Mountainland Pediatrics: Emergencies

Cardiopulmonary Resuscitation (CPR)

In the past, we used the "ABC's of CPR " because it reminded us that there was a very specific order in which a person should be resuscitated. However, the American Heart Association updated its recommendations for CPR in October, 2010 and now recommends that an untrained rescuer begin chest compressions immediately. The ABC acronym has been changed to CAB.

Compressions

Airway

Breathing

Untrained rescuers should focus on continuous compressions and not perform mouth-to-mouth resuscitation if they are not familiar with it.

CPR FOR INFANTS (under 1 year)

EVALUATE your child's condition. Shout or gently shake your child to see if he will awaken. Put your ear next to his nose and listen for breathing. Look at the chest to see if it rises with each breath.

CALL FOR HELP. Have someone dial 911. If no one is available, do CPR for 2 minutes before calling 911.

IF YOUR CHILD IS NOT BREATHING OR WILL NOT AWAKEN:

POSITION your child. Put him on his back on a firm surface. If you think he could have injured his neck, support his head in order to keep the neck from twisting as you roll him over.

TILT THE HEAD BACK so that his nose is "in the air". Check the mouth to make sure your child has not choked on anything. (see CHOKING procedures)

BEGIN CHEST COMPRESSIONS. With an infant, place two fingers on the breastbone, with your index finger at the height of the nipples. Compress at a depth of 1 1/2 inches (about 1/3 of the chest height) at a rate of two compressions per second. Do 30 compressions.

GIVE 2 RESCUE BREATHS. For an infant, place your mouth over his mouth and nose and breathe GENTLY, watching to see if the chest rises and falls. If not, readjust the head (see POSITION above), then give 2 breaths and return to chest compressions. NOTE: If the chest will not rise (or you do not know how to do rescue breaths), skip that step and just do chest compressions. You can try it again after 30 more compressions*.

*Continue chest compressions and breathing until paramedics arrive.

CPR FOR CHILDREN (1 to 8 years)

EVALUATE your child's condition. Shout or gently shake your child's shoulders to see if he will awaken. Put your ear next to his nose and listen for breathing. Look at the chest to see if it rises with each breath.

CALL FOR HELP. Have someone dial 911. If no one is available, do CPR for 2 minutes before calling 911.

IF YOUR CHILD IS NOT BREATHING OR WILL NOT AWAKEN:

POSITION your child. Put him on his back on a firm surface. If you think he could have injured his neck, support his head in order to keep the neck from twisting as you roll him over.

TILT THE HEAD BACK so that his nose is "in the air". Check the mouth to make sure your child has not choked on anything. (see CHOKING procedures)

BEGIN CHEST COMPRESSIONS. For a child, put one hand on the chest between his nipples. Lock your elbows and press straight down about 2 inches. Continue for 30 compressions at a rate of two compressions per second.

GIVE 2 RESCUE BREATHS. For a child, place your mouth over his mouth and press his nose shut with your fingers. Breathe GENTLY, watching to see if the chest rises and falls. If not, readjust the head (see POSITION above), then give 2 breaths and return to chest compressions. NOTE: If the chest will not rise (or you do not know how to do rescue breaths), skip that step and just do chest compressions. You can try it again after 30 more compressions*.

*Continue chest compressions and breathing until paramedics arrive.

CPR FOR OLDER CHILDREN & ADULTS

EVALUATE THE VICTIM Shout or gently shake her shoulders to see if she will awaken. Put your ear next to her nose and listen for breathing. Look at the chest to see if it rises with each breath.

CALL FOR HELP. Have someone dial 911. If no one is available, do CPR for 2 minutes before calling 911.

IF THE VICTIM IS NOT BREATHING OR WILL NOT AWAKEN:

POSITION the victim. Put her on her back on a firm surface. If you think she could have injured her neck, support her head in order to keep the neck from twisting as you roll her over.

TILT THE HEAD BACK so that her nose is "in the air". Use a "Chin Lift" by pulling up on the back of the jaw to open the airway. If you did not witness the event, check the mouth to see if there is any food/foreign body.

BEGIN CHEST COMPRESSIONS. Put the heel of your hand in the middle of her chest, placing the other hand over the first hand. Lock your elbows and press straight down about 2 inches. Allow the chest to return to its normal position. Continue for 30 compressions at a rate of 100 times a minute. (Some people recommend that you press to the beat of "Stayin' Alive").

If you have NOT been trained in CPR, you may continue to just give chest compressions until help arrives or the victim wakes up. Otherwise, proceed to give rescue breaths.

If you are in a public building that has an automated external defibrillator (AED), turn it on. If you saw the victim collapse, attach the AED immediately and follow the instructions. Otherwise, perfom CPR for 1 minute before using the AED.

GIVE 2 RESCUE BREATHS. Place your mouth over her mouth (or use a CPR mask if available) and press her nose shut with your fingers. Breathe GENTLY, watching to see if the chest rises and falls. If not, readjust the head (see POSITION above), then give 2 breaths and return to chest compressions. NOTE: If the chest will not rise (or you do not know how to do rescue breaths), skip that step and just do chest compressions. You can try it again after 30 more compressions*.

*Continue chest compressions and breathing until paramedics arrive.

CHOKING, Under age 1

Prevention of Choking

Choking is the most common cause of accidental death in children under age 1. Please avoid giving your child the following items:

Chokeable foods: We restrict the following foods until children are 4 years of age:

nuts

raw carrots

popcorn

seeds

corn chips

hard candy

Hot dogs, sausage, grapes and meat must be cut into small pieces before serving.

Chokeable objects: In general, any item with a diameter less than 1.25 inches may be dangerous to your child. Older siblings may have toys with removable parts that can be swallowed. Rubber balloons are the leading cause of choking deaths from objects other than food. Try mylar balloons! Keep coins out of reach. Waste baskets often contain other small items that can find their way into small mouths.

Note: If your child is coughing and remains pink, let her try to cough out the object on her own. Choking on liquids is rarely harmful, and your child should be able to clear the fluid by herself.

If your child cannot breathe or cough and is turning blue:

CALL FOR HELP. Have someone call 911 immediately if your child is choking on a solid object.

POSITION YOUR INFANT. Sit down. Place your child face down on your forearm with your hand stabilizing his head and neck. Keep the head lower than the rest of the body.

GIVE 5 BACK BLOWS between the shoulder blades. Use the heel of your hand.

TURN YOUR CHILD OVER if she still cannot breathe. Lay her on her back on your lap (keeping the head lower than the body) and deliver 5 rapid chest thrusts over the middle of the breastbone using only TWO FINGERS.

CHECK THE MOUTH for foreign objects or food if your child is still not breathing. Do not attempt to pull out the object unless you can see it clearly and it is easy to sweep out with a finger.

BEGIN MOUTH-TO-MOUTH BREATHING. Give two breaths through the mouth or mouth and nose. See the guidelines on resuscitation. If she still is not breathing, repeat all of the above steps.

CHOKING, Over age 1

Prevention of Choking

Note: If your child or family member is coughing and remains pink, let him try to cough out the object on his own. Choking on liquids is rarely harmful, and your child should be able to clear the fluid by himself.

If your family member cannot breathe and is turning blue:

CALL FOR HELP. Have someone call 911 immediately if your child or family member is choking on a solid object.

POSITION THE VICTIM. Stand behind your child. Put your arms around him so that they are just above the belly button. Make a fist with your right hand and grab that fist with your left hand.

BEGIN ABDOMINAL THRUSTS. (The "Heimlich Maneuver"). Give a sudden inward and upward jerk of your hands. You want to try to dislodge the object from the windpipe by giving 6 to 10 abdominal thrusts in quick succession. Note: Small children can be placed on their back on the floor. Kneel at their feet and place a fist on the abdomen above the navel yet below the ribs. Place the other hand on top of the fist, and give 6-10 inward and upward abdominal thrusts. Try to do this gently if the child is small.

CHECK THE MOUTH for foreign objects or food if your child is still not breathing. Do not attempt to pull out the object unless you can see it clearly and it is easy to sweep out with a finger.

If your child does not start breathing:

BEGIN MOUTH-TO-MOUTH BREATHING. Give two breaths through the mouth or mouth and nose. See the guidelines on Cardiopulmonary Resuscitation. If they are still not breathing, repeat all of the above steps.

References

Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R, Samson RA, Kattwinkel J, Berg RA, Bhanji F, Cave DM, Jauch EC, Kudenchuk PJ, Neumar RW, Peberdy MA, Perlman JM, Sinz E, Travers AH, Berg MD, Billi JE, Eigel B, Hickey RW, Kleinman ME, Link MS, Morrison LJ, O'Connor RE, Shuster M, Callaway CW, Cucchiara B, Ferguson JD, Rea TD, Vanden Hoek TL. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S640–S656.

Illustrations in this section are used with permission of the American Medical Association, JAMA, June 6, 1986. Vol. 255, No. 21.