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(gentle piano music) - Like all scenarios, we have to ensure that the scene is safe before we begin rescue, or else we can become a victim, too. And in this scenario, you can see that the baby has probably actually got themselves into a bad situation because they bit a cord that was frayed and may have been electrocuted. So, before we ever touch this baby, we've gotta make sure that we de-energize the source of the electrocution. In this case, I follow with my eyes the cord, right back to its source of energy, and I carefully unplug it and ensure that there's no longer any chance of getting electrocuted. It's at this time, if there are bystanders, it wouldn't be bad to call 9-1-1 or have somebody go call 9-1-1 while we then grab the baby and bring them to a place where there's a hard surface so that we begin rescue. Carefully roll the baby, bring them to a hard surface. Now, let's take a look at infant CPR. But, before we get into the actual skills, let's talk about a few important parts. And one of those is, make sure that the surface that you lay the baby on is hard and it will not allow the body of the baby to sink into padding, and that's a part of the reason why I'm not on the floor on a carpeted, padded surface. We wanna make sure that every compression I give is maximal. We wanna make sure that it is actually doing what it's supposed to do and that the baby's body is not sinking into that surface, diminishing the effect of the compression. Number two, when it comes to infants and children, they're so respiratory-driven, they're so oxygen-driven that we wanna make sure to make a note whether or not they went into cardiac arrest in our presence or whether we found them already in cardiac arrest. Because if we found them in cardiac arrest and we don't know how long they've been down, we know they need oxygenation really bad. And so, we're gonna actually postpone contacting 9-1-1 or EMS to give them CPR when we don't have a phone readily available. If we have a phone available or we have somebody who can go call 9-1-1, then by all means, don't delay EMS. But, if you don't have a way to call 9-1-1 and we found the baby already in cardiac arrest, we're gonna deliver two minutes of CPR before we interrupt to go call 9-1-1. If the baby was witnessed, we call 9-1-1 immediately, and then go right into CPR. It's not wrong to carry the baby with you, either. So, if you found the baby downstairs and you know you have to bring them up to meet the ambulance, you could carry the baby with you and get the 9-1-1 call made, and then begin your CPR right away. In this case, the scene is safe, our gloves are on, our CPR shield is available, and I actually do have a cellphone that's available. So, I'm gonna call 9-1-1 because the baby is not responding. I've already tapped their feet, I've already tapped their chest. They didn't move, they didn't cry, they didn't talk, they didn't move to my tickling, and they certainly are not breathing normally. So, I know this is a medical emergency, so I called 9-1-1, I actually put the phone on the speaker so that the dispatch center can coach me through this event. I'm not alone anymore, I have help. Now, I'm gonna bare the chest of the baby and I'm gonna find the imaginary line between the nipples. I'm now gonna put my two fingers down on the center of the chest to begin my one-third the depth of the chest, or approximately one and a half deep compressions at a rate between 100 and 120 times per minute. One and two, and three and four, and five and six, and seven and eight, and nine and 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30. Now, I'm gonna take my CPR shield with a one-way valve. I'm gonna cover the nose and mouth of the baby. Now, watch as I do the head tilt/chin lift. I'm not bringing the head fully back like I would a large child or an adult because a baby's airway is only the size of their pinky. So, what we're doing is bringing the baby's head into more of a neutral position. Remember, infants don't really have much of a neck, so if their chin is too close to their chest or their head is tilted back too far, both can actually diminish the openness of their airway. So, I want them in more of a neutral position. Now, there's another little way to remember that, and I call it the sniffing position. Now, what do I mean by sniffing position? Well, what I mean is, if you walked into a room and someone were baking cookies, you wouldn't really put your nose down like you were smelling a flower, you would maybe put it a slightly bit up into the air and, (sniffs) ooh, someone's baking cookies. What's that smell? So, that's what we mean by the sniffing position. It's not fully back, it's just slightly raised. And so, we bring the baby's head into the neutral position or slightly-sniffing position. Now, I'm gonna seal my mouth over the nose and mouth of the baby and deliver a rescue breath. As I deliver the breath, I see the chest rise and fall. I'm gonna deliver my second breath. As I give my second breath, the air goes in again. Now, I'm gonna repeat the chest compressions. 30 chest compressions between a rate of 100 to 120 times a minute. Then, I'm gonna give them two more rescue breaths, and I'm gonna continue this cycle of 30 chest compressions to two rescue breaths and I'm not going to stop until EMS arrives, and AED arrives, or someone equally trained or higher relieves me from this skill.
In this lesson, you'll learn how to perform CPR on an infant. Much of the process will look the same as adult and child CPR, but again there are some subtle yet crucial differences to take note of – namely, the techniques for performing chest compressions and delivering rescue breaths.
Like in the last lesson, we'll assume that in this scenario, an infant has suddenly gone into cardiac arrest and you don't know why.
Pro Tip #1: Babies are very oxygen driven. If you don't know how long an infant has been in cardiac arrest, you should assume that their need for oxygen is extreme and vital for recovery. Which is why beginning CPR trumps everything else, except for making sure the scene is safe.
Infant-related cardiac arrests are typically the result of:
- Drowning
- Choking/airway obstruction
- Electrocution
Regardless of what led to the infant's condition, just as before, all you know for sure is that the victim is unresponsive and not breathing normally, if at all. And that CPR is required.
Pro Tip #2: The compressions you perform on an infant are a bit different than those you perform on adults and children. The depth is still 1/3 the depth of the chest, or in this case, around 1.5 inches. And the rate is still 100 – 120 per minute. However, the technique for performing compressions is different, as outlined below.
Infant CPR Compression Technique
- Remove the infant's clothing to reveal the imaginary nipple line.
- Place two fingers on 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.
- Perform compressions using just your hand and arm strength, not your body weight.
How to Provide Care
Of course, the first thing you want to do is make sure the scene is safe, your gloves are on, and that you have your rescue shield, and begin calling out to the baby to assess whether or not he or she is responsive.
Are you OK? Can you hear me?
If you don't get an initial response and you can see that the infant still isn't breathing normally, place your hand on his or her forehead and tap on the bottom of the baby's feet. If you still do not get a response, proceed with the following steps.
- Call 911 and activate EMS. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc.
Warning: Remember Pro Tip #1? Time is of the essence. If you or someone witnessed the infant go into cardiac arrest and it just happened, call 911. But if you don't know how long the infant has been like that, unless there is a bystander nearby that can call 911 or if your phone is out and ready for use, begin CPR immediately. And call 911 after delivering two minutes of CPR.
- If you've determined at this point that the infant isn't moving or breathing normally and requires CPR, perform 30 chest compressions using the technique outlined above at a rate between 100 – 120 compressions per minute, or around two compressions per second. And remember to allow the chest to fully recoil in-between compressions.
Pro Tip #3: When performing CPR, it's important that the victim is laying on a hard surface. While moving unconscious adults isn't possible, moving infants is, so find a hard surface. Why? When you perform chest compressions on say, a couch, the victim will sink with each compression, thereby reducing the depth of the compressions and the effectiveness of CPR.
- Put the infant's head into a neutral or slightly sniffing position. Babies don't really have necks, so if the chin is too close to the chest or the head is tilted back too far, this will diminish the openness of their airway.
- 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 two rescue breaths – Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath.
Pro Tip #4: What does slightly sniffing look like? Imagine you just walked into a kitchen where someone was baking and you caught a whiff of something good. You raise your head up just slightly as you flex your nostrils for a better scent. That's slightly sniffing.
- If you haven't already called 911, do so now. Otherwise, don't ever interrupt CPR unless it's urgent, like calling 911.
- Go right back into 30 chest compressions followed again by two rescue breaths.
Continue to perform 30 chest compressions to two rescue breaths until EMS arrives, an AED is located, someone equally trained relieves you, or the victim becomes responsive and begins breathing normally again.
The Five Fears of CPR Rescue
One common problem we see is when people have persistent fears that they can't shed, it prevents them from even attempting to make a rescue.
In this section, we're going to address those fears and hopefully eliminate them, so you'll have the confidence to push through and make a difference when faced with an emergency.
The five fears are:
- Uncertainty of skills. You're worried that you don't know what to do, and that you'll do more harm than good.
- Might hurt or kill the victim. You're worried that a mistake on your part will spell trouble for the victim.
- Lawsuits. You're worried about getting sued, whether someone only thinks you did something wrong or you actually did do something wrong.
- Threat of contracting a disease. You're worried about blood and bodily fluids that contain pathogens that you would then contract.
- The scene is unsafe. You're worried that the scene may be unsafe and that you'll become a victim, too.
At first glance, these fears may sound reasonable. However, let's tackle them one by one using some common sense that should help you eliminate your fears, so that you can become the best rescuer that you can be.
Uncertain of Skills
This should only be a real concern if there's no way for you to refresh your training. However, since we designed our course content to be viewed whenever it's convenient for you, rather than when an instructor is ready to teach, there's really no excuse.
Whenever you feel that you're deficient in a particular area of training, go back to the training library for a refresher. It's self-paced and available 24/7.
Effort and knowledge are the cures for uncertainty. If you put in the time and master your skills, this uncertainty will vanish, and you'll be amazed that you were ever apprehensive to begin with.
Might Hurt or Kill the Patient
When a person is unconscious, isn't breathing normally, and has no pulse, they're already dead. And while it may sound silly to say this, it's true: Their condition cannot get worse.
That person will remain dead unless someone with life-saving skills gets involved. This alone should alleviate a lot of fear and worry about making the situation worse.
During CPR compressions, a lot of new students worry about the possibility of breaking ribs or injuring a patient some other way. But this isn't really possible. Read that first paragraph again – the patient is dead and cannot get worse. However, with your help, they may get better.
Lawsuits
The good news is that since 1985's Good Samaritan Act, people who attempt to help others are protected legally, with a couple of exceptions:
- If you intended to hurt the victim
- If you go above and beyond your level of training
The Good Samaritan Act has essentially immunized people from lawsuits when they try to help others in need.
Threat of Contracting a Disease
As long as you have gloves and a rescue shield, this shouldn't be much of a concern. Those two pieces of equipment will keep those nasty pathogens, if there are any, on the patient's side, while you the rescuer remain on your side.
A Word About Hand's Only CPR
Research has shown that, especially with adults and in the first few minutes, hands-only CPR is just as effective as full CPR. So, if you don't feel comfortable or confident in doing full CPR, or if you're lacking protective equipment, hands-only CPR will still benefit the victim.
The Scene is Unsafe
This is actually a legitimate concern and a reason to delay a rescue attempt. You can still call 911 and get EMS on the way. But if the scene is dangerous, don't do anything that will make you the next victim. Remain at a safe distance until the scene becomes safe, and then go in.
These five fears prevent around 90 percent of people from using the skills they learned. It's natural to have them, but it's essential to shed them. Put in the time and effort when it comes to your training and you'll crush those fears. Someone's life may depend on it.