Performance Guidelines

Relief of Obstructed Airway: Unconscious Child (1 to 8 years)

Objectives Critical Performance Reason

Assessment:
Determine unresponsiveness. Shout for help.

Action:
Position the child on back.

Tap or gently shake victim's shoulder.

Shout "Are you OK?" Call out "Help!"

Turn child on back holding head and body as a unit, supporting head and neck.
This initial call for help is to alert bystanders so they can activate the EMS system while you care for the child.

Action:
Open the airway.

Assessment:
Determine breathlessness.

Use the head tilt–chin lift maneuver to position the child's head in a neutral position and open the airway.

Place your ear over the child's mouth and observe the chest.

Look at the chest for movement.

Listen for the sounds of
breathing.

Feel for breath on your cheek.

You must determine that the child is not breathing.

Action:
Open the airway and try to give 2 rescue breaths. Observe the rise of the chest with each breath.

Action:
If initial rescue breaths are unsuccessful, reposition the head and try again. If repeat attempts are unsuccessful, perform Heimlich thrusts.

Use the thumb and forefinger of the hand that is maintaining pressure on the child's forehead to pinch the nostrils closed. Make a tight seal with your mouth over the child's mouth. Give 2 rescue breaths.

Reposition the child's head and lift the chin. Pinch the nostrils closed. Seal the mouth properly and try again to give rescue breaths.

Complete airway obstruction by a foreign body is assumed if the child becomes unconscious, but if the child is found unconscious, an attempt must be made to get some air into the lungs. If the chest rises, the airway is open. If the chest does not rise, the airway is obstructed.

Improper head tilt–chin lift is the most common reason that airway obstruction is not relieved.

Action:
Perform the Heimlich maneuver (up to 5 thrusts). The Heimlich maneuver:
Kneel at the child's hips if the child is on the floor; stand at child's side if the child is on a table. If the child is large, you may kneel astride the child's thighs. Place the heel of one hand on the abdomen midline, slightly above the navel and well below the sternum and xiphoid. Place the second hand directly on top of the first hand. Press into the abdomen with quick upward thrusts. Such thrusts can force air upward into the airway from the lungs with enough pressure to expel the foreign body.

Action:
Perform tongue-jaw lift. Check for a foreign object and if you see it, remove it. Lift tongue and jaw forward by putting your thumb in the child's mouth over the tongue and wrapping your fingers around the lower jaw. If you see a foreign body, remove it. Do not perform a blind finger sweep. A dislodged foreign body may now be manually accessible if it has not been expelled. Blind finger sweeps may push the obstructing object back into or further into theairway.

Action:
Open the airway and try to give rescue breaths. If unsuccessful, reposition the head and try again.
Position the child's head using the head tilt–chin lift maneuver. Seal the mouth properly and try again to give rescue breaths.

If the airway remains obstructed, alternate the following maneuvers in rapid sequence:

Perform Heimlich maneuver.
Perform tongue-jaw lift, check for foreign body, and remove it if seen.
Open the airway.
Attempt, reattempt rescue breathing while maintaining an open airway.

Repeat this sequence until
successful.

By this time another attempt must be made to get some air into the victim's lungs.

You must try again to dislodge the foreign body and give rescue breaths.

Persistent attempts should be made in sequence to relieve the obstruction. As the child becomes more deprived of oxygen, the muscles will relax, and maneuvers that were previously ineffective may become effective.

Action:
Activate the EMS system after approximately 1 minute.
If you are alone, activate the EMS system after approximately 1 minute of effort.

If there is no breathing, give 2 breaths. Check for a pulse.

If a pulse is present, provide 20 breaths per minute and continue to monitor pulse.
If there is no pulse, begin cycles of compressions and breaths.

If breathing resumes and there is no evidence of trauma, place the child on one side in the recovery position and await the arrival of emergency personnel.

Objectives	Critical Performance	Reason
Assessment: Determine unresponsiveness. Shout for help. Action: Position the child on back.	Tap or gently shake victim's shoulder. Shout "Are you OK?" Call out "Help!" Turn child on back holding head and body as a unit, supporting head and neck.	This initial call for help is to alert bystanders so they can activate the EMS system while you care for the child.
Action: Open the airway. Assessment: Determine breathlessness.	Use the head tilt–chin lift maneuver to position the child's head in a neutral position and open the airway. Place your ear over the child's mouth and observe the chest. Look at the chest for movement. Listen for the sounds of breathing. Feel for breath on your cheek.	You must determine that the child is not breathing.
Action: Open the airway and try to give 2 rescue breaths. Observe the rise of the chest with each breath. Action: If initial rescue breaths are unsuccessful, reposition the head and try again. If repeat attempts are unsuccessful, perform Heimlich thrusts.	Use the thumb and forefinger of the hand that is maintaining pressure on the child's forehead to pinch the nostrils closed. Make a tight seal with your mouth over the child's mouth. Give 2 rescue breaths. Reposition the child's head and lift the chin. Pinch the nostrils closed. Seal the mouth properly and try again to give rescue breaths.	Complete airway obstruction by a foreign body is assumed if the child becomes unconscious, but if the child is found unconscious, an attempt must be made to get some air into the lungs. If the chest rises, the airway is open. If the chest does not rise, the airway is obstructed. Improper head tilt–chin lift is the most common reason that airway obstruction is not relieved.
Action: Perform the Heimlich maneuver (up to 5 thrusts).	The Heimlich maneuver: Kneel at the child's hips if the child is on the floor; stand at child's side if the child is on a table. If the child is large, you may kneel astride the child's thighs. Place the heel of one hand on the abdomen midline, slightly above the navel and well below the sternum and xiphoid. Place the second hand directly on top of the first hand. Press into the abdomen with quick upward thrusts.	Such thrusts can force air upward into the airway from the lungs with enough pressure to expel the foreign body.
Action: Perform tongue-jaw lift. Check for a foreign object and if you see it, remove it.	Lift tongue and jaw forward by putting your thumb in the child's mouth over the tongue and wrapping your fingers around the lower jaw. If you see a foreign body, remove it. Do not perform a blind finger sweep.	A dislodged foreign body may now be manually accessible if it has not been expelled. Blind finger sweeps may push the obstructing object back into or further into theairway.
Action: Open the airway and try to give rescue breaths. If unsuccessful, reposition the head and try again.	Position the child's head using the head tilt–chin lift maneuver. Seal the mouth properly and try again to give rescue breaths. If the airway remains obstructed, alternate the following maneuvers in rapid sequence: Perform Heimlich maneuver. Perform tongue-jaw lift, check for foreign body, and remove it if seen. Open the airway. Attempt, reattempt rescue breathing while maintaining an open airway. Repeat this sequence until successful.	By this time another attempt must be made to get some air into the victim's lungs. You must try again to dislodge the foreign body and give rescue breaths. Persistent attempts should be made in sequence to relieve the obstruction. As the child becomes more deprived of oxygen, the muscles will relax, and maneuvers that were previously ineffective may become effective.
Action: Activate the EMS system after approximately 1 minute.	If you are alone, activate the EMS system after approximately 1 minute of effort. If there is no breathing, give 2 breaths. Check for a pulse. If a pulse is present, provide 20 breaths per minute and continue to monitor pulse. If there is no pulse, begin cycles of compressions and breaths. If breathing resumes and there is no evidence of trauma, place the child on one side in the recovery position and await the arrival of emergency personnel.