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Now let's imagine that we had a conscious infant who was choking that's now become unconscious. If we haven't already activated EMS by calling 911 this is the time to activate EMS. But because technology now is so prevalent with mobile devices we don't really have to worry too much anymore about not having access to some device that can communicate. If you have your phone now would be the time to call 911 turning on speakerphone and allow dispatch to help walk you through the steps of how to rescue this patient. In the meantime I'm going to go ahead and bare the chest the be able to reveal the important landmarks so that I know that I'm doing effective chest compressions when we get to that point. I also want to take a moment to express that it's important that we have a hard surface. If we have something padded like a really thick carpet or maybe a changing table with a pad, it may actually stop the effectiveness or hinder the effectiveness of the chest compressions as the baby's body may sink at least a half- inch into that pad. So it's pretty important that we make sure that whatever surface the baby's on when we do the rescue that it is rigid and helps support the baby's body while we do this procedure. Now I'm going to draw an imaginary line between the nipples and drop my two fingers onto the sternum of the baby. It's at this point that I'm going to start with 30 compressions that are at least one-third of the depth of the chest of the baby's chest wall. I'm going to do 30 compressions. Four, five, six, seven, eight, nine, ten, eleven, twelve, thirteen, fourteen, fifteen, sixteen, seventeen, eighteen, nineteen, twenty, twenty-one, twenty-two, twenty-three, twenty- four, twenty-five, twenty-six, twenty-seven, twenty-eight, twenty-nine, thirty. Now I'm going to put the baby's head in a neutral position or a sightly sniffing position. I'm looking in the mouth for any type of product that may have come up. But I don't see any. We're not going to perform a blind finger sweep. We don't want to risk pushing the object back down if it's that far back. We only sweep it out if we can visually see it. Now I'm going to put my mask with a one-way valve over the mouth and nose of the baby and I'm going to attempt a breath. I give a breath but the chest does not rise and fall. So I'm going to reposition the baby's head and attempt another breath. I attempt another rescue breath but it does not go in. So I'm simply going to repeat the 30 chest compressions. After those 30 chest compressions I'm not going to look into the airway. If I can actually see the product in the baby's mouth I'm going to use my pinky finger to actually sweep the object out with a hooking motion. So I sweep in there and sure enough I'm able to pull the object out. Now I cover the baby's mouth and nose with my one-way valve again and I attempt a breath. Covering the nose and mouth of the baby I put my air in and sure enough I see the chest rise and fall! That's great! Now I'm going to give one more. Chest rise and fall again. Once I have the airway open if the baby does not spontaneously begin breathing again on their own, doesn't start moving or show signs of consciousness I'm going to go right back into my chest compressions, 30 times, followed by two small breaths, followed by 30 more compressions. I'm going to continue this cycle of 30 compressions to 2 rescue breaths until EMS arrives, until AED arrives, or until somebody equally trained or higher comes to relieve me.
In this lesson, you'll learn how to help a choking victim who is an unconscious infant. And just like our last two fictional choking scenarios, this victim went unconscious while you were trying to help them.
Much of this lesson will look exactly like the last two choking lessons that you just finished. But remember that we learn through repetition, you can always expect to learn a couple new things in every lesson, and the importance of the material, as it could literally save someone's life.
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on, and that you have your rescue shield handy.
- Call 911 and activate EMS if you haven't already done so. Enlist the help of a bystander if one is available.
Pro Tip #1: While repetitive and maybe not necessary, it bears repeating: The prevalence of technology has reached a point where everyone has a cell phone or mobile device. And those devices tend to have speakers making them hands-free. Also remember that in an emergency your adrenaline will likely be spiked and your brain mildly dazed and confused. If you're having trouble remembering your rescue skills, dispatch can help.
- Draw an imaginary line across the infant's nipples and place two fingers on the lower part of the sternum in the center of the infant's chest. Your fingers should be perpendicular to the chest, meaning your knuckles are directly above your fingers during compressions.
- Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, use only your fingers to supply the force for the chest compressions, and count as you perform them.
Pro Tip #2: It's important that the infant is laying on a hard surface that can support his or her bodyweight and not one that is padded. If the baby sinks into the surface – like a thick carpet or sofa cushion – this will greatly reduce the effectiveness of chest compressions.
- Conduct compressions that go to a depth of 1/3 of the infant's chest cavity, which should be around 1.5 inches deep, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
- Perform 30 chest compressions.
Remember, once you perform a chest compression, make sure you allow for full recoil of the chest cavity. You want to allow the chest to come all the way back to the neutral position before performing another compression.
- Lift the infant's chin and put the head into a neutral or slightly sniffing position.
- Look inside their mouth. See if any obstructions came loose from the chest compressions. If you see something, sweep it out using your little finger. If you don't, continue with the following steps.
Pro Tip #3: Do not perform blind finger sweeps, as this can push an object back down the throat and make dislodging more difficult. Only perform a finger sweep if you see something. And with infants, it's best to use your pinky finger.
- Grab the rescue shield and place it over the victim's mouth and nose.
- Seal your mouth over the infant's mouth and nose.
- Deliver a rescue breath and watch for the victim's chest to rise. If the chest doesn't rise, reposition the head and chin and try again. If the second breath also doesn't result in a chest rise, go right back into your 30 chest compressions.
- Look inside the infant's mouth again after the 30 chest compressions. If you see an object, sweep it out and try two more rescue breaths.
- If the rescue breaths go in this time – causing the chest to rise and fall – reassess the victim for signs of breathing normally and/or responsiveness.
Remember, we're assuming your chest compressions were able to dislodge the obstruction and you got it out of the victim's mouth. At this point, either they're breathing normally and becoming more responsive, or they're not. If not, continue to perform 30 compression to two rescue breaths.
Continue to perform CPR until EMS arrives, an AED is located, or the victim becomes responsive and begins breathing normally again.