sternum (avoid the xiphoid).
Supporting the head, sandwich the infant between your hands and arms and turn the infant on his or her back, keeping the head lower than the trunk.

Deliver up to 5 thrusts over the lower half of the breastbone, using the same landmarks as those for chest compression. Make sure your fingers are not placed over the very bottom of the sternum (xiphoid).

Deliver the chest thrusts more slowly than when doing chest compressions.
Such thrusts can force air upward into the airway from the lungs with enough pressure to expel the foreign object.

Action:
Repeat the sequence of 5 back blows and 5 chest thrusts until the object is expelled or until the infant becomes unconscious. Be persistent!
Alternate these maneuvers in rapid sequence:

Back blows
Chest thrusts
Persistent attempts should be made to relieve the obstruction. As the infant becomes more deprived of oxygen, the airway muscles will relax, and maneuvers that were previously ineffective may become effective.

Objectives	Critical Performance	Reason
Assessment: Determine complete airway obstruction either by observing sudden onset of signs of complete airway obstruction or by the circumstances in which the infant is found.	Rescuer must identify complete airway obstruction by the presence of breathing difficulty, an absent or ineffective cough, dusky color, and an inability to make sounds. If the infant is able to cough or cry, do not interfere with the infant's attempts to expel the object.	In the conscious infant it is essential to recognize the signs of complete airway obstruction and take prompt action. If the infant is able to cough or cry, air is getting through the trachea (windpipe) and the obstruction is not complete. In such a situation, you may make things worse by interfering.
If the infant is unable to cry or cough effectively: Action: Deliver up to 5 back blows.	Support the infant's head and neck with one hand firmly holding the jaw. Place the infant face down on your forearm, keeping the head lower than the trunk. With the heel of your free hand, deliver up to 5 back blows forcefully between the infant's shoulder blades.	You must hold the infant's head firmly to avoid injury. The back blows increase pressure in the airway and may help dislodge the object.
Action: Deliver up to 5 chest thrusts over the lower half of the sternum (avoid the xiphoid).	Supporting the head, sandwich the infant between your hands and arms and turn the infant on his or her back, keeping the head lower than the trunk. Deliver up to 5 thrusts over the lower half of the breastbone, using the same landmarks as those for chest compression. Make sure your fingers are not placed over the very bottom of the sternum (xiphoid). Deliver the chest thrusts more slowly than when doing chest compressions.	Such thrusts can force air upward into the airway from the lungs with enough pressure to expel the foreign object.
Action: Repeat the sequence of 5 back blows and 5 chest thrusts until the object is expelled or until the infant becomes unconscious. Be persistent!	Alternate these maneuvers in rapid sequence: Back blows Chest thrusts	Persistent attempts should be made to relieve the obstruction. As the infant becomes more deprived of oxygen, the airway muscles will relax, and maneuvers that were previously ineffective may become effective.