Emergency Cardiovascular Care Library

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Text File | 1998-01-05 | 9KB | 53 lines

<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>Performance Guidelines</H1><H2>Relief of Obstructed Airway: Unconscious Child(1 to 8 years)</H2><H2><TABLE WIDTH="800" HEIGHT="677" BORDER="1" CELLSPACING="2" CELLPADDING="5"><TR><TD WIDTH="25%" HEIGHT="24"> </TD><TD WIDTH="25%">Objectives</TD><TD WIDTH="25%">Critical Performance</TD><TD WIDTH="25%">Reason</TD></TR><TR><TD HEIGHT="240" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/ch_help.gif" WIDTH="172" HEIGHT="135" ALIGN="BOTTOM" NATURALSIZEFLAG="0"> <A NAME="anchor1"></A> <IMG SRC="Book_PBLS/PBLS_source_art/ch_turn.gif" WIDTH="171" HEIGHT="181" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP">Assessment: Determine unresponsiveness. Shout for help. <A NAME="anchor2"></A> <A NAME="anchor3"></A> <A NAME="anchor4"></A> Action: Position the child on back.</TD><TD VALIGN="TOP">Tap or gently shake victim's shoulder. <A NAME="anchor5"></A> Shout "Are you OK?" Call out "Help!" <A NAME="anchor6"></A> <A NAME="anchor7"></A> Turn child on back holding head and body as a unit, supporting head andneck.</TD><TD VALIGN="TOP">This initial call for help is to alert bystanders so they can activate theEMS system while you care for the child.</TD></TR><TR><TD HEIGHT="272" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/ch_headtilt.gif" WIDTH="168" HEIGHT="195" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP">Action: Open the airway. <A NAME="anchor8"></A> <A NAME="anchor9"></A> <A NAME="anchor10"></A> Assessment: Determine breathlessness.</TD><TD VALIGN="TOP"><A NAME="anchor534706"></A>Use the head tilt–chin lift maneuverto position the child's head in a neutral position and open the airway. <A NAME="anchor11"></A> Place your ear over the child's mouth and observe the chest. <A NAME="anchor12"></A> Look at the chest for movement. <A NAME="anchor13"></A> Listen for the sounds of breathing. <A NAME="anchor14"></A> Feel for breath on your cheek.</TD><TD VALIGN="TOP"> <A NAME="anchor15"></A> <A NAME="anchor16"></A> <A NAME="anchor17"></A> <A NAME="anchor18"></A> You must determine that the child is not breathing.</TD></TR><TR><TD HEIGHT="24" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/ch_mouth.gif" WIDTH="166" HEIGHT="172" NATURALSIZEFLAG="0" ALIGN="BOTTOM"></TD><TD VALIGN="TOP">Action: Open the airway and try to give 2 rescue breaths. Observe the rise of thechest with each breath. <A NAME="anchor19"></A> Action: If initial rescue breaths are unsuccessful, reposition the head and tryagain. If repeat attempts are unsuccessful, perform Heimlich thrusts.</TD><TD VALIGN="TOP">Use the thumb and forefinger of the hand that is maintaining pressureon the child's forehead to pinch the nostrils closed. Make a tight sealwith your mouth over the child's mouth. Give 2 rescue breaths. <A NAME="anchor20"></A> Reposition the child's head and lift the chin. Pinch the nostrils closed.Seal the mouth properly and try again to give rescue breaths.</TD><TD VALIGN="TOP">Complete airway obstruction by a foreign body is assumed if the childbecomes unconscious, but if the child is found unconscious, an attempt mustbe made to get some air into the lungs. If the chest rises, the airway isopen. If the chest does not rise, the airway is obstructed. <A NAME="anchor21"></A> Improper head tilt–chin lift is the most common reason that airwayobstruction is not relieved.</TD></TR><TR><TD HEIGHT="24" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/ch_heimunc.gif" WIDTH="171" HEIGHT="140" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP">Action: Perform the Heimlich maneuver (up to 5 thrusts).</TD><TD VALIGN="TOP">The Heimlich maneuver: Kneel at the child's hips if the child is on the floor; stand at child'sside if the child is on a table. If the child is large, you may kneel astridethe child's thighs. Place the heel of one hand on the abdomen midline, slightlyabove the navel and well below the sternum and xiphoid. Place the secondhand directly on top of the first hand. Press into the abdomen with quickupward thrusts.</TD><TD VALIGN="TOP">Such thrusts can force air upward into the airway from the lungs with enoughpressure to expel the foreign body.</TD></TR><TR><TD HEIGHT="24" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/ch_tongjaw.gif" WIDTH="165" HEIGHT="158" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP">Action: Perform tongue-jaw lift. Check for a foreign object and if you see it, removeit.</TD><TD VALIGN="TOP">Lift tongue and jaw forward by putting your thumb in the child's mouth overthe tongue and wrapping your fingers around the lower jaw. If you see aforeign body, remove it. Do not performa blind finger sweep.</TD><TD VALIGN="TOP">A dislodged foreign body may now be manually accessible if it has not beenexpelled. Blind finger sweeps may push the obstructing object back intoor further into theairway.</TD></TR><TR><TD HEIGHT="24" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/ch_mouth.gif" WIDTH="167" HEIGHT="182" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP">Action: Open the airway and try to give rescue breaths. If unsuccessful, repositionthe head and try again.</TD><TD VALIGN="TOP">Position the child's head using the head tilt–chin lift maneuver.Seal the mouth properly and try again to give rescue breaths. <A NAME="anchor22"></A> If the airway remains obstructed, alternate the following maneuvers inrapid sequence: <A NAME="anchor23"></A> <UL> <LI>Perform Heimlich maneuver. <LI>Perform tongue-jaw lift, check for foreign body, and remove it if seen. <LI>Open the airway. <LI>Attempt, reattempt rescue breathing while maintaining an open airway.</UL>Repeat this sequence until successful.</TD><TD VALIGN="TOP">By this time another attempt must be made to get some air into the victim'slungs. <A NAME="anchor24"></A> You must try again to dislodge the foreign body and give rescue breaths. <A NAME="anchor25"></A> Persistent attempts should be made in sequence to relieve the obstruction.As the child becomes more deprived of oxygen, the muscles will relax, andmaneuvers that were previously ineffective may become effective.</TD></TR><TR><TD HEIGHT="24" VALIGN="TOP"><IMG SRC="Book_PBLS/PBLS_source_art/boy_phone.gif" WIDTH="167" HEIGHT="173" ALIGN="BOTTOM" NATURALSIZEFLAG="0"></TD><TD VALIGN="TOP">Action: Activate the EMS system after approximately 1 minute.</TD><TD VALIGN="TOP">If you are alone, activate the EMS system after approximately 1 minuteof effort. <A NAME="anchor26"></A> <UL> <LI>If there is no breathing, give 2 breaths. Check for a pulse. <UL> <LI>If a pulse is present, provide 20 breaths per minute and continue to monitor pulse. <LI>If there is no pulse, begin cycles of compressions and breaths. </UL> <LI>If breathing resumes and there is no evidence of trauma, place the child on one side in the recovery position and await the arrival of emergency personnel.</UL></TD><TD VALIGN="TOP"> </TD></TR></TABLE></H2></BODY></HTML>