Chapter 5: Basic Life Support for Infants

 

Lesson Objectives

After completing this lesson, participants should be able to:

•   Demonstrate how to properly open the airway for an unresponsive infant.

•   Demonstrate how to perform rescue breathing for an infant.

•   Demonstrate how to perform CPR for an infant.

•   Demonstrate how to clear an obstructed airway in a responsive infant.

•   Demonstrate how to clear an obstructed airway in an unresponsive infant.

Approximate Time: 30 minutes

Skill Practice: Yes

DVD Covers Points in Lesson: Yes

PowerPoint™ Presentation Supports Points in Lesson: Yes

 

Teaching Points

•   Cardiac arrest in infants (less than 1 year of age), as in children, is usually the result of respiratory failure. It may be caused by injury, suffocation, airway obstruction, smoke inhalation, infection, drowning, or sudden infant death syndrome (SIDS). The heart fails because it is deprived of oxygen.

•   Refer to Table 5-1 for a list of common problems in children and infants.

•   If an infant is motionless:

  Check for responsiveness and breathing. Gently tap the infant and shout or flick the soles of the infant’s feet with your fingers. Visualize the chest for signs of breathing.

  If you are alone, complete your assessment and provide 2 minutes of care before going for help. If two providers are present, one should go for help while the other cares for the infant.

  If the unresponsive infant is not breathing or has agonal gasps, feel for a brachial pulse. If a pulse is present, provide rescue breathing. If the pulse is absent or the pulse rate is less than 60 beats per minute with signs of poor perfusion (ie, cyanosis, pallor, decreased level of consciousness), begin CPR starting with chest compressions.

•   Perform rescue breathing in an unresponsive infant who has a pulse, but is not breathing or has agonal gasps.

  Open the infant’s airway using the head tilt-chin lift maneuver unless you suspect a spinal injury. Gently tilt back the head less than you would for a child. Do not hyperextend the head or neck. To lift the chin, place your finger(s) on the bony part of the jaw. Do not press on the soft tissue under the infant’s chin. If you suspect a spinal injury, open the airway with the jaw-thrust maneuver.

  Once the airway is open, create a tight seal over the infant’s mouth with a ventilation mask or your mouth. Rescue breaths only require the amount of air to produce visible chest rise. Gently blow into the infant’s mouth and nose, watching for chest rise and fall.

  Provide rescue breathing at a rate of 12 to 20 breaths per minute (one breath every 3 to 5 seconds). Hyperventilation can result if you breathe too forcefully or too fast. Avoid this by maintaining an open airway and giving just enough air to produce visible chest rise (approximately 1-second puffs).

  If the chest does not rise, reposition the head and attempt to deliver another breath. If two attempts are unsuccessful, suspect an airway obstruction that needs to be cleared.

•   CPR is indicated for an infant who is pulseless or has a heart rate less than 60 beats per minute with signs of poor perfusion.

  Use two fingers to perform chest compressions. Place your index finger along an imaginary line between the infant’s nipples, with your middle and ring fingers next to your index finger. Raise your index finger so your middle and ring fingers remain in contact with the chest.

  Compress the chest at least one third the depth of the chest (about 1 ½”) with the pads of your fingertips at a rate of at least 100 compressions per minute. Ensure that the chest fully recoils following each compression.

  After 30 chest compressions, open the airway and deliver two rescue breaths.

  If you are alone, give 30 compressions and 2 breaths per cycle. Perform 2 minutes of CPR, then go for help.

  If two health care providers are present, give 15 compressions and 2 breaths per cycle. Providers should switch roles every 2 minutes to minimize fatigue.

  Continue CPR until a defibrillator arrives or the infant starts to move. Limit interruptions to 10 seconds or less.

  When an advanced airway is in place during two-person infant CPR, do not deliver “cycles” of CPR. Instead, providers should ventilate the infant at a rate of 8 to 10 breaths per minute (one breath every 6 to 8 seconds) and perform compressions at a rate of at least 100 per minute. Do not attempt to synchronize breaths and compressions; there should be no pause in chest compressions to deliver breaths.

  When two providers are performing CPR on an infant or neonate, the two-thumb encircling hands technique should be used. This method provides better blood flow than the two-finger method and is less tiresome for the provider performing compressions.

•   If an infant is coughing forcefully, has adequate air exchange, and has normal skin color, suspect a mild airway obstruction. Observe the infant, but do not interfere with his or her attempts to expel the obstruction.

•   If an infant cannot cough, cry, or breathe; is coughing weakly; is turning blue (cyanosis); or is making high-pitched sounds during inhalation (stridor), he or she has severe airway obstruction and requires immediate treatment.

•   To perform care for a responsive infant with a sever airway obstruction:

1.  Position the infant facedown over your forearm with his or her head lower than the chest. Support the infant’s jaw with your hand.

2.  Lower the infant and your forearm to your thigh.

3.  Use the heel of your hand to give the infant five back slaps between the shoulder blades.

     a. Deliver each back slap with enough force to dislodge the obstruction.

4.  Place the infant between your hands and arms and turn the infant faceup.

5.  If the backslaps did not dislodge the foreign body, give five chest thrusts.

     a. Use the same location for chest thrusts as chest compressions.          

6.  Observe the infant throughout the process to see if the obstruction dislodges.

     a. If it does not, continue the cycles of five back slaps and five chest thrusts until the obstruction is dislodged or the infant becomes unresponsive.

•   If an infant becomes unresponsive during your attempts at relieving an airway obstruction:

1.  Position the infant on a firm, flat surface.

2.  Perform chest compressions immediately (do not check for a pulse), using the same landmark as you would for CPR.

     a.        Perform 30 chest compressions if you are alone.

b.  Perform 15 compressions if two providers are present.

3.  Open the airway and look in the mouth.

     a. If you see an object, attempt to remove it.

     b. If you do not see an object, attempt to ventilate.

4.  If the first ventilation does not produce visible chest rise, reopen the airway and reattempt to ventilate.

5.  If both breaths do not produce visible chest rise, continue chest compressions.

6.  Repeat steps 2 through 4 until the obstruction is relieved or ALS personnel take over.

·     After 2 minutes (about five cycles) of CPR, if someone has not already done so, the health care provider should go for help.

·     Once the obstruction is relieved and your breaths produce visible chest rise, check for a pulse. The patient may have been without oxygen long enough to cause cardiac arrest, which requires CPR.

Application

•   Participants should show how to open the airway of an infant to check for breathing, and how to check for a pulse on an infant.

•   Participants should demonstrate how to perform rescue breathing for an infant.

•   Participants should demonstrate how to perform CPR for an infant.

•   Participants should demonstrate how to manage an airway obstruction on a responsive and an unresponsive infant.

•   Participants should complete the “Check Your Knowledge” questions at the end of Chapter 5 in the textbook.

 

 

© 2013 by Jones & Bartlett Learning, LLC an Ascend Learning Company • www.jblearning.com