<P><B><FONT COLOR="#ffffff">Action:<BR></FONT></B>Position the child on his or her back.</TD><TD VALIGN="TOP"><P>Tap or gently shake the shoulder. Shout "Are you OK?" Callout "Help!" If help arrives, send someone to activate the EMSsystem.</P>
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<P>Turn the child as a unit, supporting head and neck. If head or neck injuryis suspected, do not bend or turn the neck.</TD><TD VALIGN="TOP"><P>One concern is the risk of possible damage from unnecessary CPR for childrenwho are sleeping. A call for help will summon people nearby but allow youto begin CPR if necessary.</P>
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<P>For CPR to be effective, the child must be flat on his or her back ona firm, hard surface. CPR cannot be performed if the child is face down.</TD></TR><TR><TD VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/ch_headtilt.gif" WIDTH="173" HEIGHT="200" ALIGN="BOTTOM" NATURALSIZEFLAG="3"></TD><TD VALIGN="TOP"><P><B><FONT COLOR="#ffffff">Action:</FONT></B><BR>Open the airway (head tilt–chin lift).</P>
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<P><B><FONT COLOR="#ffffff">Assessment:<BR></FONT></B>Determine breathlessness.</TD><TD VALIGN="TOP"><P><A NAME="anchor525693"></A>Kneel beside the child's shoulder. Lift thechin up gently with one hand while pushing down on the forehead with theother to tilt the head back into a neutral position. Do not close the mouth.If there is evidence of trauma, open the airway using a jaw thrust.</P>
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<P>Maintain an open airway. Turn your head toward the child's chest withyour ear directly over and close to the child'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 <BR>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 child is breathing.Children may be unable to breathe because the tongue is obstructing theairway.</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. Rescue breathing should notbe performed on someone who is breathing effectively.</TD></TR><TR><TD ALIGN="CENTER" VALIGN="TOP"><P ALIGN=LEFT><IMG SRC="Book_PBLS/PBLS_source_art/ch_mouth.gif" WIDTH="177" HEIGHT="188" NATURALSIZEFLAG="0" ALIGN="BOTTOM"></TD><TD VALIGN="TOP"><A NAME="anchor545647"></A><B><FONT COLOR="#ffffff">Action:</FONT></B><BR>If the child is not breathing, provide rescue breathing. Give 2 rescue breaths(1 to 1½ seconds per breath). Observe the rise of the chest witheach breath.</TD><TD VALIGN="TOP"><P>Pinch the child's nostrils closed with the thumb and forefinger of thehand maintaining pressure on the child's forehead while lifting the chinwith the other hand. Open your mouth wide, take a deep breath, and makea tight seal over the child's mouth. Breathe into the child's mouth twice,completely refilling your lungs between breaths. Watch for the child's chestto rise. Each rescue breath is given over 1 to 1½ seconds, allowingthe child's lungs to deflate between breaths.</P>
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<P>If the rescue breaths do not cause the child's chest to rise, the airwayis obstructed. Reposition the head, lift the chin, and try again. If thechest still does not rise with the rescue breath, start the <A HREF="http://localhost:8032/servlet/lp?url=Book_PBLS/pg07_06.htx"TARGET="_blank">relief of obstructed airway sequence.</A></TD><TD VALIGN="TOP"><P>It is important to get as much oxygen as possible into the child. 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 child's chest rise and fall</FONT></UL><P>Improper head tilt–chin lift is the most common reason that airwayobstruction is not relieved.</TD></TR><TR><TD VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/ch_pulsethr.gif" WIDTH="181" HEIGHT="276" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP"><B><FONT COLOR="#ffffff">Assessment:</FONT></B><BR>Determine pulselessness.</TD><TD VALIGN="TOP"><P><A NAME="anchor661198"></A>Using the hand that is farther from the child'sforehead, place 2 or 3 fingers on the child's Adam's apple (voice box) justbelow the chin. Slide the fingers into the groove between the Adam's appleand the neck muscle on the side of the neck near you. Maintain head tiltwith the other hand. Feel for the carotid pulse.</P>
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<UL> <LI><FONT COLOR="#ffffff">If a pulse is present and breathing has not resumed, breathe for the child at a 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 is beatingeffectively, you should feel a strong, rapid pulse within a few seconds.If you do not feel a pulse, begin chest compressions.</TD></TR><TR><TD VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/ch_chestcom.gif" WIDTH="184" HEIGHT="187" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP"><B><FONT COLOR="#ffffff">Action:<BR></FONT></B>Begin the first cycle of chest compressions.</TD><TD VALIGN="TOP"><P><A NAME="anchor655705"></A>To begin the first cycle:<BR>Move the hand that is not maintaining head tilt to the child's chest. Placethe heel of the hand on the lower half of the breastbone (sternum). Do notplace your hand over the very bottom of the sternum (the xiphoid). Compressthe child's chest downward approximately one third to one half the depthof the chest (this is about 1 to 1½ inches, but these measurementsare not precise) at a rate of 100 times per minute.</P>
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<P>Compress smoothly and evenly, keeping your fingers off the child's ribs.</P>
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<P>Between compressions, release pressure and allow the chest to returnto its normal position, but do not lift the hand off the chest. Say a mnemonicto maintain the proper rate and ratio. Count aloud to establisha rhythm:"one-two-three-four-five-breathe . . . ."</TD><TD VALIGN="TOP"><P>Proper hand placement is important to maximize effective compressionsand minimize the risk of injury to the child.</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 ALIGN="CENTER"> </TD><TD><B>Action:<BR></B>Give <B><FONT COLOR="#ffffff">5</FONT></B> compressions and<B> <FONT COLOR="#ffffff">1</FONT></B> breath.</TD><TD VALIGN="TOP"><A NAME="anchor566461"></A>Ventilate properly. After every <B><FONT COLOR="#ffffff">5</FONT></B>compressions, deliver <B><FONT COLOR="#ffffff">1</FONT></B> rescue breath.</TD><TD VALIGN="TOP">Adequate oxygenation must be maintained.</TD></TR><TR><TD VALIGN="TOP"><P><IMG SRC="Book_PBLS/PBLS_source_art/boy_phone.gif" WIDTH="185" HEIGHT="195" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></P>
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<P><IMG SRC="Book_PBLS/PBLS_source_art/ch_pulsethr2.gif" WIDTH="184" HEIGHT="146"ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP"><P><A NAME="anchor552588"></A><B>Action:<BR></B>Activate the EMS system at the end of 20 cycles or 20 rescue breaths(approximately 1 minute of CPR).</P>
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<P>After EMS activation, resume CPR, beginning with chest compressions.Check every few minutes for return of pulse.</TD><TD VALIGN="TOP"><P>Know your local EMS telephone number. If a second <BR>person is available, he or she should telephone the local EMS immediately.</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<I> </I>pulse<I> </I></FONT><B><FONT COLOR="#bafddc">and</FONT></B><FONT COLOR="#ffffff"> breathing resume and are regular and there is no evidence of trauma, turn the child to the side, continue to monitor breathing and pulse, and await emergency <BR> personnel.</FONT></UL></TD><TD VALIGN="TOP">Notification of the EMS system at this time allows the caller to give completeinformation about the child's condition.</TD></TR></TABLE></BODY></HTML>
