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<HTML> <HEAD> <META NAME="GENERATOR" CONTENT="Adobe PageMill 2.0 Win"> <TITLE>Untitled Article</TITLE> </HEAD> <BODY TEXT="#bafddc" LINK="#ffcc66" VLINK="#5cf373" BGCOLOR="#006666" ALINK= "#fb1814"> <H1><A NAME="anchor107005"></A>PEDIATRIC BASIC LIFE SUPPORT</H1> <HR ALIGN=LEFT> <A NAME="anchor1"></A> NOTE: The course you take may contain information on CPR for infants or children or both. Check with your instructor to find out which sections of the book you should study. <A NAME="anchor2"></A> Written material alone does not constitute a CPR course. To gain the skills of CPR, it is necessary to practice with manikins, with trained instructors as guides. <A NAME="anchor3"></A> <HR ALIGN=LEFT> <A NAME="anchor4"></A> <IMG SRC="Book_PBLS/PBLS_source_art/ped_chain.gif" WIDTH="468" HEIGHT="132" ALIGN= "BOTTOM" NATURALSIZEFLAG="3"> <A NAME="anchor5"></A> <A NAME="anchor6"></A> <H1><A NAME="anchor107592"></A>Introduction</H1> Injuries are one of the leading causes of death and disability in children. One of every three deaths among children in the United States results from an injury. The total number of injuries, of course, far exceeds the number of deaths. <A NAME="anchor7"></A> This year one of five children will have an injury serious enough to require treatment in a hospital emergency room. That is one of five children in your neighborhood, one of five in your family, one of five in your care, and this statistic does not include visits to the doctor's office or treatment at home. <A NAME="anchor8"></A> Injuries can cause a moment's fright, a wave of guilt, and a few hours or days of healing. They can also cause serious brain and other organ damage, long-term disability, incredible anguish, and even death. <A NAME="anchor9"></A> Injuries to children occur everywhere. They occur in cities, suburbs, and rural areas; in high-, middle-, and low-income families; in large apartment buildings and single-family homes; in schools and day-care centers; on streets and playgrounds; and in cars. <A NAME="anchor10"></A> The goal of this course is to reduce the number of childhood deaths caused by injuries and breathing or cardiovascular problems. This can be accomplished in part by reducing hazards in the child's environment and promoting safe practices in everyday living. To do this, parents and caregivers need to know how children are injured and how those injuries can be prevented. The safety section of this course provides that information. The goal of the course can also be accomplished by teaching emergency measures to clear the airway and perform cardiopulmonary resuscitation (CPR). <A NAME="anchor11"></A> At the heart of the program is the checklist in Appendix B. It serves as a guide for an inspection of your home, school, day-care facility, or wherever a child spends time. By following the recommendations you can help create a safe environment and reduce the chance of injury. <A NAME="anchor12"></A> It is beyond the scope of this or any course or book to alert you to every hazard in a child's environment. For this reason, young children must not be left unsupervised. While it is up to you to watch them carefully, caring for children can be made easier by creating an environment that is as free of hazards as possible. <A NAME="anchor13"></A> The American Academy of Pediatrics (AAP) offers additional information on injury prevention. The Injury Prevention Program (TIPP) was developed by the AAP to help physicians teach parents how to help their children avoid injuries. Ask your doctor about The Injury Prevention Program. <A NAME="anchor14"></A> Unfortunately children do get hurt, even in safe environments. The extent of injury can be minimized and death may even be prevented by the actions of a trained caregiver. In this course you will learn how to perform CPR and how to give first aid to infants and children who are choking. <A NAME="anchor15"></A> These skills can help save lives. As you learn the steps of basic lifesaving you will learn how to <A NAME="anchor16"></A> <UL> <LI>Recognize an infant or child in distress <LI>Act quickly and effectively to get help <LI>Help a choking infant or child by performing the correct maneuvers for relief of foreign-body airway obstruction (FBAO) <LI>Activate the emergency medical services (EMS) system <LI>Help an infant or child who is not breathing or is without a heartbeat by performing CPR </UL> The course has two sessions, each lasting approximately 3 or 4 hours (depending on whether your course teaches procedures for infants or children or both). The following topics will be covered: <A NAME="anchor17"></A> <H3>Session 1</H3> Welcome and introduction of instructors <A NAME="anchor18"></A> Program overview <A NAME="anchor19"></A> Infant and child safety <A NAME="anchor20"></A> CPR for infants and/or children <A NAME="anchor21"></A> Relief of FBAO in infants and/or children <A NAME="anchor22"></A> <H3>Session 2</H3> Review of safety inspection using the checklist <A NAME="anchor23"></A> Review of CPR and techniques for relieving FBAO <A NAME="anchor24"></A> Written examination <A NAME="anchor25"></A> Evaluation of CPR <A NAME="anchor26"></A> Evaluation of techniques for relieving FBAO <A NAME="anchor27"></A> <A NAME="anchor629410"></A>Some rescue procedures are performed in the same way regardless of the victim's age. A few procedures are performed differently, depending on whether the victim is an infant (under 1 year old) or a child (1 to 8 years old). Because of time limitations, the course you are taking may emphasize the procedures for one age group. If this is the case, you will be evaluated on only the procedures taught. This course does not teach the techniques of CPR and relief of FBAO for children older than 8 years and for adult victims. Such techniques differ from those for infants and children, and are described in other American Heart Association (AHA) textbooks (eg, Heartsaver Guide). If you want to learn more, ask your instructor about additional courses. <A NAME="anchor28"></A> Adults must make the environments of young children as safe as possible and must care for children in case of an injury. Anyone who cares for young children can benefit from this program. You can create and maintain safe places for children to live and play. You can save lives by preventing injuries and performing the correct maneuvers when a child is hurt or has difficulty breathing. <A NAME="anchor29"></A> By taking this course, you will take a big step toward reducing childhood injuries and deaths. Your hard work and study can make a difference.<HR ALIGN=LEFT> <A NAME="anchor30"></A> <H1><A NAME="anchor109260"></A>1. The Emergency Medical Services System</H1> An EMS system is a communitywide, coordinated means of responding to sudden illness or injury. It is a complete rescue system. An effective EMS system has many elements. You must understand two of these: <A NAME="anchor31"></A> <UL> <LI>Entry into the system <LI>Rescue and transportation </UL> <H2>Entry Into the System</H2> Everyone should be able to recognize the warning signals of choking and breathing difficulty in patients of all ages, as well as the signals of heart attack and stroke in adults. Everyone should be able to provide immediate emergency care to sustain life until arrival of EMS personnel. <A NAME="anchor32"></A> As soon as an emergency is recognized, a bystander or some delegated person must place a telephone call to activate the EMS system. If the emergency involves a child, however, a trained rescuer should begin CPR immediately and send someone else to activate the EMS system. When telephoning for help, be prepared to provide the following information: <A NAME="anchor33"></A> <BLOCKQUOTE> 1. Where the emergency is, giving the address or names of cross streets, roads, or other landmarks if possible <A NAME="anchor34"></A> 2. Telephone number from which you are calling <A NAME="anchor35"></A> 3. What happened — auto accident, fall, breathing difficulty, etc <A NAME="anchor36"></A> 4. How many persons need help <A NAME="anchor37"></A> 5. Condition of the victim(s) <A NAME="anchor38"></A> 6. What is being done for the victim(s) <A NAME="anchor39"></A> 7. Any other information requested <A NAME="anchor40"></A> </BLOCKQUOTE> Hang up only when told to do so by the operator/dispatcher. <A NAME="anchor41"></A> <H2>Rescue and Transportation</H2> Bystanders trained in basic life support should perform immediate rescue procedures, including CPR when indicated, until the EMS system or local rescue unit responds. When trained professionals arrive at the scene, they assume responsibility for the victim. <A NAME="anchor42"></A> If an EMS system is not available in your community, the victim should be taken immediately to the nearest hospital emergency department. <A NAME="anchor43"></A> <TABLE WIDTH="450" BORDER="0" CELLSPACING="2" CELLPADDING="0"> <TR> <TD WIDTH="48%">Know your local emergency telephone number and keep it posted near your telephone. (In many communities this is 911. If you are not sure, check your telephone book.) <A NAME="anchor44"></A> Know the location of the nearest emergency department that can provide 24-hour emergency care.</TD> <TD WIDTH="52%"> <IMG SRC="Book_PBLS/PBLS_source_art/phone_hand.gif" ALIGN="BOTTOM" WIDTH="161" HEIGHT="150" NATURALSIZEFLAG="3"></TD></TR> </TABLE> <A NAME="anchor45"></A> <HR ALIGN=LEFT> <A NAME="anchor46"></A> <H1><A NAME="anchor111965"></A>2. Infant and Child Safety</H1> The most common causes of fatal injuries in infants, children, and adolescents include motor vehicle crashes, pedestrian or bicycle-related head injuries, burns or smoke inhalation, falls, firearms (including unintentional injuries, homicides, and suicides), and drowning. Many of these injuries can be avoided if we are aware of the hazards around our children and if we take steps to reduce these hazards. We must do this in our homes, schools, day-care centers, and wherever our children spend time. We must promote safe practices in everyday living. <A NAME="anchor47"></A> We must also be aware that young children cannot care for themselves. If left alone, they may get hurt. As adults who care for young children, we must always be aware of our responsibilities, which vary according to the ages of the children. No environment is totally safe. The most important element in any child-safety program may well be a watchful and attentive adult. <A NAME="anchor48"></A> <IMG SRC="Book_PBLS/PBLS_source_art/car_seat.gif" WIDTH="384" HEIGHT="200" ALIGN= "BOTTOM" NATURALSIZEFLAG="3"> <A NAME="anchor49"></A> <A NAME="anchor50"></A> <H2><A NAME="anchor610925"></A>Motor Vehicle and Traffic Safety</H2> Injuries suffered while riding in cars are the No. 1 preventable cause of death in young children. <A NAME="anchor51"></A> Young children are easily thrown in an impact. Because a young child's head is large in proportion to the body, unrestrained children tend to fly head-first into the windshield or head-first out of the car when a collision occurs. Severe or fatal head injuries often result. Even in a low-speed crash, an infant or small child can smash into the windshield, dashboard, or air bag with a force comparable to falling from a third-story window. It is not safe to hold a child on your lap in a car. In the event of a crash, the child will be thrown into the body of the car or be crushed by your weight. <A NAME="anchor52"></A> The BACK seat is the BEST seat for children 12 years old or younger. In this location in the automobile, the properly restrained child is least likely to sustain injuries in a crash because the child is away from the dashboard and windshield and is prevented from being catapulted out of the seat. <A NAME="anchor53"></A> You have probably heard about injuries resulting from air bags. Air bags are designed to save lives when used with seat belts and they can protect drivers and passengers who are correctly "buckled up." An air bag inflates very quickly and forcefully to cushion a victim during a crash. When it inflates, an air bag can strike anything or anyone — including children — located too near the dashboard, and the impact of the air bag can cause serious head and neck injuries. Air bags have saved more than 1500 lives nationwide, but air bag deployment also has been associated with the deaths of several children and a small adult. Most of those injured by air bags have not used car seats and seat belts properly. <A NAME="anchor54"></A> No infants or children in car seats should be positioned in the front seat of a car with a passenger-side air bag. Rear-facing infant seats should never be secured in the front seat of any car with a passenger-side air bag. A rear-facing safety seat positions the infant's head very near the front of the car, near the dashboard. If the air bag inflates, it can drive the infant seat into the back of the automobile seat, injuring the infant's head and neck. In a car seat even a child aged 1 to 4 years may be injured by an air bag because the car seat positions the child near the front of the automobile seat, close to the dashboard and the air bag. Until "smart" air bags are widely available, the following steps can reduce the risk of injury from air bags: <A NAME="anchor55"></A> <UL> <LI>All car passengers must be properly restrained in seat belts. <UL> <LI>Infants less than 20 pounds: Use rear-facing car seats in the BACK seat. Never place an infant in the front seat of a car with a passenger-side air bag. <LI>Infants more than 20 pounds and children up to 4 years old: Use car seats in the BACK seat. </UL> <LI>Children over 4 years old and adults: Use lap and shoulder belts. Be sure that the lap belt rests low across the child's hips and that the shoulder belt crosses from hip to shoulder, not across the neck. Booster seats may be needed for children 4 to 7 years old to restrain them properly with a lap-shoulder restraint system. <LI>The BEST seat for children 12 years old and younger is the BACK seat. <UL> <LI>Never place an infant in the front seat of a car with a passenger-side air bag. <LI>No children in car seats should be in the front seat. <LI>If possible, only adults and children over 12 years old should sit in the front seat. </UL> <LI>When children or small adults are seated in the front seat, move the front seat as far away from the dashboard as possible. <LI>For questions about children and air bags, call the National Highway Traffic Safety Administration Auto Safety Hotline toll-free at 1-800-424-9393. </UL> Car safety seats and seat belts can prevent most severe injuries to passengers of all ages if they are used correctly. Infants and children up to 4 years of age or 40 pounds in weight must always ride in a car safety seat. The safety seat will hold the child securely in the car and help absorb the forces of even violent crashes. The child must be secured in the car safety seat with the harness or straps that are part of the safety seat, and the safety seat must also be secured in the car using the car seat belt. The car safety seat should be secured in the back seat of the car, particularly if the car has a passenger-side air bag. <A NAME="anchor56"></A> Children older than 4 years or larger than 40 pounds in weight should always wear seat restraints when riding in cars. Lap and shoulder belts provide better protection than lap belts alone. The shoulder belt should cross from the child's shoulder across the chest to the hips. The lap belt should be adjusted until it is snug, and it should rest over the child's hips. All children 12 years old and younger should be restrained in the back seat of the car. If it is necessary to carpool children in a car with a passenger-side air bag, put the largest child in the front seat (no children in car safety seats) and move the seat as far away from the dashboard as possible. <A NAME="anchor57"></A> Children learn by example. Be sure that you — and every person who rides with you — are buckled up for every ride. Follow the watchwords of the AAP and "Make every ride a safe ride." Remember, the BEST seat for children 12 years old and younger is the BACK seat. <A NAME="anchor58"></A> Not all children who die from traffic injuries are passengers in cars. Many are injured while walking or playing near streets or while riding bicycles. Infants and toddlers are most commonly injured by cars backing up in driveways or parking lots. Children between the ages of 5 and 9 who are struck by cars typically dart out in front of traffic in the middle of the block. Parents must supervise children closely; adults must watch for children when driving. Children must be taught early in life to cross streets at intersections, to always stop at curbs, and to stop, look both ways, and listen for cars before crossing any street. <A NAME="anchor59"></A> Children riding bicycles can be injured when they collide with cars or other fixed objects or when they are thrown from the bicycle. The most serious bicycle-related injuries are head injuries, which can cause death or permanent brain damage. Most (85%) of these head injuries can be prevented if children wear bicycle helmets approved by the Snell Memorial Foundation or the American National Standards Institute (ANSI) whenever they ride a bicycle. The helmet must fit snugly to protect the child properly. <A NAME="anchor60"></A> <H2>Indoor Safety</H2> One of the most important safety items in any area where children spend time is an emergency sticker on the phone. This sticker should include the telephone numbers of the police, fire department, ambulance, local hospital, physician, and poison control center in your area and your home address and telephone number. <A NAME="anchor61"></A> <H3>Burns and Smoke Inhalation</H3> Fires and burns are frequent causes of death and injury in children. The highest number of burn injuries occurs in the very young. Most burns are caused by a scald from a hot liquid. Many scalds occur in the kitchen when toddlers grab pot handles extending over the stove, spilling the boiling contents on themselves. Burns may also be inflicted (child abuse). <A NAME="anchor62"></A> <A NAME="anchor600660"></A>Children can also be scalded by hot water in sinks or tubs when a parent or caregiver leaves them alone momentarily or when another child bathes a younger child with water that is too hot. To prevent these injuries, reduce the temperature of your hot water heater to between 120°F and 130°F. (Most water heaters are preset at 150°F.) At 140°F, water takes only 6 seconds to cause a scald burn, whereas at 120°F, it takes 5 minutes to cause a scald burn. <A NAME="anchor63"></A> <A NAME="anchor617081"></A>Flame burns most commonly occur when a house catches fire or when bed sheets or clothing are ignited by open flames or cigarettes. Many burn injuries have been prevented with the development of flame-retardant children's sleepwear. Electric short circuits also may cause house fires and deaths. Do not use appliances with frayed cords or damaged plugs. <A NAME="anchor64"></A> Most deaths and serious injuries in house fires are caused by smoke inhalation, which can be prevented by installing and maintaining smoke detectors on each level of the home or day-care center. Smoke detectors must have batteries, however, and these batteries must be changed twice every year. Develop a schedule to be sure your smoke detector batteries are changed. For example, change them every fall and spring when changing the clocks from and to daylight savings time. <A NAME="anchor65"></A> Burns can also occur when a child comes into contact with hot irons, curling irons, or heating sources, such as woodstoves. These burns are preventable by keeping irons out of the child's reach and by placing a barrier around all woodstoves, hot radiators, and other heating sources. <A NAME="anchor66"></A> <H3>Falls</H3> Falls are the most frequent cause of injury to children younger than 6 years. About 200 children die from falls each year. <A NAME="anchor67"></A> A common fall occurs when a baby climbs out of a crib. Many crib injuries, in fact, result from an unsafe crib. A small child can sustain a fracture if arm, leg, or head becomes wedged between the crib rails and the mattress. In some such cases the child can suffocate. Infants can die from strangulation if their heads become caught between the widely spaced bars of some older cribs or if clothing becomes caught on finials (corner posts) that extend above the side rail. <A NAME="anchor68"></A> Twenty percent of all falls occur on stairs. It is important to keep stairways as safe as possible by providing adequate lighting, removing toys, tacking down loose carpet, and using appropriate gate enclosures. Avoid the accordion-type gate with wide gaps at the top. Instead, use a safety gate that is permanently mounted or firmly attached to the wall with double closures that cannot be operated by children. Use of infant walkers is discouraged because of the dangers they create, especially near stairs or ramps. <A NAME="anchor69"></A> Children may also suffer permanent injury and death by falling from upper-floor windows. Open such windows only from the top or 4 to 5 inches up from the bottom and secure them at the proper height with a burglar lock available at any hardware store. Gates should be placed over the lower portion of windows in high-rise buildings. <A NAME="anchor70"></A> <H3>Firearms</H3> Injuries from firearms are a leading cause of death and permanent injury in children and adolescents, and these injuries have been increasing at an alarming rate. Most firearm injuries result from handguns, which can often be found in the home loaded and readily accessible to children (eg, under a pillow or in a drawer). An increasing number of injuries and deaths occur when children and adolescents take guns to school. <A NAME="anchor71"></A> If a gun is kept in the home, adults should ensure that it cannot be found or operated by children. Homes of preadolescents and adolescents (10 years old or older) or persons with a history of violent behavior, depression, or drug or alcohol abuse are high-risk homes. Guns should be kept with increased caution and surveillance or not kept in these homes, because there is an increased likelihood that the gun will be associated with intentional or unintentional injury, homicide, or suicide. <A NAME="anchor72"></A> When a gun is kept in any home it should be stored unloaded, and the ammunition should be stored in a location separate from the gun. Trigger locks or lockboxes should secure every gun in the home. The guns should be checked daily by an adult to ensure that children have not touched them, played with them, or taken them to school. <A NAME="anchor73"></A> <H3>Poisoning</H3> Childhood poisoning is a common problem in our society. We have access to more than 250 000 household products, many with harmful chemicals. Many of us have miniature drugstores in our homes and even in our desk drawers at work. It is not surprising that curious and exploring children are often victims of poisoning. <A NAME="anchor74"></A> Some common poisons found in the home include <A NAME="anchor75"></A> <UL> <LI>Prescription and nonprescription medications, most importantly iron pills, vitamins containing iron, Tylenol, and aspirin <LI>Plants <LI>Cleansers, polishing agents, ammonia, and detergents <LI>Cosmetics and hair care products (ie, hair coloring agents) <LI>Alcohol and liquor <LI>Insect and rodent poisons, moth balls <LI>Gasoline, kerosene, and other petroleum products <LI>Pesticides, weed killers, and fertilizers <LI>Lye and acids <LI>Paint and paint thinners </UL> The best place to obtain poison information is your regional poison control center. The staff there can provide accurate, up-to-date, and immediate information about almost any poisonous or potentially poisonous product. They will also provide immediate first-aid instructions and treatment recommendations. This service is available 24 hours a day. You should be familiar with the telephone number of the poison control center in your area and post it near your telephone. <A NAME="anchor76"></A> <A NAME="anchor594302"></A>Syrup of ipecac (to cause vomiting) should be kept in every home with young children. It is a helpful treatment for various types of poisoning, but it should be used only when prescribed by a doctor or poison control center. The vomiting can help the poisoned child and eliminate unnecessary and costly trips to an emergency facility. For some poison ingestions, inducing vomiting is not indicated and may be harmful. Always check with the poison control center or your doctor before giving ipecac. <A NAME="anchor77"></A> <A NAME="anchor596767"></A>Safe storage of medicine, vitamins, and household cleaning supplies is one of the most important methods of poison prevention. Poisons should never be stored in empty food or drink containers (eg, kerosene in cola bottles). These items should be stored in specially designed and labeled containers, in high places out of a child's sight and reach. Even high shelves that are thought to be safe have been reached by resourceful children who stack objects and climb to reach them. A high, locked cabinet is the best place to store poisons. <A NAME="anchor78"></A> Many poison control centers report that their most frequent type of call involves children who have eaten plants. Eating or merely chewing on certain household plants can result in serious poisoning. Parents and caregivers should learn the names and toxicity of the plants in and around the home or childcare area and remove those that are poisonous.* Consult your local poison control center to determine if a plant (including stems, leaves, bulbs, flowers, fruit, nuts, seeds, and berries) is poisonous. <A NAME="anchor79"></A> *See Ogzewalla CD, Bonfiglio JF, Sigell LT. Common plants and their toxicity. Pediatr Clin North Am. 1987;34:1557-1598. <A NAME="anchor80"></A> <H3>Toy Injuries</H3> Most toy-related injuries occur from children falling on, tripping over, or being hit by toys. Choking from inhalation of small toys or parts of toys is the second most common toy injury. Half of the deaths from toy-related injuries involve children who choke on balloons, ride tricycles into pools, or are struck by motor vehicles while riding tricycles. <A NAME="anchor81"></A> Electric or battery-powered toys can overheat, melt, and start fires, causing other toy-related injuries. Button-shaped batteries (eg, for watches or cameras) will often cause severe tissue damage if ingested and can burn tissue if placed in body cavities. Call your poison control center if such a battery is swallowed or becomes lodged in a child's body. <A NAME="anchor82"></A> <H3>Choking and Suffocation</H3> Choking and suffocation are among the most common causes of preventable death in children younger than 1 year and a common cause of death in children younger than 14 years. <A NAME="anchor83"></A> Choking is caused by the inhalation of food or objects. Strangulation or suffocation is caused by constriction about the neck or blockage of the nose, mouth, or windpipe (trachea). Choking, strangulation, or suffocation results in blockage of the airway passages, which interferes with breathing. This can cause death or brain damage. <A NAME="anchor84"></A> The most common objects that choke, strangle, or suffocate children are <A NAME="anchor85"></A> <UL> <LI>Food items, such as hot dogs, grapes, nuts, popcorn, and hard candy. Formula, milk, or juice can cause choking if these liquids are given to an infant who is lying down, especially from a propped bottle. <LI>Toys and parts of toys that are small enough to place in the mouth. Uninflated balloons or pieces of balloons are frequent causes of choking and can be particularly hard to remove. <LI>A variety of other small items, such as coins, marbles, buttons, beads, safety pins <LI>Drapery and extension cords <LI>Plastic bags <LI>Cords from which toys and objects such as rattles, pacifiers, and jewelry are hung around the child's neck </UL> <H3>Drowning</H3> Drowning is a major cause of accidental death in children. Drowning is suffocation by immersion in water, resulting in death. The household bath is the most common site for drowning in the first year of life. Infants, toddlers, and preschoolers must always be supervised by an adult in the bath or near any container of water, including buckets and toilets. They should not be left alone near the water. Toilet lids should be closed, and industrial buckets (5 gallons or more) should be made inaccessible to toddlers. Young children can drown in only a few inches of water. <A NAME="anchor86"></A> <H2>Outdoor Safety</H2> When children play outdoors, they are expected to be active. We can help prevent injuries by following some simple safety guidelines. <A NAME="anchor87"></A> Most important, children should play away from streets. This eliminates the temptation to follow a ball or other toy into the street. Toddlers playing outside should always be supervised, and young children playing near animals must always be with an adult. <A NAME="anchor88"></A> <H3>Drownings</H3> Drownings in backyard swimming pools are a leading cause of death and permanent brain damage in children, particularly among infants and toddlers. A toddler is by nature inquisitive, and water offers exciting possibilities. The natural curiosity of toddlers, their inability to appreciate the danger and depth of water, and the attraction of water play can be a dangerous combination. The young child is capable of getting into a swimming pool alone but may be incapable of getting out and may become helpless in the water. <A NAME="anchor89"></A> Access to swimming pools should be carefully controlled. All pools, hot tubs, and spas should be surrounded by a nonclimbable fence at least 5 feet high, with a self-closing, self-latching gate. You must not consider the house to be part of the fence, because toddlers may leave the house and find themselves in the pool area. Pool covers and pool alarms may give a false sense of security because they will not prevent drownings. Contrary to popular belief, the drowning child often sinks quietly without screaming for help. Children should always be supervised when they play in or around water, and all toys should be removed from the pool area at the end of every supervised swim period so that children are not lured back into the water. Parents and older children in a home with a swimming pool should learn CPR. <A NAME="anchor90"></A> While on docks or at beaches or rivers, children should wear life vests. Children can fall into these waters suddenly and quietly. Children swimming in moving water should wear approved flotation devices. No child should ever swim alone. <A NAME="anchor91"></A> <H2>Playground Injuries</H2> The playground is a frequent site of childhood injury. The number and severity of these injuries can be reduced if we ensure that all playground equipment is safe. Attachments, cables, and seats of swings should be inspected regularly, particularly at the beginning and middle of every summer, and kept in good repair. Playgrounds should be built on energy-absorbing surfaces, such as sand, wood chips, or rubber padding. Concrete and grass do not provide adequate cushioning for children when they fall. <A NAME="anchor92"></A> <H2>Safety Checklist</H2> The checklist in Appendix B has been developed to help you make a child's daily environment as safe as possible. It is based on the most up-to-date injury information available and is designed to guide you through an inspection of your home, day-care center, school, baby-sitter's home, or wherever a child spends time. Take it with you on your inspection tour and circle the appropriate answers to the questions. You may be surprised to detect several potential dangers that you can remedy. <A NAME="anchor93"></A> <H2>Conclusions</H2> This safety section is intended to alert you to some of the hazards in your child's environment. You can help prevent injury and death to the children around you by following the recommendations of your course instructor and those listed in the checklist. <A NAME="anchor94"></A> The following safety supplies are recommended for any area where children spend time: <A NAME="anchor95"></A> <UL> <LI>Syrup of ipecac to use in certain types of poisoning <LI>Plastic plug covers for electric outlets to protect children from electric shock <LI>Plastic outlet covers to use when an electric cord is plugged into the outlet <LI>Cabinet latches and locks to keep children away from medicines, cleaning supplies, knives, etc <LI>Emergency telephone numbers for quick dialing in case of an emergency <LI>A smoke detector with working battery to provide early warning and help reduce fire deaths <LI>A hot-water gauge (such as a meat or candy thermometer) for measuring the temperature of tap water to prevent scalding <LI>An out-of-reach hook-and-eye latch to prevent children from gaining entry to the basement or garage, where dangerous products are often stored </UL> These safety devices will not only help reduce childhood injuries, but they will also give you the immediate satisfaction of knowing that you have taken steps to improve the safety of a child's environment. <A NAME="anchor96"></A> <IMG SRC="Book_PBLS/PBLS_source_art/safety.gif" WIDTH="415" HEIGHT="205" ALIGN= "BOTTOM" NATURALSIZEFLAG="3"> <A NAME="anchor97"></A> <HR ALIGN=LEFT> <A NAME="anchor98"></A> <H1><A NAME="anchor114773"></A>3. Prudent Heart Living: You Are in Control</H1> Heart disease is the No. 1 killer of Americans. This disease is thought to begin in childhood and progress through adolescence and young adulthood, but it usually does not cause any visible symptoms until middle adulthood. Even young children, however, may demonstrate or develop conditions that increase the risk of heart disease. These conditions include high blood pressure and high levels of blood cholesterol. "Prudent heart living" is a lifestyle designed to minimize the risk of future heart disease. <A NAME="anchor99"></A> Many risks associated with heart disease are influenced by lifestyle — what you eat, how much you exercise, and how you care for your health. Children begin developing lifestyle patterns at an early age. Once developed, the patterns are difficult to change. You can't begin preventing heart disease too soon. <A NAME="anchor100"></A> Children often choose to eat junk food and other high-fat foods unless they are taught the importance of eating nutritious food. With such an understanding and many opportunities to practice positive eating habits, children will be able to make wise choices and encourage others to do the same. Children should be taught at an early age the importance of a healthy diet, regular exercise, and regular medical care. <A NAME="anchor101"></A> Children learn from the attitudes, behavior, and lifestyles of the adults around them. You are a model for them. The best way to encourage positive attitudes and behavior about food, physical activity, and rest is to practice what you preach. As you model positive health habits and encourage these habits in children, you will reduce your likelihood of heart disease also. <A NAME="anchor102"></A> Important risk factors for heart disease are smoking, a diet rich in saturated fats and cholesterol, sedentary living, and high blood pressure. <A NAME="anchor103"></A> <H2>Smoking</H2> Exposure to tobacco smoke is the most preventable cause of heart and lung disease in the United States. The risk of heart disease is directly related to the number of cigarettes a person smokes daily and the amount of exposure to the smoking of others. People who smoke a pack of cigarettes a day have more than twice the risk of heart disease as a person who has never smoked. The risk is even greater in people who also have high blood pressure and high levels of cholesterol in their blood. Tobacco smoke is also harmful to nonsmokers in the household. Second-hand smoke ("passive smoking") can actually cause infants to develop respiratory problems and can worsen asthma and other respiratory diseases in children and adults. <A NAME="anchor104"></A> Children develop attitudes about smoking at an early age and imitate the behavior of their parents or primary caregivers. Research shows that children of parents who smoke are more likely to smoke than children of nonsmokers. <A NAME="anchor105"></A> If you smoke, try to stop completely or reduce the number of cigarettes you smoke daily. If you quit smoking, it will reduce your risk of heart disease, eliminate the effects of passive smoking on other members of the household, and set a good example of healthy behavior for your children. While you are trying to quit smoking, smoke only outside or in well-ventilated areas, and don't smoke in the car. This is important for the health of your children and anyone in the home with respiratory disease. Tobacco smoke accumulates in household furnishings (including draperies, upholstery, and carpeting) and may take as long as 3 to 6 months to disappear, so the effects of passive smoking on your family may not disappear immediately after you quit smoking. <A NAME="anchor106"></A> <H2>Diet</H2> Children begin to develop lifelong eating habits and attitudes toward food at an early age. Eating habits established during childhood are hard to change. They affect two major risk factors associated with heart disease: high blood cholesterol and high blood pressure. Diets high in cholesterol and saturated fats contribute to high blood cholesterol levels. Obesity and excessive salt intake contribute to high blood pressure. <A NAME="anchor107"></A> Because diet is a major risk factor in the development of heart disease, the AHA is especially concerned with helping children develop positive attitudes about nutritious foods. <A NAME="anchor108"></A> The AHA recommends that you consume foods low in cholesterol and saturated fats, eat a variety of foods every day, prevent obesity by limiting calorie intake to the amount needed for normal growth and development, limit salt intake, and reduce the amount of fat in the diet. <A NAME="anchor109"></A> To reduce the amount of fat in the diet: <A NAME="anchor110"></A> <UL> <LI>Limit meat, seafood, and poultry to 6 ounces per day. <LI>Use skinless chicken, turkey, or fish in most main dishes. <LI>Choose lean cuts of meat and remove visible fat. <LI>Substitute meatless or low-meat main dishes for regular entrees. <LI>Use no more than 5 to 8 teaspoons of oil or fat per day. <LI>Use skim milk and low-fat cheese. </UL> To help control cholesterol: <A NAME="anchor111"></A> <UL> <LI>Eat no more than three egg yolks per week. <LI>Limit use of shrimp, lobster, and organ meats (ie, liver, heart). </UL> When you reduce the amount of saturated fat in your diet, a higher percentage of total calories must come from other sources — proteins and carbohydrates. If carbohydrates provide the extra calories, complex carbohydrates (cereals, fruits, and vegetables) are recommended rather than sugar. Although sugar is not a risk factor for heart disease, it is associated with increased risk of tooth decay and obesity. <A NAME="anchor112"></A> Children tend to like or dislike foods their parents like or dislike. To encourage good eating habits, set a good example by eating nutritious foods and trying new and different foods. Be casual about introducing a new food. Encourage children to taste it, but don't force the issue. To make vegetables appealing to children, try serving them raw. Cut them into interesting shapes and serve them with low-fat dips or sauces. <A NAME="anchor113"></A> Avoid candy, chips, soft drinks, and other foods that are high in calories but low in nutrients. Offer apple wedges, bananas, carrots, and other fruits and vegetables for snacks. Encourage children to drink water and natural juices rather than soft drinks. <A NAME="anchor114"></A> Limit the amount of fried food in the diet. Bake or broil meats. Use a variety of seasonings to create a variety of tastes. When you do fry food, use vegetable oil. <A NAME="anchor115"></A> A calm, unhurried atmosphere at mealtime helps children develop positive attitudes toward food. Allow children to serve themselves, with help as needed. Provide small portions and let children ask for seconds. Avoid overwhelming children with servings that are too large. Don't encourage children to "clean" their plates because this can encourage overeating. Make sure children do not substitute snack foods high in fats or salt for meals. <A NAME="anchor116"></A> Serve a variety of foods at meals, including fruit, vegetables, cereals, pasta, low-fat dairy products, fish, poultry, and lean meats. <A NAME="anchor117"></A> Following these guidelines and reducing risk factors may reduce the risk of heart attack or stroke. At the very least, the result will be good general health and physical fitness for every member of the family. Children will benefit most by learning the habits of prudent heart living early in life. <A NAME="anchor118"></A> The AHA publishes other materials that further explain the essentials of prudent heart living. Contact your local AHA affiliate for details. <A NAME="anchor119"></A> <H2>Physical Activity</H2> Children begin to control their bodies and use them effectively in the preschool years. By age 6 most children have mastered movements basic to developing sport skills in later childhood and adulthood. At the same time children are developing attitudes about physical activity and its importance in daily life. Children who enjoy movement and physical activity usually continue to enjoy them into adulthood. Also, children who know that physical activity is important to health probably will include it as a regular part of their adult lives. <A NAME="anchor120"></A> A regular program of aerobic physical activity strengthens the heart so that it pumps more blood per beat. This allows the heart to beat at a slower rate. <A NAME="anchor121"></A> Physical activity improves blood circulation throughout the body so that the heart, lungs, and other organs work together more effectively. Physical activity is also important in controlling weight and reducing stress. <A NAME="anchor122"></A> Some children are naturally active, given opportunity and encouragement. Such children probably do not require a structured exercise program for cardiovascular fitness. However, they do need opportunities to walk, run, jump, kick, throw, and catch. Activities should correspond to each child's abilities and interests and should be fun. As children engage in physical activity, they will begin to understand how such movement helps them become stronger and healthier. <A NAME="anchor123"></A> Adults should set a good example for children by exercising regularly. Climb stairs instead of taking the elevator. If you must go up or down several flights, climb two or three and then take the elevator. Walk short distances to the store and other places instead of driving. You and your child will benefit from such activities. <A NAME="anchor124"></A> Rest is also important for healthy heart living. Encourage quiet activities such as reading and working puzzles. Adequate sleep is equally important to health. <A NAME="anchor125"></A> <H2>High Blood Pressure</H2> High blood pressure is directly related to the development of heart disease. When high blood pressure is combined with other risk factors, such as obesity or exposure to tobacco smoke, the risk of heart attack or stroke is greatly increased. <A NAME="anchor126"></A> If you have not had your blood pressure checked recently, now is the time to do it. Children, adolescents, and adults should have their blood pressure checked as part of their regular medical check-ups. High blood pressure can be controlled, and there is evidence that control of high blood pressure will reduce the risk of heart disease.<HR ALIGN=LEFT> <A NAME="anchor127"></A> <H1><A NAME="anchor116071"></A>4. Normal Heart and Lung Anatomy and Function</H1> The heart, a muscle about the size of a clenched fist, is located in the center of the chest behind the breastbone (sternum) and in front of the spine. It has four chambers with valves that regulate the flow of blood through the heart chambers and into the pulmonary artery and the aorta. The aorta and other arteries carry blood away from the heart and connect to small blood vessels called capillaries in the body organs. The capillaries join together to form veins that carry blood back to the heart and into the lungs by way of the pulmonary artery. The coronary arteries are special arteries that supply blood to the heart muscle itself. <A NAME="anchor128"></A> <H3>Location of the Heart</H3> <H3><IMG SRC="Book_PBLS/PBLS_source_art/ch_hrtloc.gif" WIDTH="358" HEIGHT="283" ALIGN= "BOTTOM" NATURALSIZEFLAG="3"></H3> <H3> </H3> <H3> </H3> The Heart and Circulatory System <A NAME="anchor129"></A> <IMG SRC="Book_PBLS/PBLS_source_art/ch_hrtcir.gif" WIDTH="484" HEIGHT="474" ALIGN= "BOTTOM" NATURALSIZEFLAG="3"> <A NAME="anchor130"></A> The function of the heart is to pump blood to the lungs, where it picks up oxygen, and to pump the oxygen-enriched blood to all parts of the body. The heart pumps approximately 5 quarts (almost equal to 5 liters) of blood per minute in an adult. All cells of the body require oxygen to carry out their normal functions. When the heart stops (cardiac arrest), oxygen is not circulated, and the oxygen stored in the brain and other vital organs is used up quickly. <A NAME="anchor131"></A> The heartbeat is triggered by natural electric impulses sent through the heart 60 to 150 times a minute. The younger the child, the more rapid the heartbeat. During exercise the heart of the average adult can pump up to 25 ½ quarts (about 25 liters) each minute. Less blood is pumped by the heart of a physically active child, but the amount of blood pumped is proportionate to size. <A NAME="anchor132"></A> The lungs are basically air sacs (alveoli) surrounded by capillaries. Nerve impulses from the brain to the chest muscles and the diaphragm cause breathing. With each breath air is carried through the airways (nose, mouth, throat, larynx, trachea, and bronchi) and into the air sacs of the lungs. <A NAME="anchor133"></A> Parts of the Airway <A NAME="anchor134"></A> <IMG SRC="Book_PBLS/PBLS_source_art/ch_airsys.gif" WIDTH="380" HEIGHT="285" ALIGN= "BOTTOM" NATURALSIZEFLAG="3"> <A NAME="anchor135"></A> Air at sea level is approximately 21% oxygen. As breathing fills the air sacs, the blood around the air sacs picks up the oxygen and carries it back to the heart, which pumps it throughout the body. As oxygen is taken from the blood by cells in the body, carbon dioxide is given off as a waste product. Carbon dioxide is returned by the blood to the air sacs and exhaled out of the body. Normally, the blood picks up only one fourth of the oxygen in the air. The rest is exhaled. This is why mouth-to-mouth breathing can provide the victim with enough oxygen (about 16% oxygen) to help support life. <A NAME="anchor136"></A> When breathing stops (respiratory arrest), the heart may continue to pump blood for several minutes, carrying existing stores of oxygen to the brain and the rest of the body. Early, prompt rescue efforts for the victim of respiratory arrest or choking (foreign-body airway obstruction) can prevent the heart from stopping (cardiac arrest) and maintain oxygen delivery to the brain and body. <A NAME="anchor137"></A> <A NAME="anchor138"></A> <HR ALIGN=LEFT> <A NAME="anchor139"></A> <H1><A NAME="anchor117149"></A>5. Introduction to CPR Techniques</H1> CPR involves a combination of mouth-to-mouth rescue breathing (or other artificial ventilation techniques) and chest compressions to help the victim of sudden respiratory or cardiac arrest survive until advanced life support care can be provided. CPR keeps some oxygenated blood flowing to the brain and other vital organs until medical treatment can restore normal heart action. <A NAME="anchor140"></A> Heart disease is rare in infants and children and an uncommon cause of cardiac arrest in children. Instead, the typical cause of cardiac arrest in infants and children is lack of oxygen supply to the heart muscle caused by a breathing problem, respiratory arrest, or shock. Breathing problems can occur because of choking, suffocation, airway disease, lung disease, near-drowning, or injuries involving the airway or brain. If a child stops breathing, cardiac arrest follows in a very short time. If breathing assistance is provided for such a victim, cardiac arrest may actually be prevented. <A NAME="anchor141"></A> If CPR is started promptly and advanced life support is available quickly, the victim has a chance to survive. CPR includes three basic rescue skills, known as the ABCs of CPR: Airway, Breathing, and Circulation. <A NAME="anchor142"></A> <TABLE WIDTH="450" BORDER="1" CELLSPACING="2" CELLPADDING="5"> <TR> <TD WIDTH="225" VALIGN="TOP"><H2>Airway</H2> <CENTER> </CENTER> <A NAME="anchor143"></A> <CENTER><IMG SRC="Book_PBLS/PBLS_source_art/ch_poshead.gif" WIDTH="190" HEIGHT= "294" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></CENTER></TD> <TD WIDTH="225" VALIGN="TOP"><A NAME="anchor499905"></A>When a person loses consciousness, the muscles relax and the tongue falls backward and obstructs the airway. Therefore, the first action for successful resuscitation is to open the airway. It is important to remember that the back of the tongue and other structures in the back of the throat are the most common cause of airway obstruction in the unconscious victim. Since these structures are all attached to the lower jaw, the airway can usually be opened by tilting the victim's head back and moving the lower jaw (chin) up and outward. This action lifts the tongue and its attachments from the back of the throat.</TD></TR> <TR> <TD VALIGN="TOP" WIDTH="225"><H2> Breathing</H2> <H2> </H2> <H2> </H2> <H2><IMG SRC="Book_PBLS/PBLS_source_art/ch_mouth.gif" WIDTH="190" HEIGHT="200" ALIGN= "BOTTOM" NATURALSIZEFLAG="3"></H2> </TD> <TD VALIGN="TOP" WIDTH="225">When breathing stops, only a small amount of oxygen remains in the lungs and bloodstream. Therefore, when breathing stops, cardiac arrest and death quickly follow. Mouth-to-mouth rescue breathing is the quickest way to get oxygen into the victim's lungs. The air you breathe into the victim contains enough oxygen to supply the victim's needs. Rescue breathing must be performed until the victim can breathe on his or her own or until trained professionals take over. Remember: If the victim's heart is beating, you must (1) maintain an open airway and (2) breathe at a rate of once every 3 seconds for infants or children (20 times per minute). If the victim's heart is not beating, you will have to perform mouth-to-mouth rescue breathing plus chest compressions.</TD></TR> <TR> <TD VALIGN="TOP" WIDTH="225"><H2>Circulation</H2> <H2><IMG SRC="Book_PBLS/PBLS_source_art/ch_chestcom.gif" WIDTH="190" HEIGHT="189" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></H2> </TD> <TD VALIGN="TOP" WIDTH="225">The third skill of CPR is chest compressions, which help to circulate blood and maintain some blood flow to the lungs, brain, heart, and other vital organs. Whenever chest compressions are performed, mouth-to-mouth rescue breathing or rescue breathing provided with medical equipment by EMS personnel must also be performed.</TD></TR> </TABLE> <A NAME="anchor144"></A> <HR ALIGN=LEFT> <A NAME="anchor145"></A> <H1><A NAME="anchor119383"></A>6. Relief of Foreign-Body Airway Obstruction</H1> Airway obstruction (choking) remains a common cause of death and disability in children. A complete airway obstruction means that the breathing passages are totally blocked and the victim is unable to speak, cough, or breathe. It is important to recognize signs of distress and respond quickly and effectively. You will learn how to give first aid to victims of choking. These procedures are different for infant and child victims. The maneuvers for both are described in <A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/PBLS_entire_text.htx#anchor120662" TARGET="_blank">chapter 7</A>. <A NAME="anchor146"></A> <H2>Causes</H2> A variety of foods and foreign bodies can obstruct a child's airway. The most common causes of airway obstruction are toys, small parts of toys, balloons, and foods such as hot dogs, round candies, nuts, and grapes. Airway obstruction may also occur when illnesses such as epiglottitis or croup cause the air passages to swell and narrow, but these diseases require medical attention and will not be relieved by the techniques you are about to learn. <A NAME="anchor147"></A> <H2>Prevention</H2> Many incidents of choking in children can be prevented by following these guidelines: <A NAME="anchor148"></A> <UL> <LI>Prevent children from walking, running, playing, or crying with food or foreign objects in their mouths. <LI>Keep small objects (marbles, beads, small toys, thumbtacks, etc) away from infants and preschool children. <LI>Serve each infant and child food that is appropriate for his or her age and size. Avoid nuts, popcorn, and small, hard candies before age 4. <LI>Cut children's food into small pieces. <LI>Teach children to chew slowly and thoroughly and to not laugh and talk while eating. </UL> <H2><A NAME="anchor589260"></A>Recognition of Foreign-Body Airway Obstruction</H2> Airway obstruction should be suspected in an infant or child who suddenly chokes and begins to cough, gag, or have high-pitched noisy breathing. An older child may also use the "universal distress signal" of choking: clutching the neck between the thumb and index finger. You may ask the child if he or she is choking, and the child may nod. <A NAME="anchor149"></A> <A NAME="anchor558529"></A>Airway obstruction may be partial or complete. In partial airway obstruction, air exchange may be good or poor. The child may be able to cough, although there may be wheezing between coughs. If a child is coughing vigorously, the airway is only partially obstructed. Do not attempt to relieve the obstruction. As long as air exchange continues to be good, do not interfere, but take the child to a physician or medical center. <A NAME="anchor150"></A> Poor air exchange is characterized by an ineffective cough, high-pitched noises while inhaling, increasing breathing difficulty, and blueness of the lips, nails, and skin. When these signs are observed, treat the infant or child as though he or she has a complete airway obstruction. <A NAME="anchor151"></A> If the infant or child has a complete airway obstruction, no air can be expelled, so he or she will be unable to make a sound. The infant or child with complete airway obstruction requires immediate help to relieve the obstruction. <A NAME="anchor152"></A> <H2>Maneuvers</H2> The maneuvers described in the <A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/PBLS_entire_text.htx#anchor222576" TARGET="_blank">Performance Guidelines</A> should be performed when an infant or child demonstrates complete airway obstruction and aspiration of a foreign body is witnessed or strongly suspected (eg, after attempts to ventilate fail). The infant or child may be conscious or may lose consciousness as you begin to help. <A NAME="anchor153"></A> The maneuvers are also appropriate when an unconscious, nonbreathing child is found and the airway remains obstructed despite attempts to open it. <A NAME="anchor154"></A> Not all airway obstruction is caused by a foreign object. Infections may cause airway swelling and obstruction that will not be relieved by the maneuvers described here. Children with an infectious cause of airway obstruction need prompt medical attention in a hospital's emergency department, and time should not be wasted on a futile attempt to relieve the obstruction.<HR ALIGN=LEFT> <A NAME="anchor155"></A> <H1><A NAME="anchor120662"></A>7. The Performance Guidelines and How to Use Them</H1> This section provides performance guidelines. These are designed to help you learn the basic emergency procedures taught in this course. If your course teaches maneuvers for both infants and children, you will need to study all the performance guidelines. If you are taking a course that emphasizes maneuvers for an infant or a child, you will need to study only those performance guidelines that relate to the information presented in your course. If you have any questions about which guidelines to study, ask your instructor for help. <A NAME="anchor156"></A> The performance guidelines will give you the specific steps necessary to do the following: <A NAME="anchor157"></A> <A NAME="anchor158"></A> <A NAME="anchor222576"></A>Perform CPR: <A NAME="anchor159"></A> <UL> <UL> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/pg07_01.htx" TARGET="_blank">On an infant whose breathing or pulse has stopped<IMG SRC="Book_PBLS/PBLS_source_art/PBLS_perfg_icon.gif" WIDTH="45" HEIGHT="32" ALIGN="MIDDLE" NATURALSIZEFLAG="3"></A> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/pg07_02.htx" TARGET="_blank">On a child whose breathing or pulse has stopped<IMG SRC="Book_PBLS/PBLS_source_art/PBLS_perfg_icon.gif" WIDTH="45" HEIGHT="32" ALIGN="MIDDLE" NATURALSIZEFLAG="3"></A> </UL> </UL> Clear an airway obstructed by foreign material: <A NAME="anchor160"></A> <UL> <LI>Infant: <UL> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/pg07_03.htx" TARGET="_blank">Conscious<IMG SRC= "Book_PBLS/PBLS_source_art/PBLS_perfg_icon.gif" WIDTH="45" HEIGHT="32" ALIGN="MIDDLE" NATURALSIZEFLAG="3"></A> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/pg07_04.htx" TARGET="_blank">Becomes unconscious during attempts<IMG SRC="Book_PBLS/PBLS_source_art/PBLS_perfg_icon.gif" WIDTH="45" HEIGHT="32" ALIGN="MIDDLE" NATURALSIZEFLAG="3"></A> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/pg07_05.htx" TARGET="_blank">Unconscious <IMG SRC= "Book_PBLS/PBLS_source_art/PBLS_perfg_icon.gif" WIDTH="45" HEIGHT="32" ALIGN="MIDDLE" NATURALSIZEFLAG="3"></A> </UL> <LI>Child: <UL> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/pg07_06.htx" TARGET="_blank">Conscious<IMG SRC= "Book_PBLS/PBLS_source_art/PBLS_perfg_icon.gif" WIDTH="45" HEIGHT="32" ALIGN="MIDDLE" NATURALSIZEFLAG="3"></A> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/pg07_07.htx" TARGET="_blank">Becomes unconscious during attempts<IMG SRC="Book_PBLS/PBLS_source_art/PBLS_perfg_icon.gif" WIDTH="45" HEIGHT="32" ALIGN="MIDDLE" NATURALSIZEFLAG="3"></A> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/pg07_08.htx" TARGET="_blank">Unconscious<IMG SRC= "Book_PBLS/PBLS_source_art/PBLS_perfg_icon.gif" WIDTH="45" HEIGHT="32" ALIGN="MIDDLE" NATURALSIZEFLAG="3"></A> </UL> </UL> This section contains pictures of each important step as well as a description of the step, guidelines for performance, and the reason for the step. Use this section <A NAME="anchor161"></A> <UL> <LI>Before you take a CPR course to help you prepare for what is ahead <LI>During your CPR course as you practice with a manikin <LI>After you have finished the course to refresh your memory </UL> CPR, like any skill, should be practiced occasionally to keep the important steps straight. Then if an emergency arises, you may be able to help save a life. Refresh your skills at least every 1 to 2 years by contacting an AHA office and taking a refresher course. It will take only a little of your time, and you will feel good knowing that you are still able to perform CPR. A refresher course also keeps you informed about advances in CPR technique. <A NAME="anchor162"></A> Never rehearse or practice CPR on another person! <A NAME="anchor163"></A> Reading material does not, by itself, constitute a CPR course. It is necessary to practice with manikins, with trained instructors to guide you, to gain the skills of CPR.<HR ALIGN=LEFT> <A NAME="anchor164"></A> <H2>Links to Skill Performance Sheets: (printable)</H2> <UL> <LI>Child: <UL> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/sps01.htx" TARGET="_blank">Child One-Rescuer CPR<IMG SRC="Book_PBLS/PBLS_Source_art/ico_sps.gif" ALIGN="MIDDLE" WIDTH= "31" HEIGHT="32" NATURALSIZEFLAG="3"></A> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/sps02.htx" TARGET="_blank">Child Foreign-Body Airway Obstruction — Conscious<IMG SRC="Book_PBLS/PBLS_Source_art/ico_sps.gif" ALIGN="MIDDLE" WIDTH="31" HEIGHT="32" NATURALSIZEFLAG="3"></A> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/sps03.htx" TARGET="_blank">Child Foreign-Body Airway Obstruction — Unconscious<IMG SRC="Book_PBLS/PBLS_Source_art/ico_sps.gif" ALIGN="MIDDLE" WIDTH="31" HEIGHT="32" NATURALSIZEFLAG="3"></A> </UL> <LI>Infant: <UL> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/sps04.htx" TARGET="_blank">Infant One-Rescuer CPR<IMG SRC="Book_PBLS/PBLS_Source_art/ico_sps.gif" ALIGN="MIDDLE" WIDTH= "31" HEIGHT="32" NATURALSIZEFLAG="3"></A> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/sps05.htx" TARGET="_blank">Infant Foreign-Body Airway Obstruction — Conscious<IMG SRC="Book_PBLS/PBLS_Source_art/ico_sps.gif" ALIGN="MIDDLE" WIDTH="31" HEIGHT="32" NATURALSIZEFLAG="3"></A> <LI><A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/sps06.htx" TARGET="_blank">Infant Foreign-Body Airway Obstruction — Unconscious<IMG SRC="Book_PBLS/PBLS_Source_art/ico_sps.gif" ALIGN="MIDDLE" WIDTH="31" HEIGHT="32" NATURALSIZEFLAG="3"></A> </UL> </UL> </BODY> </HTML>