<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 Child (1to 8 years)</FONT> <TABLE WIDTH="800" BORDER="1" CELLSPACING="2" CELLPADDING="5"><TR><TD WIDTH="25%"> </TD><TD WIDTH="25%">Objectives</TD><TD WIDTH="25%">Critical Performance</TD><TD WIDTH="25%">Reason</TD></TR><TR><TD WIDTH="25%" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/ch_choke.gif" WIDTH="166" HEIGHT="210" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD WIDTH="25%" VALIGN="TOP"><B><FONT COLOR="#ffffff">Assessment:</FONT></B><BR>Determine <B><FONT COLOR="#ffffff">complete</FONT></B> airway obstructionby observing sudden onset of signs, including ineffective cough, increasingbreathing difficulty, or blueness of lips, nails, or skin.</TD><TD WIDTH="25%" VALIGN="TOP"><P>The child is unable to speak or cough effectively. The rescuer asks "Areyou choking?"</P>
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<P>The child may be using the universal distress signal of choking: clutchingthe neck between the thumb and index finger.</P>
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<P><B><FONT COLOR="#ffffff">If the child is able to speak or cough effectively,do not interfere </FONT></B>with his or her attempts to expel the object.</TD><TD WIDTH="25%" VALIGN="TOP"><P>In the conscious child, it is essential to recognize the signs of completeairway obstruction and take prompt action.</P>
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<P>If the child is able to speak or cough, air is getting past the obstructionand the obstruction is not complete. In such a situation you may make thingsworse by interfering.</TD></TR><TR><TD VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/ch_heim.gif" WIDTH="167" HEIGHT="226" ALIGN="BOTTOM"NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP"><B><FONT COLOR="#ffffff">Action:</FONT></B><BR>If a cough is absent or ineffective: perform the Heimlich maneuver untilthe foreign body is expelled or the child becomes unconscious. Be persistent!</TD><TD VALIGN="TOP"><P><B><FONT COLOR="#ffffff">The Heimlich maneuver:</FONT></B> Stand behindthe child and wrap your arms around the child's waist. Grasp one fist withyour other hand and place the thumb side of your fist in the child's midlineslightly above the navel but below the xiphoid and ribs. Press your fistinto the child's abdomen with quick inward and upward thrusts. Each abdominalthrust should be delivered decisively, with the intent of relieving theobstruction.</P>
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<P>Several thrusts may be necessary to expel the object.</TD><TD VALIGN="TOP">Such thrusts can force air upward from the lungs into the airway with enoughpressure to expel the foreign body. Persistent attempts should be made insequence to relieve the obstruction. As the child becomes more deprivedof oxygen, the muscles will relax, and maneuvers that were previously ineffectivemay become effective.</TD></TR></TABLE></H2></BODY></HTML>
