<HTML><HEAD> <META NAME="GENERATOR" CONTENT="Adobe PageMill 2.0 Win"> <TITLE>Untitled Document</TITLE></HEAD><BODY TEXT="#bafddc" BGCOLOR="#006666" LINK="#ffcc66" ALINK="#fb1814" VLINK="#5cf373"><H1><FONT COLOR="#eca413">Performance Guidelines</FONT></H1><H2><FONT COLOR="#f38568">Relief of Obstructed Airway: Conscious Infant(younger than 1 year)</FONT></H2><P><TABLE WIDTH="800" BORDER="1" CELLSPACING="2" CELLPADDING="5"><TR><TD WIDTH="25%"> </TD><TD WIDTH="25%"><B><FONT COLOR="#ffffff">Objectives</FONT></B></TD><TD WIDTH="25%"><B><FONT COLOR="#ffffff">Critical Performance</FONT></B></TD><TD WIDTH="25%"><B><FONT COLOR="#ffffff">Reason</FONT></B></TD></TR><TR><TD> </TD><TD VALIGN="TOP"><B><FONT COLOR="#ffffff">Assessment:</FONT></B><BR>Determine <B><FONT COLOR="#ffffff">complete</FONT></B> airway obstructioneither by observing sudden onset of signs of complete airway obstructionor by the circumstances in which the infant is found.</TD><TD VALIGN="TOP"><P>Rescuer must identify <B><FONT COLOR="#ffffff">complete</FONT></B> airwayobstruction by the presence of breathing difficulty, an absent or ineffectivecough, dusky color, and an inability to make sounds.</P>
<A NAME="anchor1"></A>
<P><B><FONT COLOR="#ffffff">If the infant is able to cough or cry, do notinterfere</FONT></B><I> </I>with the infant's attempts to expel the object.</TD><TD VALIGN="TOP"><P>In the conscious infant it is essential to recognize the signs of <B><FONT COLOR="#ffffff">complete</FONT></B><I> </I>airway obstruction and takeprompt action.</P>
<A NAME="anchor2"></A>
<P>If the infant is able to cough or cry, air is getting through the trachea(windpipe) and the obstruction is <B><FONT COLOR="#ffffff">not</FONT></B>complete. In such a situation, you may make things worse by interfering.</TD></TR><TR><TD><IMG SRC="Book_PBLS/PBLS_source_art/inf_blow.gif" WIDTH="173" HEIGHT="182" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP"><P>If the infant is <B><FONT COLOR="#ffffff">unable</FONT></B><I> </I>tocry or cough effectively:</P>
<A NAME="anchor3"></A>
<P> </P>
<A NAME="anchor4"></A>
<P> </P>
<A NAME="anchor5"></A>
<P><B><FONT COLOR="#ffffff">Action:</FONT></B><BR>Deliver up to 5 back blows.</TD><TD VALIGN="TOP"><P>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 thanthe trunk.</P>
<A NAME="anchor6"></A>
<P>With the heel of your free hand, deliver up to 5 back blows forcefullybetween the infant's shoulder blades.</TD><TD VALIGN="TOP">You must hold the infant's head firmly to avoid injury. The back blows increasepressure in the airway and may help dislodge the object.</TD></TR><TR><TD> <IMG SRC="Book_PBLS/PBLS_source_art/inf_thrust.gif" WIDTH="163" HEIGHT="167"ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD><B><FONT COLOR="#ffffff">Action:</FONT></B><BR>Deliver up to 5 chest thrusts over the lower half of the sternum (avoidthe xiphoid).</TD><TD VALIGN="TOP"><P>Supporting the head, sandwich the infant between your hands and armsand turn the infant on his or her back, keeping the head lower than thetrunk.</P>
<A NAME="anchor7"></A>
<P>Deliver up to 5 thrusts over the lower half of the breastbone, usingthe same landmarks as those for chest compression. Make sure your fingersare not placed over the very bottom of the sternum (xiphoid).</P>
<A NAME="anchor8"></A>
<P>Deliver the chest thrusts more slowly than when doing chest compressions.</TD><TD VALIGN="TOP">Such thrusts can force air upward into the airway from the lungs with enoughpressure to expel the foreign object.</TD></TR><TR><TD> </TD><TD VALIGN="TOP"><B><FONT COLOR="#ffffff">Action:</FONT></B><BR>Repeat the sequence of 5 back blows and 5 chest thrusts until the objectis expelled or until the infant becomes unconscious. Be persistent!</TD><TD VALIGN="TOP"><P>Alternate these maneuvers in rapid sequence:</P>
<A NAME="anchor9"></A>
<UL> <LI><FONT COLOR="#ffffff">Back blows</FONT> <LI><FONT COLOR="#ffffff">Chest thrusts</FONT></UL></TD><TD VALIGN="TOP">Persistent attempts should be made to relieve the obstruction. As the infantbecomes more deprived of oxygen, the airway muscles will relax, and maneuversthat were previously ineffective may become effective.</TD></TR></TABLE></BODY></HTML>
