<P><B><FONT COLOR="#ffffff">Action:</FONT></B><BR>Position the infant on his or her back.</TD><TD VALIGN="TOP"><P>Tap or gently shake victim's shoulder. Call out "Help!" Ifhelp arrives, send someone to activate the EMS system.</P>
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<P>Turn the infant as a unit, supporting head and neck. Place the infanton 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 avoidbending or turning the neck.</TD><TD VALIGN="TOP"><P>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 ifnecessary.</P>
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<P>For CPR to be effective, the infant must be flat on his or her back ona firm surface. CPR cannot be performed if the infant is face down.</TD></TR><TR><TD HEIGHT="332" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/inf_headtilt.gif" WIDTH="169" HEIGHT="167" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP"><P><B><FONT COLOR="#ffffff">Action:</FONT></B><BR>Open the airway <BR>(head tilt–chin lift).</P>
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<P><B><FONT COLOR="#ffffff">Assessment:</FONT></B><BR>Determine breathlessness.</TD><TD VALIGN="TOP"><P>Lift the chin up and out gently with one hand while pushing down on theforehead with the other to tilt the head back into a neutral position. Don'tclose the mouth. If <BR>trauma is suspected, use the jaw thrust to open the airway.</P>
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<P>Maintain an open airway. Turn your head toward the infant's chest withyour ear directly over and close to the infant's mouth.</P>
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<P><B><FONT COLOR="#ffffff">Look</FONT></B> at the chest for movement<I>.</I></P>
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<P><B><FONT COLOR="#ffffff">Listen</FONT></B> for the sounds of breathing.</P>
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<P><B><FONT COLOR="#ffffff">Feel</FONT></B> for breath on your cheek.</TD><TD VALIGN="TOP"><P>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.</P>
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<P>Hearing and feeling are the only true ways of determining the presenceof effective breathing. If there is chest movement but you cannot feel orhear air, the airway may still be obstructed.</P>
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<P>Rescue breathing should not be performed on someone who is breathingeffectively.</TD></TR><TR><TD HEIGHT="438" VALIGN="TOP"><P><IMG SRC="Book_PBLS/PBLS_source_art/inf_premouth.gif" WIDTH="208" HEIGHT="200"ALIGN="BOTTOM" NATURALSIZEFLAG="3"></P>
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<P><IMG SRC="Book_PBLS/PBLS_source_art/inf_mouth.gif" WIDTH="198" HEIGHT="170" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP"><A NAME="anchor542025"></A><B><FONT COLOR="#ffffff">Action:</FONT></B><BR>If the victim is not breathing, provide rescue breathing. Give 2 slow rescuebreaths (1 to 1½ seconds per breath). Observe the rise of the chestwith each breath.</TD><TD VALIGN="TOP" WIDTH="28%"><P><A NAME="anchor646500"></A>Maintain pressure on the infant's foreheadto keep the head tilted. With the other hand lift the chin, open your mouthwide and take a deep breath. Cover the infant's mouth and nose with yourmouth, making a tight seal. Breathe into the infant's mouth and nose twice,completely refilling your lungs between breaths. Watch for the infant'schest to rise.</P>
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<P>Each rescue breath is given over 1 to 1½ seconds, allowing theinfant's lungs to deflate between breaths. If the rescue breaths do notcause the infant's chest to rise, the airway is obstructed. Reposition thehead, lift the chin, and try again. If the chest still does not rise withthe rescue breath, start the <A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/pg07_03.htx" TARGET="_blank">reliefof obstructed airway sequence</A>.</TD><TD VALIGN="TOP"><P>It is important to get as much oxygen as possible into the infant. Ifyour rescue breathing is effective, you will</P>
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<UL> <LI><FONT COLOR="#ffffff">Feel air going in as you blow</FONT> <LI><FONT COLOR="#ffffff">Feel the air leaving your own lungs</FONT> <LI><FONT COLOR="#ffffff">See the infant's chest rise and fall</FONT></UL><P>The most common cause of an obstructed airway is that the airway hasnot been properly opened.</TD></TR><TR><TD HEIGHT="276" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/inf_pulse.gif" WIDTH="203" HEIGHT="168" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP"><B><FONT COLOR="#ffffff">Assessment: </FONT></B>Determine pulselessness.</TD><TD VALIGN="TOP"><P><A NAME="anchor641603"></A>Place 2 or 3 fingers on the inside of theinfant's upper arm, between the elbow and shoulder. Press gently on theinside of the arm with your index and middle fingers. Maintain head tiltwith the other hand. Feel for the brachial pulse.</P>
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<UL> <LI><FONT COLOR="#ffffff">If pulse is present and breathing has not resumed, breathe for the infant at the rate of 20 times per minute.</FONT> <LI><FONT COLOR="#ffffff">If there is no pulse, start chest compressions.</FONT></UL></TD><TD VALIGN="TOP"> This step should not take more than a few seconds. If the heart isbeating effectively, you should be able to feel a strong, rapid pulse withina few seconds. If you do not feel a pulse, begin chest compressions.</TD></TR><TR><TD HEIGHT="587" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/inf_chestc1.gif" WIDTH="201" HEIGHT="151" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP"><B><FONT COLOR="#ffffff">Action:</FONT></B><BR>Begin the first cycle of chest compressions.</TD><TD VALIGN="TOP"><P><A NAME="anchor635121"></A>To begin the first cycle, imagine a line drawnbetween 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 therelative sizes of rescuers' hands and infants' chests, these instructionsare only guidelines. After finding the position for compressions, make sureyour fingers are not over the bottom of the sternum (xiphoid). Compressthe infant's chest downward approximately one third to one half the depthof the chest (about ½ to 1 inch, but these measurements are not precise)at least 100 times per minute.</P>
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<P>Compress smoothly and <BR>evenly, and release pressure between compressions to allow the chest toreturn to its normal position. Do not lift your fingers <BR>off the chest.</P>
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<P>To achieve a proper rate and ratio, count aloud: "one-two-three-four-five-breathe. . . ."</TD><TD VALIGN="TOP"><P> Proper finger placement is important to maximize the effectivenessof compressions and minimize the risk of injury to the infant.</P>
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<P>With each compression, you want to squeeze the heart and increase pressurewithin the chest so that blood moves to the vital organs.</TD></TR><TR><TD HEIGHT="130" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/inf_chestc1.gif" WIDTH="201" HEIGHT="151" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP"><B><FONT COLOR="#ffffff">Action:</FONT></B><BR>Give 5 compressions and 1 breath.</TD><TD VALIGN="TOP"><A NAME="anchor563601"></A>Ventilate properly. After every 5 compressions,deliver 1 rescue breath. Pause briefly after each 5th compression to deliverthe <BR>1 breath.</TD><TD VALIGN="TOP">Adequate oxygenation must be maintained.</TD></TR><TR><TD HEIGHT="535" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/boy_phone.gif" WIDTH="180" HEIGHT="195" ALIGN="BOTTOM" NATURALSIZEFLAG="3"></TD><TD VALIGN="TOP"><P><B><FONT COLOR="#ffffff">Action:</FONT></B><BR>Activate the EMS system at the end of 20 cycles or 20 rescue breaths (approximately<BR>1 minute).</P>
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<P>After EMS notification, resume CPR, beginning with chest compressions.Check every few <BR>minutes for return of pulse.</TD><TD VALIGN="TOP"><P>Know your local EMS telephone number. If a second person is available,he or she should telephone the local EMS immediately while you continueCPR. If you are alone, perform CPR for approximately 1 minute <B><FONT COLOR="#ffffff">before</FONT></B>activating the EMS system.</P>
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<UL> <LI><FONT COLOR="#ffffff">If the pulse returns, check for spontaneous breathing.</FONT> <UL> <LI><FONT COLOR="#ffffff">If there is no breathing, give 1 rescue breath every 3 seconds (20 breaths per minute) and monitor the pulse.</FONT> <LI><FONT COLOR="#ffffff">If breathing resumes, maintain an open airway and monitor breathing and pulse.</FONT> </UL> <LI><FONT COLOR="#ffffff">If pulse<B> </B></FONT><B><FONT COLOR="#bafddc">and</FONT><FONT COLOR="#ffffff"> </FONT></B><FONT COLOR="#ffffff">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.</FONT></UL></TD><TD VALIGN="TOP">Notification of the EMS system at this time allows the caller to give completeinformation about the infant's condition.</TD></TR></TABLE></H3><H3> </H3><H3> </H3><H3> </H3><H3> </H3><H3> </H3><H3> </H3></BODY></HTML>
