Institute for Medical Simulation & Education

BASIC CARDIAC LIFE SUPPORT (BCLS)PROGRAMME

DONT’s

DO’s

• Washyourhandsorusehandrubbeforeandaftermanikincontact.

• Disinfectmanikin’smouthandnosewith70%methylatedspiritaftereachparticipant’scontact.

• Useadisposablefaceshieldwhenperformingmouth-to-mouthventilation.

• Informthestaffofthetrainingcentreifyouhave:–Wetskinrashesonyourhands,inyour

mouthoraroundyourlips.–HepatitisB.–Anupperrespiratoryinfection.–Medicalproblemse.g.heart,asthmaor

orthopaedicproblems.• Disinfectmanikinsaftereachpractical

sessionfollowingguidelinesprovidedbythetrainingcentre.

• Donoteatordrinkduringpracticaltrainingtoavoidcontaminationofmanikinswithfoodparticles.

• Donotusepentomarkanyareaofthemanikin.

• Donotattempttoforcethemanikin’smouthopenbeyond2.5cm.

• Donotuselipstickifpractisingonthemanikin.

• Donotperformorpractisechestcompressiononavictimwithapulse,practiseonlyonamanikin.

SAFETYINCPRTRAINING

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Copyright©2011ProducedbyInstitueforMedicalSimulation&Education,SGH

Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystemortransmitted,inanyformorbyanymeans,electronic,mechanical,photocopying,recordingorotherwise,withoutthepriorpermissionofthecopyrightowner.

Module 1 INTRODUCTION 2

Module 2 ThE ChAIN OF SURvIvAL 3

Module 3 ThE hEART 4 3.1 Anatomy&Function 3.2 HeartAttack 3.3 RiskFactorsofHeartAttack 3.4 PrudentHeartLiving

Module 4 ADULT CARDIO-PULMONARY RESUSCITATION (CPR) 9 4.1 Definition 4.2 StepsofAdultOne-ManCPR

Module 5 ADULT RECOvERY POSITION 19

Module 6 ADULT FOREIGN BODY AIRWAY OBSTRUCTION (FBAO) 21 6.1 Introduction 6.2 RecognitionofFBAO 6.3 ReliefofFBAOintheConsciousAdult 6.4 ReliefofFBAOintheUnconsciousAdult

Module 7 INFANT CARDIO-PULMONARY RESUSCITATION (CPR) 27 7.1 Introduction

Module 8 INFANT RECOvERY POSITION 35

Module 9 INFANT FOREIGN BODY AIRWAY OBSTRUCTION (FBAO) 37 9.1 Introduction 9.2 ReliefofFBAOintheConsciousInfant 9.3 ReliefofFBAOintheUnconsciousInfant

Module 10 APPLICATION OF POCKET MASK 43

Module 11 SUMMARY ChECKLIST 47

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Module 1 INTRODUCTION

InSingapore,heartdiseaseisthesecondcommonestcauseofdeath,beingresponsibleforabout24%oftotalmortality.About2,400personsdevelopanacuteheartattackinSingapore.Inaddition,nearly1000peoplesufferfromsuddencardiacarrestintheout-of-hospitalenvironmentandanotherfewhundredsustainsuddencardiacarrestafterreachinghospital.Thetotalsurvivalrateforthegroupofpre-hospitalcollapsesisabout2.6%.

PubliceducationandtraininginCardio-PulmonaryResuscitation(CPR)arecrucialinreducing“suddendeath”becausethemajorityofthesedeathsoccuroutofhospital.Oneofthemoststartlingideasofmodernmedicineisthat“suddendeath”canbereversed.Theactionstakenduringthefirstfewminutesofan“Emergency”arecriticaltovictimsurvival.Itcanbeperformedbyanyofus,anywhere.Allthatisneededisourtwohands.

REMEMBER:CPR can save lives.

Do it well. Do it right. And the victim gets a chance at life.

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Module 2 ThE ChAIN OF SURvIvAL

Theconceptof“ChainofSurvival”isthebestapproachtothetreatmentofvictimsincardiacarrest.Thefourlinksinthischainare:EarlyRecognitionandAccesstoEmergencyCare,EarlyCPR,EarlyDefibrillationandEarlyAdvancedCardiacCare.

Early Recognition and Access

EarlyCPR

EarlyDefibrillation

EarlyAdvanced Care

First Link : Early Recognition and Access Earlyrecognitionandaccessreferstoshorteningthetimeintervalfromonsetof

heartattackorcardiacarresttoarrivalofatrainedemergencycareteam.Itincludes:• recognitionofearlywarningsignsofheartattacke.g.chestpain,sweatiness,

shortnessofbreath,nauseaorvomiting• recognitionofcardiacarreste.g.unconscious,nobreathingandnopulseor

‘signsofcirculation’• rapidcallforthefirstresponseteam• allowingambulancespriorityontheroadssothattheycanreachthepatientquickly• allowingparamedicsrapidaccessandpriorityinuseofelevatorsinhigh-rise

buildings.

Second Link : Early CPR Thebrainstartsdyingwithinminuteswhentheheartstopspumping.CPRneeds

tobeinitiatedassoonaspossibletoprovideoxygenandbloodflowtothebrainandheartandremoveexcesscarbondioxidefromthelungs.CPRcannotalwaysre-starttheheart.Itcanhoweverbuythevaluabletimeneededtokeepthevitalorgansaliveuntildefinitivehelparrives.

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Rib

Sternum

Heart

Xiphoidprocess

The heart as a Pump

Inferiorvenacava

Superiorvenacava

Rightpulmonaryartery

Leftpulmonaryartery

Leftpulmonaryveins

Third Link : Early Defibrillation Thisprocedurecanfrequentlyre-starttheheartifcarriedoutearly.Studieshave

shownthatearlydefibrillationismostlikelytoimprovesurvivalratesforout-of-hospitalcardiacarrestpatients.Everyemergencyvehicletransportingcardiacarrestpatientsshouldbeequippedwithadefibrillator.Defibrillationworksbestinthefirstfewminutesafteronsetofcardiacarrest.Ifinitiatedtoolate,theheartwillnotrespondtoelectricaltherapy.Foreveryminuteofdelayindeliveringdefibrillationfollowingcollapse,thesurvivalratedecreasesby7–10%.

Fourth Link : Early Advanced CareAdvancedCardiacLifeSupportstabilisestheresuscitatedvictim’sconditioninthe

mostcriticalphase.Itconsistsofadvancedairwaymanagementandadministrationofmedicationandisfrequentlycarriedoutinthein-hospitalenvironment.

Module 3 ThE hEART

3.1 ANATOMY & FUNCTIONTheheartisahollow,conical,muscularorgansituatedinthecentreofthechestbetweenthelungsandbehindthesternum(breastbone).Itisaboutthesizeofaclenchedfist.

Itreceivesblooddepletedofoxygenfromallpartsofthebodyandpumpsittothelungs.Thereoxygenistakenupandtheoxygen-enrichedbloodreturnstothehearttobedistributedtoallpartsofthebody.Thecoronaryarteriesarebloodvesselsthatsendoxygen-richbloodtothemusclesoftheheart.

The heart in Relation to the Chest

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3.2 hEART ATTACKHeartattackusuallyoccurswhenabloodclotsuddenlyandcompletelyblocksanalreadydiseasedcoronaryartery.Coronaryarterydiseaseistheend-resultofagradualbuild-upoffattydeposits(cholesterolplaques)andbloodcellsintheinnerliningofthecoronaryarterialwall,aprocessalsoknownas“atherosclerosis”.Overaperiodofyears,thisleadstogradualnarrowingofthelumenofthevessel,therebyreducingbloodflowtoheartmuscle.Occasionally,thesurfaceofaplaquemaysplitorcrack,andattractbloodclots,whichthencausecompleteobstructionofthelumen,resultingin“heartattacks”.

Symptoms of heart AttackHowtorecognizeaHeartAttack• Chestdiscomfortorpainisthemostcommonsymptom.Itusuallyhasthefollowing

characteristics:– uncomfortablepressure,squeezing,fullness,tightness,orpain.– usuallylocatedatthecentreofthechestbehindthebreastbone.–mayspreadtoeithertheshoulder,neck,

lowerjaw,oreitherarmandoccasionallytotheupperabdomen.

– usuallylastslongerthan20minutes.• Othersymptomsmayincludeanyorallofthe

following:– sweating– nausea(afeelingofwantingtovomit)– shortnessofbreath–weakness

Coronary Arteries

LeftAnteriorDescendingArtery

LeftCircumflexArtery

RightCoronaryArtery

LeftCoronaryArtery

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Photo Courtesy of SCDF

Common Causes Of Sudden Death• HeartAttack• ForeignBodyAirwayObstruction• Drowning• Stroke• DrugOverdose• Suffocation• SmokeInhalation• Electrocution• SevereAllergicReactions• SevereTrauma,e.g.AutomobileAccident

Manyofthesedeathscanbepreventedifthevictimsgetprompthelp–ifsomeonetrainedinCPRprovidesproperlife-savingfirst-aiduntilothermedicalexpertisetakeover.

3.3 RISK FACTORS OF hEART ATTACKThereareanumberofwell-recognisedriskfactorsforaheartattack.Allriskfactorscanbemodifiedtodecreasethechanceofheartattack.Themoreriskfactorsarepresent,thegreatertheriskofhavingaheartattack.

• Majorriskfactorsthatcannot be changed:– heredity–malegender– increasingage

• Symptomsmayoccursuddenlyandnotbetypical,sothatsomevictimsmaynotrealisethattheyarehavingaheartattack.Theymayalsothinkthattheproblemisduetoindigestion.

If you meet anyone with these symptoms, arrange for immediate transportation to the

nearest emergency medical facility by dialling

995 for an emergency ambulance.

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• Majorriskfactorsthatcan be changed:– cigarettesmoking – highbloodpressure– highbloodcholesterollevels– diabetesmellitus

• Otherriskfactorsthatcan be modified:– obesity– physicalinactivity– stress

3.4 PRUDENT hEART LIvING PrudentHeartLivingincludesadoptingalifestyletohelpminimisetheriskofafutureheartattack.Reducingriskfactorslowersthechanceofhavingaheartattackorstroke.

• Controlhighbloodpressure–treatmentgenerallyincludesdietarychangeandmedication.Takemedicationregularlyasprescribedbyyourdoctor.

• Quitsmokingcompletely.

• Eatwisely–reducesaturatedfatandcholesterolinthediet.EataBalanceddiet.

• Reduceweightifyouareoverweight–countcaloriesinyourfoodintake.

• Exerciseregularly–exercisetonesthemuscles,stimulatesbloodcirculation,helpsavoidexcessweightgainandpromotesageneralfeelingofwellbeing.

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CARDIO-PULMONARYRESUSCITATION(CPR)

Adult

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Module 4 ADULT CARDIO-PULMONARY RESUSCITATION (CPR)

4.1 DEFINITION

Cardio-PulmonaryResuscitation(CPR)includesaseriesofassessmentsandinterventionsthatsupportcardiacandpulmonaryfunctions.Whencardiacarrestoccurs,theheartstopsbeatingandcirculationceases.Unlessthecirculationisre-startedquickly,organdeathwillbegintooccur.Themostsensitiveorganisthebrainandifitscirculationtothebrainisnotre-startedwithin4to6minutes,permanentandirreversibledamagecanoccur.ItisthereforeimportanttostartCPRasquicklyaspossible.

Aircontainsapproximately21%oxygenatsealevel.Duringitspassagethroughthebody,onlyabout5%oftheoxygenisutilisedandhenceexhaledaircontainsapproximately16%oxygen.WhenmouthtomouthventilationisdoneduringCPR,thereisjustsufficientoxygenintheexhaledairtokeepthevictimalive.Chestcompressionsqueezestheheartbetweenthebreastboneandthespineandtherebyhelpstocirculatethebloodanddeliverthisoxygentothevitalorgans,especiallythebrain,heartandkidneys.

IfCPRisperformedpromptlyandcorrectly,1) heartfunctionmayberestored,and2) circulationmaybemaintaineduntilinstitutionofotherlifesupportmeasures.

Thenextsectiontakesyoustep-by-stepthroughtheproceduresneededtoperformCPRorcardio-pulmonaryresuscitation–thebasicskillneededtosavelifeintheeventofcardiacarrest.

4.2 STEPS FOR ADULT ONE-MAN CPR

STEP 1 ChECK FOR DANGER

• Lookoutforunsafeenvironmenteg,electricalcurrent,fire,possibleexplosion,constructionworksorpoisonousgas.

• Ensurethatthesceneissafeforyoutohelp.

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STEP 2 ASSESS UNRESPONSIvENESS

Quicklyassessanddeterminewhetherthevictimisresponsive.Therescuershouldtaporgentlyshakethevictimonhis/hershouldersandaskloudly:“Hello!Hello!AreyouOK?”

Avoidviolentshakingofthevictimasthismightresultininjury.Also,avoidunnecessarymovementsoftheneckintheeventofinjurytotheheadandneck.

Ifthevictimdoesnotrespond,he/sheislikelytobeunconscious.Unconsciousnessmaybedueto:• Anairwaythatisobstructed(blocked)byfood,secretionsoratonguethathasfallen

backwards.• Breathingthathasstopped.• Aheartthathasstoppedbeating,usuallybecauseofaheartattack.

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STEP 3 ShOUT FOR hELP & ACTIvATE EMERGENCY MEDICAL SERvICES (EMS)

Ifthevictimdoesnotrespond,callloudlyforhelpandimmediatelydial995foranemergencyambulance.

TherescuershouldactivatetheEmergencyMedicalServices(EMS)assoonashehasdeterminedthatanadultvictimisunconsciousandrequiresemergencycare.

Ifthereisanotherpersonaround,askhim/hertodothecalling.WhencallingtheEMS,state:• Locationofvictim.• Thetelephonenumberyouarecallingfrom.• Whathappened(e.g.thatsomeoneishavingaheartattack/isunconscious).• Numberofvictims.• Hanguponlyafterinstructedtodosobythedispatcher.

Inaddition,thereisanincreasingnumberofAEDs(automatedexternaldefibrillators)thatarecurrentlybeingdeployedinpublicareas.Thesecanalsobelifesaving.ThuscallforanAED.Sayloudly“Help!CallAmbulance995,GetAED”. BC

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Airwayblocked

Tonguefallsback

Withheadtilt-chinlift,theairwayisclear

STEP 4 POSITION ThE vICTIM

ForCPRtobeeffective,thevictimmustlieonafirm,flatsurface.Ifthevictimislyingfacedown,oronhis/herside,youwillneedtorollthevictimoverontohis/herback.

Dotakecarethatthehead,neckandbodyaresupportedandturnedsimultaneouslyduringre-positioning.

STEP 5 OPEN ThE AIRWAY

PerformaHead tilt-chin lift Manoeuvretoopentheairway.Intheunresponsivevictim,muscletoneisimpairedresultinginthetonguefallingbackandobstructingtheairway.Asthetongueisattachedtothelowerjaw,movingthelowerjawforwardwillliftthetongueawayfromthebackofthethroatandopentheairway.

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• Placeonehandonthevictim’sforeheadandapplyfirmbackwardpressurewithyourpalmtotilttheheadback.

• Placethefingersofyourotherhandunderthebonypartofthelowerjawtoliftthejawforward.

STEP 6 ChECK FOR NORMAL BREAThING

Placeyourearandcheekoverthevictim’smouthandnoseandassessforbreathing(upto10seconds):

–Lookfortheriseandfallofthechest.

–Listenforairescapingduringexhalation.

–Feelfortheflowofairfromthevictim’smouthandnosemovingpastyourcheeks.

*GaspingisNOTconsideredasnormalbreathing.

Caution• Donotpressdeeplyintothesofttissuesunderthechinbecausethismightobstructtheairway.

• Performagentlechinliftifheadorneckinjuryissuspected.

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STEP 7 ASSESS FOR PULSE (FOR hEALThCARE PROvIDERS ONLY)

• Maintainheadtilt,locatetheAdam’sappleorcentreofthethroatofthevictimwiththeindexandmiddlefingers.

• Slideyourfingersdownintothegrooveatthesideofthenecknearyou(Thisisthelocationofthecarotidpulse).

• Applygentlepressureandfeelforthecarotidpulseupto10seconds.• Ifthevictimhasnopulseorifunsureofthepresenceofnormalbreathingorpulse

within10seconds,startchestcompressions.

* Forlaypersons,itisnotnecessarytocheckforpulse.Ifvictimhasnobreathing,startchestcompressions.

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XiphiSternum

STEP 8 LOCATE hAND POSITION FOR ChEST COMPRESSION

Chestcompressiontechniqueconsistsofserial,rhythmicapplicationsofpressureoverthelowerhalfofthesternum(breastbone).Tolocatethecorrecthandpositionforchestcompression:

• Maintainheadtilt,runyourmiddlefingerfromthelowermarginofthevictim’sribcagetillyoureachtheXiphiSternum.

• Placeyourindexfingernexttothemiddlefinger.

• Placetheheelofonehandnexttotheindexfinger.

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• Removetheindexandmiddlefingers.• Placetheheeloftheotherhandontop

ofthehandonthesternum.

• Interlacethefingersofbothhandsandliftthefingersoffthechestwall.

• Straightenbothelbowsandlocktheminposition.

• Positionyourshoulderdirectlyoverthevictim’schest.

STEP 9A PERFORM ChEST COMPRESSION

• Useyourbodyweighttocompressthevictim’schestbyatleast5cm.• Countyourcompressions: 1and2and3and4and5and 1and2and3and4and10and 1and2and3and4and15 1and2and3and4and20 1and2and3and4and25 1and2and3and4and30.

• Performchestcompressionsatarateofatleast100perminute.Allowcompleterecoilofthechestwallaftereachcompression.

• Theratioofcompressionandventilationis30compressions:2breaths.

• healthcare Providers–Checkpulseafter5cyclesof30compressions:2ventilations.Ifnopulseorunsurepresenceofpulse,resumeCPR.

• Laypersons –ContinueperformingCPRuntilhelparrivesorvictimstartsmoving.

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DONT’s

DO’s

STEP 9B MOUTh-TO-MOUTh BREAThING

Toperformmouth-to-mouth-breathing:• Maintainheadtilt-chinlift.• Pinchthenosewithyour

thumbandindexfingertopreventairfromescapingthroughthevictim’snose.

• Sealyourmouthoverthevictim’smouthandgive2shortbreathsinquicksuccessiononeaftertheother.

• Releasethenostrilstoallowexhalationaftereachbreath.

• Eachrescuebreathshouldmakethechestrise.

• Thedurationforeachbreathis1second.• Ventilationvolumeisbetween400to600ml.Note : Toogreatavolumeofairislikelytocauseairtoenterthestomachandresultingastricdistension.

GUIDELINES FOR PROPER COMPRESSION

• Maintainyourhandsonthesternum(breastbone)duringeachupstroke.

• Releasethepressureonthechestaftereachcompressiontoallowbloodtoflowintothechestandheart.

• Useyourbodyweighttoperformthechestcompression.• Keepthefingersoffthechestwall.• Compressatrateofatleast100perminute.

• Donotliftthehandsfromthesternum(breastbone),otherwisecorrecthandpositionmaybelost.

• Donotbounceorjerkduringcompressionsasthesemovementsmaycauseinjuries.

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ChECK DANGER

UNRESPONSIvE?Tapshoulderfirmly

Askloudly

ShOUT “hELP! CALL AMBULANCE 995,

GET AED” Activate EMS

OPEN AIRWAYHeadtilt,chinlift

NOT BREAThING NORMALLY?Look,Listen,Feel

Upto10sec

30 ChEST COMPRESSIONSCentreofchest/lowerhalfofsternum

Depthatleast5cmRateatleast100permin

Allowcompletechestrecoil

OPEN AIRWAYHeadtilt,chinlift

2 BREAThS1secperbreath,tidalvolume400-600mltillchestjustrises

CONTINUE UNTIL PATIENT WAKES UPAED ARRIvES AND ANALYSING

hEART RhYThM EMERGENCY TEAM TAKES OvER CPR

ChECK CAROTID PULSEForhealthcareprovidersonly

Definepulseandnormalbreathingwithin10sec

No

No

No

hEALThCARE PROvIDERS –

Checkpulseafter5cyclesof

30compressions:2ventilations.IfNopulseorunsureofpresenceofpulse,

resumeCPR

IF UNABLE / UNWILLING TO DO MOUTh-TO-MOUTh FOR ANY REASONDO CONTINUOUS ChEST COMPRESSIONS AT LEAST 100 / MINUTE

Adult 1-man CPRD

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A

B

C

FlowchartcourtesyofNRC

STEP 10 RE-ASSESSMENT (FOR hEALThCARE PROvIDES ONLY)

• Assessthevictimforpulseandbreathingafterevery5cyclesofCPR30:2.• Ifpulseisabsent(ifunsureofpulseandvictimhasnobreathing,assumecardiac

arrest),continueCPR30:2.• Ifboththepulseandbreathingarepresent,positionthevictimintherecovery

position.• Continuetomonitorthevictim’spulseandbreathingeveryfewminutesasthesecan

stopsuddenly.

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B

C

A

Module 5 ADULT RECOvERY POSITION

Therecoverypositionisusedinthemanagementofvictimswhoareunresponsivebuthavebreathingandpulse.Whenanunresponsivevictimislyingsupine,theairwaymaybecomeobstructedbythetongueormucusandvomit.Theseproblemsmaybepreventedwhenthevictimisplacedintherecoveryposition,becausefluidcandraineasilyfromthemouth.

Ifthereisnoevidenceoftrauma,placethevictimintherecoveryposition.Thispositionkeepstheairwayopen.Thefollowingstepsarerecommended:

STEP 1 POSITION ThE vICTIM

A) Tuckthehandnearertoyou,armstraightandpalmupwardunderthevictim’sthigh.B) Bringthearmfurtherfromyouacrossthevictim’schestandplacethebackofhis

handagainsthischeek.C)Usingyourotherhand,bendthevictim’sfarkneetoa90degreesangle.

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STEP 2 ROLL ThE vICTIM TOWARDS ThE RESCUER

• Putyourpalmagainstthevictim’spalmthatisonthecheekandmaintainposition.Usingyourotherhand,holdthevictim’sfarhipandrollhimtowardsyouuntilheislyingonhisside.

• Useyourkneestosupportthevictim’sbodyasyouturnhimsoastopreventhimfromrollingtoofarforward.

STEP 3 FINAL RECOvERY POSITION

• Ensurethatthevictim’shead(cheek)islyingonthebackofhispalm.• Checkthatthevictim’sotherhandislyingfreealongsidehisbodywithpalmfacing

upwards.• Theformerfarleg

shouldpreferablybebentatthekneeatabout90degrees.

• Continuetomonitorthevictim’spulseandbreathingeveryfewminutesasthesecanstopsuddenly.

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Module 6 ADULT FOREIGN BODY AIRWAY OBSTRUCTION (FBAO)

6.1 INTRODUCTIONCompleteairwayobstructionisanemergencythatwillresultindeathwithinminutes,ifnottreatedimmediately.Completeairwayobstructionindicatesthatthebreathingpassagesaretotallyblocked.Thevictimisunabletospeak,breatheorcough.

Asmostchokingincidentsareassociatedwitheating,andarecommonlywitnessed,thechanceofsurvivalincreasesiftherescuerisabletointerveneimmediatelywhenthevictimisstillconscious.TechniquesusedtoreliefFBAOincludetheHeimlichManoeuvre(abdominalthrusts)andchestthrusts(forpregnantandobesevictims).

TheHeimlichManoeuvre,alsoknownassubdiaphragmaticabdominalthrustsorabdominalthrustsisrecommendedforrelieveofFBAOinresponsiveadultsandchildrenof1to8yearsofage.

TheHeimlichManoeuvre(abdominalthrusts)elevatesthediaphragmandincreaseairwaypressure,whichforceairoutfromthelungs.Thiscreatesanartificialcoughandexpelstheforeignbodyfromtheairway.

Inobeseorpregnantvictims,thechestthrustisrecommended.

COMMON CAUSES OF FBAOAirwayobstructioncanresultfromeitherintrinsic,orextrinsiccauses.

INTRINSIC CAUSES• Thetonguefallingbackwardintothepharynxinthesupineunconsciousvictim.• Bloodfromheadandfacialinjuriestrickleintotheairway.• Regurgitatedstomachcontentsgoingintotheairway.

EXTRINSIC CAUSES• Foreignbodiese.g.food,denturesetc.

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Universal Choking Sign

6.2 RECOGNITION OF FOREIGN BODY AIRWAY OBSTRUCTION (FBAO)FBAOcancausepartialorcompleteairwayobstruction.Coughingisthebody’snaturaldefenceagainstairwayobstruction.

Avictimwithpartialairwayobstructionwillcoughinanattempttoexpeltheforeignbody.Ifthevictimiswheezing(breathingnoisilywithawheezingsound)orcoughing,thismeansthattheairwayispartiallyobstructed.Donotinterfere.Allowthevictimtocoughtoexpeltheobjecthimself.

Incompleteairwayobstruction,thevictimisunabletospeak,breatheorcoughandmaybecomecyanotic.Thevictimwillclutchhisneckwiththethumbandfingers,whichistheuniversaldistresssignalforchoking.Thisrequiresimmediateaction.

6.3 RELIEF OF FBAO IN ThE CONSCIOUS ADULT TechniquesusedtorelieveFBAOinaconsciousadultincludetheHeimlich

Manoeuvre(abdominalthrusts)andchestthrusts.

A) The heimlich Manoeuvre ( Abdominal Thrust ) Technique

STEP 1

• Todeterminewhetherthevictimischoking,ask,“Areyouchoking?”• Ifthevictimisabletocough,askhimtocoughashardashecantogettheforeign

bodyoutofhisupperairway.• Ifthevictim’sairwayisobstructed,hewillnotbeabletospeak,breatheorcough.The

victim’sfacemayturnblue.Therescuershouldimmediatelyproceedtothenextstep.

STEP 2

• Ifthevictimisupright,therescuerstandsbehindthevictim.Ifthevictimissitting,therescuerkneelsdownandpositionshimselfbehindthevictim.

• Positiononefootbetweenthevictim’slegs.

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heimlich Manoeuvre (Abdominal Thrust)

STEP 3

• Placeyourarmsaroundthevictim’sabdomenandlocatethenavel.

• Withonehand,place2fingersjustabovethenavel.• Makeafistwiththeotherhand.• Placethethumb-sideofthefistagainsttheabdomen

abovethe2fingers.• Releasethe2fingersbutmaintainyourfistagainstthe

abdomen.• Leanthevictimforwardandgraspyourfistwiththe

otherhand.• Givesuccessiveinward and upwardthrusts

(setof5abdominalthrusts).• Checkifforeignbodyisexpelledaftereverysetof5abdominalthrusts.• Repeatabdominalthrustsuntiltheforeignbodyisexpelledorthevictimbecomes

unconscious.

B) Chest Thrust Technique

ChestthrusttechniqueisusedasanalternativetoHeimlichManoeuvre.Itisperformedonaconsciousobeseorpregnantvictim.

STEP 1

• Todeterminewhetherthevictimischoking,ask“Areyouchoking?”Ifthevictimischoked,thevictimwillnotbeabletospeak, breathe or cough.

STEP 2

• Ifthevictimisupright,therescuerstandsbehindthevictim.Ifthevictimissitting,therescuerkneelsdownandpositionsbehindthevictim.

• Positiononefootbetweenthevictim’slegs.

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STEP 3

• Placearmsunderthevictim’sarmpitstoencirclethechest.

• Makeafistwithonehand.• Placethethumb-sideofthefist

onthemiddleofthevictim’sbreastbone.

• Graspsfistwiththeotherhandandgivesuccessive quick backward thrusts (setof5chestthrusts).

• Checkifforeignbodyisexpelledaftereverysetof5chestthrusts.

• Iftheobstructionisstillnotrelieved,continuetodeliverthesetof5chestthrustsfirmlyanddistinctlyuntiltheforeignbodyisexpelledorthevictimbecomesunconscious.

6.4 RELIEF OF FBAO IN ThE UNCONSCIOUS ADULT

Foranunconscious adult,proceedwiththefollowingsteps:

STEP 1

• Positionvictimonafirm,flatsurfaceandimmediatelyactivateEmergencyMedicalServicesbydialling995foranemergencyambulance.

STEP 2

• Start30chestcompressions(ThehandpositionforchestcompressionisthesameasforAdultCPR).

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STEP 3

• Openvictim’sairwaybypeformingheadtilt-chinlift.• Checkvictim’smouthforanyvisibleforeignbodies.• Useahookedindexfingerandremoveanyobviousobstructingforeignbodies.

STEP 4

• Checkfornormalbreathing:Look,Listen&Feel(upto10seconds).• Ifbreathingisabsent,attempttoventilate(1stattempt).• Ifairwayisblocked,re-positionwiththeHeadTilt-ChinLiftprocedure.• Attempt2ndventilation.

STEP 5

• Ifairwayisstillblocked,perform30chestcompressions,thenproceedbacktoheadtilt-chinliftandcheckforforeignbody.

• RepeatStep3&4tillhelparrivesorabletogive2successfulventilation.

STEP 6

• Assessthevictimforpulse&breathingoncetheairwayiscleared.• Ifpulse(forhealthcareprovidersonly)&breathingareabsent,assumecardiacarrest,

continue30:2.• Ifbothpulse&breathingarepresent,positionthevictimintherecoveryposition• Continuetomonitorthevictim’spulseandbreathingeveryfewminutesasthesecan

stopsuddenly.BC

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CARDIO-PULMONARYRESUSCITATION(CPR)

Infant

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Module 7 INFANT CARDIO-PULMONARY RESUSCITATION (CPR)

7.1 INTRODUCTION

Aninfantisachildwhoisupto1yearold.Infantsrarelycollapsebecauseofaprimaryheartproblem.Cardiacarrestisusuallysecondarytootherevents,suchasmajortraumaorrespiratoryproblems.Therefore,rescuersmustdetectandpromptlytreatearlysignsofrespiratoryfailuretopreventcardiacarrest.

STEP 1 ChECK FOR DANGER

• Lookoutforunsafeenvironmenteg,electricalcurrent,fire,possibleexplosion,constructionworksorpoisonousgas.

• Ensurethatthesceneissafeforyoutohelp.• Oneshouldalwaysensurethesafetyofrescuer(s)andinfantattheonset.

STEP 2 ASSESS UNRESPONSIvENESS

• Quicklyassessanddeterminewhethertheinfantisresponsivebytappinggentlyontheinfant’sshoulders.

• Avoidviolentshakingandunnecessarymovementsoftheinfant’sheadandneckasthismightresultininjury.

• Iftheinfantdoesnotrespond,he/sheislikelytobeunconscious.

• Possiblecausesofunconsciousnessmaybe:– anairwaythatisobstructed(blocked)

byfood,secretionsoratonguethathasfallenbackwards.

– breathingthathasstopped.– aheartthathasstoppedbeating.

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STEP 3 ACTIvATE EMERGENCY MEDICAL SERvICE (EMS)

Whentheinfantdoesnotrespond:• Ifyou arealone, immediatelycommenceCPR30:2forapproximately2minutes

beforecalling995foranambulance.• Ifasecond rescuer is present,askhim/hertoactivatetheEMSsystembydiallingthe

ambulancenumber995.

WhencallingEMS995,state:• Locationofinfant.• Thetelephonenumberyouare

callingfrom.• Whathappened• Numberofvictims.• Hanguponlyafterinstructedtodo

sobythedispatcher.

STEP 4 POSITION ThE INFANT

• ForCPRtobeeffective,theinfantmustlieonafirmflatsurface,thelegstraightenedandthearmsplacedalongsidethebody.

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STEP 5 OPEN ThE AIRWAY

Performaheadtilt-chinliftmanoeuvretoopentheairway.Inanunconsciousinfant,muscletoneisimpairedresultinginthetonguefallingbackandobstructingtheairway.Asthetongueisattachedtothelowerjaw,movingthelowerjawforwardwillliftthetongueawayfrombackofthethroatandopentheairway.

Perform a head tilt-chin lift manoeuvre :• Placeonehandontheinfant’sforeheadand

applyfirmbackwardpressurewithyourpalmtotilttheheadback.

• Placethefingersofyourotherhandunderthebonypartofthelowerjawtoliftthejawforward.

Caution• Donotpressdeeplyintothesofttissuesunderthechinoroverextendtheinfant’sneckbecausethismayblocktheairway.

• Performagentlechinliftifheadorneckinjuryissuspected.BC

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STEP 6 ChECK FOR NORMAL BREAThING

• Placeyourearandcheekovertheinfant’smouthandnoseandassessfor

breathing(upto10seconds):–Lookfortheriseandfallof

thechest.–Listenforairescaping

duringexhalation.–Feelfortheflowofairfrom

theinfant’smouthandnosemovingpastyourcheeks.

*GaspingisNOTconsideredasnormalbreathing.

STEP 7 ASSESS FOR PULSE (FOR hEALThCARE PROvIDERS ONLY)

• Maintainheadtiltandlocatethebrachialpulse(whichisontheinneraspectoftheupperarm)withtheindexandmiddlefingers.

• Applygentlepressureandfeelforthebrachialpulsewithin10seconds.

• Iftheinfanthasnopulse(ifunsureofpulse)andisnotbreathing,startchestcompressions.

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STEP 8 LOCATE LANDMARK FOR ChEST COMPRESSION

Chestcompressionsinaninfantconsistofserial,rhythmicapplicationsofpressureoverthelowerhalfofthesternum(breastbone).Tolocatethecorrectlandmarkforchestcompression:

• Maintainheadtiltwithonehand.• Drawanimaginarylinebetweenthe

infant’snipplesusingyourindexfingeroftheotherhand.

• Placetheindexfingeron the imaginary line.

• Placeyourmiddleandringfingersnexttotheindexfinger.BC

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• Movethe3fingerstothecentreofthesternum(breastbone).

• Positionthefingersupright.

• Liftofftheindexfingerbutmaintainthemiddleandringfingerscontactonthesternum(breastbone).

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STEP 9A PERFORM ChEST COMPRESSION

• Leanforwardandplaceyourcheekneartheinfant’smouthandnose.

• Useyourmiddleandringfingerstocompressthesternum(breastbone)4cm.

• Countyourcompressions: 1and2and3and4and5and 1and2and3and4and10and 1and2and3and4and15 1and2and3and4and20 1and2and3and4and25 1and2and3and4and30.• Performchestcompressionsatarateofatleast100perminute.• healthcare Providers–Checkpulseafter5cyclesof30compressions:

2ventilations.Ifnopulseorunsurepresenceofpulse,resumeCPR.• Laypersons –ContinueperformingCPRuntilhelparrivesorinfantstartsmoving.

Note : Tofacilitateventilationwithoutdelaystore-positionthehead,useonehandtomaintaintheheadtiltpositionwhileperformingchestcompressions. BC

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DONT’s

DO’s

• Maintainyour2fingersonthesternum(breastbone)duringeachupstroke.

• Releasethepressureonthechestaftereachcompressiontoallowbloodtoflowintothechestandheart.

• Compressatrateofatleast100perminute.

• Donotliftthefingersfromthesternum(breastbone),otherwisecorrectfingerpositionmaybelost.

• Donotbounceorjerkduringcompressionsasthesemovementsmaycauseinjuries.

GUIDELINES FOR PROPER COMPRESSION

STEP 10 RE-ASSESSMENT (FOR hEALThCARE PROvIDERS ONLY)

• Assesstheinfantforpulseandbreathingafterevery5cyclesofCPR30:2.

• Ifpulseisabsent(ifunsureofpulseandinfanthasnobreathing,assumecardiacarrest),continueCPR30:2.

• Ifboththepulseandbreathingarepresent,positiontheinfantintherecoveryposition.

• Continuetomonitortheinfant’spulseandbreathingeveryfewminutesasthesecanstopsuddenly.

STEP 9B MOUTh TO MOUTh & NOSE BREAThING

Performmouth to mouth & nose breathing asfollows:• Maintainaheadtilt-chinlift.• Sealyourmouthovertheinfant’smouthand

give2shortbreathsinquicksuccessiononeaftertheother.

• Eachrescuebreathshouldmakethechestrise.• Thedurationforeachbreathis1second.• Ventilationvolumeisapproximately30mlper

breath.• Allowexhalationbetweenbreaths.

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Module 8 INFANT RECOvERY POSITION

8.1 INTRODUCTION

Therecoverypositionisusedinthemanagementofinfantswhoareunresponsivebutarebreathing.Whenanunresponsiveinfantislyingsupine,theairwaymaybecomeobstructedbythetongueormucusandvomit.Theseproblemsmaybepreventedwhentheinfantisplacedintherecoveryposition,becausefluidcandraineasilyfromthemouth.

Therecoverypositionforaninfantdiffersfromtheadultposition.Theinfantisputonthelateral(side)positionwhenpulseandbreathinghaveresumed.

Thispositionkeepstheairwayopen.Thefollowingstepsarerecommended:

STEP 1 POSITION ThE INFANT

• Placetheinfant’sarmsalongsidethebody.• Straightentheinfant’slegs.

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STEP 3 FINAL RECOvERY POSITION

• Supporttheinfant’sbackwithasoftpillow/cushion.

• Ensurethattheinfant’sheadisnotoverextendedorflexed.

• Staywiththeinfantandcontinuetomonitorthepulseandbreathingeveryfewminutesasthesecanstopsuddenly.

STEP 2 ROLL ThE ChILD TOWARDS ThE RESCUER

• Supporttheinfant’sheadandneckwithonehand.

• Placetheotherhandontheinfant’ship.

• Gentlyrollorturntheinfantonthesidetowardtherescuer.

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Module 9 INFANT FOREIGN BODY AIRWAY OBSTRUCTION (FBAO)

9.1 INTRODUCTION

Airwayobstruction(choking)isacommoncauseofinfantdeathanddisability.Completeairwayobstructionindicatesthatthebreathingpassagesaretotallyblocked.Theinfantisunabletospeak(makenoises),breatheorcough.Chokingininfantsiscommonestduringeatingorplayingwithsmallobjects.

Inawitnessedchokingevent,thechanceofsurvivalincreasesiftherescuerisabletointervenewhentheinfantisstillconscious.Theobstructedairwaycanbeclearedusingacombinationofbackblowsandchestthrusts.

COMMON CAUSES OF FBAOAirwayobstructioncanresultfromeitherintrinsic,orextrinsiccauses.

INTRINSIC CAUSES• Thetonguefallingbackwardintothepharynxinanunconsciousinfant.• Bloodfromheadandfacialinjuriestricklingintotheairway.• Regurgitatedstomachcontentsgoingintotheairway.

EXTRINSIC CAUSES• Foreignbodiese.g.food,smallobjectsortoysetc.

RECOGNITION OF FBAOIncompleteairwayobstruction,theinfantmayexhibitthefollowingsigns:• Suddenonsetofrespiratory/breathingdistress.• Cyanosis(bluelips,nailorskin).• Unabletospeak(makenoises).• Unabletobreathe.• Unabletocough.

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9.2 RELIEF OF FBAO IN ThE CONSCIOUS INFANT

STEP 1 ASSESSMENT

• Assessforsignsofcompleteairwayobstructione.g.unabletomakenoises,breatheorcough.

• Ifinfantischoking,attempttorelievetheairwayobstructionimmediately.

STEP 2 SUPPORT ThE INFANT

• Supportingtheinfant’sheadandbodybetweenyourhandsandforearmsusingthe‘SandwichManoeuvre’.

• Holdtheinfant’sfacedownandrestyourforearmonyourthigh.

• Keeptheheadlowerthanthetrunk.

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STEP 3 BACK BLOWS AND ChEST ThRUSTS

• Deliver5backblowsforcefullybetweentheshoulderbladeswiththeheelofyourotherhand.

• Supporttheinfant’sheadandbodybetweenyourhandsandforearmsusingthe‘SandwichManoeuvre’afterdeliveringthe5 back blows.

• Turntheinfantoveronhis/herback,restingonyourthigh.

• Keeptheinfant’sheadlowerthanthetrunk.

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Note : Eachbackblowandchestthrustshouldbedeliveredwithsufficientforceandwiththeintentionofexpellingtheforeignbody.

STEP 4 RE-ASSESSMENT

• Checkifforeignbodyisexpelledaftereverysetof5backblowsand5chestthrustsandremoveitwithyourlittlefingeriftheforeignbodyisvisibleinthemouth.

• Iftheforeignbodyisexpelledsuccessfully,assesstheinfantforpulseandbreathing.• Iftheairwayremainsobstructedandtheinfantisstillconscious,repeatthesequence

of5backblowsand5chestthrustsuntiltheforeignbodyisexpelledortheinfantbecomesunconscious.

• Deliver5 chest thrustsoverthelowerhalfofthesternum(breastbone)bycountingaloud‘1,2,3,4,5’(landmarkforchestthrustisthesameasforinfantCPR).

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9.3 RELIEF OF FBAO IN ThE UNCONSCIOUS INFANT

Foranunconscious infant,proceedwiththefollowingsteps:

STEP 1

• PositioninfantonafirmflatsurfaceandimmediatelyactivateEmergencyMedicalServicesbydialling995foranemergencyambulance,ifasecondrescuerisavailable.

STEP 2

• Start30chestcompressions.(ThelandmarkandtechniqueisthesameasforinfantCPR).

STEP 3

• Openinfant’sairwaybyperformingheadtilt-chinlift.• Checktheinfant’smouthforvisibleforeignbodies.• Useahookedlittlefingerandremoveanyobviousobstructingforeignbodies.

STEP 4

• Checkfornormalbreathing.• Ifbreathingisabsent,attempttoventilate.• Ifairwayisblocked,re-positiontheinfant’sheadandre-attempttoventilate.• Attempt2ndventilation.

STEP 5

• Ifairwayisblocked,perform30chestcompressions.• Proceedtoheadtilt-chintiltandcheckforforeignbody.• Repeatstep3and4tillhelparrivesorabletogive2sucessfulventilations.

STEP 6

• Assessforpulseandbreathingoncetheairwayiscleared.• Ifpulseandbreathingareabsentassumecardiacarrest&continueCPR30:2.• Ifboththepulseandbreathingarepresent,positiontheinfantintherecovery

position.• Continuetomonitortheinfant’spulse,andbreathingeveryfewminutesasthesecan

stopsuddenly.• ActivateEMSifitisnotdoneearlier. BC

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APPLICATIONOFPOCKETMASK

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Maskconnectionportwithone-wayvalve

Exhalationport

Maskport

Filter

Module 10 APPLICATION OF POCKET MASK

Thepocketmaskisabarrierdeviceusedtoproviderescuebreathing.Ithasaone-wayvalvethatpreventsexchangeofsecretionsbetweenthevictimandrescuer.Itismadeoffirmplasticwithacushionedrimandisroughlytriangularinshape.Therimcreatesaflexiblesealaroundthevictim’snoseandmouth.Themaskfitsoverthevictim’smouthandnose.Thenarrowestportionofthemaskisplacedoverthebridgeofthevictim’snose.

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APPLICATION

STEP 1

• Checkthatfilter(ifincluded)issnappedfirmlyinplace.

STEP 3

• Attachone-wayvalvetomaskport.

• Directexhalationportawayfrom‘nose’endofmask.

STEP 2

• Pushoutthedome.

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Note:Ifvictimvomits,removemaskandclearvictim’sairway.Clearmaskassemblybyshakingorsweepingoutforeignmaterial.Blowthroughvalvetoverifyoperation.Re-applymasktovictimandcontinueventilation.

STEP 6

• Removeyourmouthandallowvictimtoexhale.

STEP 5

• Sealasillustrated.• Opentheairwayby

performingagentleheadtilt-chinlift.

• Blowslowlyuntilchestrises.

STEP 4

• Applytherimofthemaskfirstbetweenthevictim’slowerlipandchin.Thiswillretractthelowerlipandkeepthemouthopenunderthemask.

• Positionendmarked‘nose’overthevictim’snose.

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SUMMARYCHECKLIST

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Module 11 SUMMARY ChECKLIST

ADULT ONE-MAN CPR

STEPS ACTION

D : Danger Lookoutforunsafeenvironment,e.g.Electricalcurrent,Fire,PossibleExplosion,Constructionworks,orPoisonousgas• Ensurethatthesceneissafeforyoutohelp

R : Response Establishunresponsiveness• Call,taporgentlyshakethevictim• Calloutloudly:“Hello!Hello!AreyouOK?”

S : ShoutforHelp • Ifnoresponse,Callforambulance995&AED

A : Airway Openairway:HeadTilt-ChinLift

B : Breathing Checkfornormalbreathing:Look,Listen,&Feel(upto10seconds)LookfortheriseandfallofthechestListenforairescapingduringexhalationFeelfortheflowofairfromthevictim’smouthandnosemovingpastyourcheeks

C : Circulation Checkforpulseupto10seconds(onlyforHealthcareproviders)Ifnopulseandbreathing,startCPRForlaypersons,thereisnoneedtocheckforpulse.Ifvictimhasnobreathing,startCPR• Locatethelandmarkforchestcompression• Properbodyandhandposition• Compressverticallyatleast5cmdownwardswithcompleterelaxation

ofpressureaftereachcompressionatrateofatleast100perminute• Saymnemonic “1&2&3&4&5&1&2&3&4&10&1&2&3&4&151&2&3&4&20 1&2&3&4&251&2&3&4&30”

CPRCycle • Perform30chestcompressionsfollowedby2breaths• Thedurationforeachbreathis1second.• Ventilationvolumeisbetween400-600ml/breath• Allowlungdeflationbetweeneachbreath

Reassessment • Assessthevictimforpulseandbreathingafterevery5cyclesof30:2(forhealthcareprovidersonly)

• Ifpulseisabsent(ifunsureofpulseandvictimhasNobreathing,assumecardiacarrest),continue30:2

• Forlaypersons,continueperformingCPRuntilhelparrivesorvictimstartsmoving

RecoveryPosition

Placethevictimintherecoverypositionif:• Pulseandbreathingarepresent• Victimisunconsciousandhasnoevidenceoftrauma• Continuetomonitorvictim’spulseandbreathingeveryfewminutesas

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ADULT FOREIGN-BODY AIRWAY OBSTRUCTION (CONSCIOUS – UNCONSCIOUS)

STEPS ACTION

Conscious victim Ask:“Areyouchoking?”Victimacknowledgesbynodding.Rescuerreplies:“Icanhelp.”Assessment

HeimlichManoeuvreTechnique(NormalSize)

Standbehindthevictim.Positiononefootbetweenthevictim’slegsLocatethelandmark:• Placeyourarmsaroundthevictim’sabdomenandlocatethenavel• Withonehandplace2fingersjustabovethenavel• Makeafistwiththeotherhand• Placethumb-sideofthefistagainsttheabdomenabovethe2fingers• Releasethe2fingersbutmaintainthefistontheabdomen• Leanthevictimforwardandgraspthefistwiththeotherhand• Givesuccessiveinward-upwardthrusts• Checkifforeignbodyisexpelledaftereverysetof5abdominalthrusts• Repeatthrustsuntiltheforeignbodyisdislodgedorthevictimbecomes

unconscious

ChestThrustTechnique(Pregnant&Obese)

Standbehindthevictim.Positiononefootbetweenthevictim’slegsLocatethelandmark:• Placearmsunderthevictim’sarmpitstoencirclethechest• Makeafistwithonehand• Placethumb-sideoffistonthemiddleofthevictim’sbreastbone• Graspthefistwiththeotherhandandgivesuccessivequickbackwardthrusts• Checkifforeignbodyisexpelledaftereverysetof5chestthrusts• Repeatthrustsuntiltheforeignbodyisdislodgedorthevictimbecomes

unconscious

Unconscious victim

Whenvictimbecomesunconscious.Proceedwiththefollowingsteps:• Positionthevictimonafirm,flatsurface• Callforambulance995

• Start30chestcompressions(Thelandmark&techniqueisthesameasforadultCPR)

• Openairway:HeadTilt-ChinLift• Checkairwayandremoveanyobviousforeignbodies

• Checkfornormalbreathing:Look,Listen,&Feel(upto10seconds)• Ifbreathingisabsent,attempttoventilate(1stattempt)• Ifairwayisstillblocked,re-positionthevictim’sheadandreattempttoventilate• Attempt2ndventilation• Ifairwayisstillblocked,perform30chestcompressions• Proceedtoheadtilt-chintiltandcheckforforeignbody• RepeatSteptillhelparrivesorabletogive2successfulventilations

• Checkpulse(forhealthcareprovidersonly)andbreathingonceairwayiscleared.• Ifpulseisabsent(ifunsureofpulseandvictimhasnobreathing,assumecardiac

arrest),continueCPR30:2

RecoveryPosition Placevictimintherecoverypositionif:• Pulseandbreathingarepresent• Continuetomonitorvictim’spulseandbreathingeveryfewminutesasthiscan

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INFANT CPR

STEPS ACTION

D : Danger Lookoutforunsafeenvironment,e.g.Electricalcurrent,Fire,PossibleExplosion,Constructionworks,orPoisonousgas• Ensurethatthesceneissafeforyoutohelp

R : Response Establishunresponsiveness:• Call,taporgentlyshaketheinfant’sshouldertoelicitresponse• Ifyouarealone,immediatelystartCPR30:2forapprox.2minutes

S : ShoutforHelp • Ifasecondrescuerispresent,askhimorhertocallforambulance995

A : Airway Openairway:HeadTilt-ChinLift

B : Breathing Checkfornormalbreathing:Look,Listen,&Feel(upto10seconds)LookfortheriseandfallofthechestListenforairescapingduringexhalationFeelfortheflowofairfromtheinfant’smouthandnosemovingpastyourcheeks

C : Circulation Checkforbrachialpulseupto10seconds(onlyforHealthcareproviders)Ifpulseisabsent(ifunsureofpulseandinfanthasnobreathing,assumecardiacarrest),start30:2Forlaypersons,thereisnoneedtocheckforpulse.Ifinfanthasnobreathing,startCPRLocatelandmarkforchestcompression:• Drawanimaginarylinebetweennipples• Placeindexfingerontheimaginaryline• Placeyourmiddleandringfingersnexttotheindexfinger• Movethe3fingerstothecentreofthesternum(breastbone)• Positionthefingersupright• Liftofftheindexfingerbutmaintainthemiddleandringfingerscontactonthe

sternum(breastbone)• Leanforwardandplaceyourcheekneartheinfant’smouthandnose• Useyourmiddleandringfingerstocompressthesternum(breastbone)by4cm

DemonstratecorrecttechniqueofcompressionKeepfingerscontactonthesternumduringeachupstrokeSaymnemonic“1&2&3&4&5&1&2&3&4&10&1&2&3&4&151&2&3&4&201&2&3&4&251&2&3&4&30”Compressionrateisatleast100perminute

CPRCycle • Perform5cyclesof30chestcompressionsfollowedby2breathsforapproximately2minutes(ForHealthcareprovidersonly)

• Thedurationforeachbreathis1second.• Ventilationvolumeisbetween30ml/breath• Allowlungdeflationbetweeneachbreath

Reassessment • Assessforpulseandbreathingafterevery5cyclesofCPR30:2(forhealthcareprovidersonly)

• Ifpulseisabsent(ifunsureofpulseandinfantisnotbreathing,assumecardiacarrest),continueCPR30:2

• Forlaypersons,continueperformingCPRuntilhelparrivesorinfantstartsmoving

RecoveryPosition • RecoveryPositionPlacetheinfantintherecoverypositionif:• Pulseandbreathingarepresent• Infantisunconsciousandhasnoevidenceoftrauma• Continuetomonitorinfant’spulse&breathingeveryfewminutesasthiscanstop

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INFANT FOREIGN-BODY AIRWAY OBSTRUCTION (CONSCIOUS – UNCONSCIOUS)

STEPS ACTION

Conscious infant Assessforsignsofcompleteairwayobstruction(choking)Ifinfantischoking,attempttoAssessmentrelievetheairwayobstructionimmediatelyAssessment

Backblows&Chestthrusts

Supporttheinfant’sheadandbodybetweenyourhandsandforearmsusingthe“SandwichManoeuvre”• Holdtheinfant’sfacedownandrestyourforearmonyourthigh• Keeptheheadlowerthanthetrunk• Deliver5backblowsforcefullybetweentheshoulderbladeswiththeheelofyour

otherhand• Supporttheinfant’sheadandbodybetweenyourhandsandforearmsafter

deliveringthe5backblows• Turntheinfantoveronhis/herback,restingonyourthigh• Keeptheheadlowerthanthetrunk• Deliver5chestthrustsoverthelowerhalfofthesternum(breastbone)bycounting

aloud‘1,2,3,4,5’.(landmarkforchestthrustisthesameasforinfantCPR)

Reassessment Checkifforeignbodyisexpelledaftereverysetof5backblowsand5chestthrustsandremoveifitisvisible• Iftheforeignbodyisexpelledsuccessfully,assesstheinfantforpulse&breathing• Iftheairwayremainsobstructedandtheinfantisconscious,repeatthesequence

of5backblowsand5chestthrustsuntiltheforeignbodyisexpelledortheinfantbecomesunconscious

Unconscious infant

Wheninfantbecomesunconscious.Proceedwiththefollowingsteps:• Positiontheinfantonafirm,flatsurface• Callforambulance995ifasecondrescuerisavailable

• Start30chestcompressions(Thelandmark&techniqueisthesameasforInfantCPR)

• Openairway:HeadTilt-ChinLift• Checkairwayandremoveanyobviousforeignbodies

• Checkfornormalbreathing:Look,Listen,&Feel(upto10seconds)• Ifbreathingisabsent,attempttoventilate(1stattempt)• Ifairwayisstillblocked,re-positiontheinfant’sheadandreattempttoventilate• Attempt2ndventilation• Ifairwayisstillblocked,perform30chestcompressions• Proceedtoheadtilt-chintiltandcheckforforeignbody• RepeatSteptillhelparrivesorabletogive2successfulventilations

• Checkpulse(forhealthcareprovidersonly)andbreathingonceairwayiscleared.• Ifpulseisabsent(ifunsureofpulseandinfanthasnobreathing,assumecardiac

arrest),continueCPR30:2

RecoveryPosition Placetheinfantintherecoverypositionif:• Pulseandbreathingarepresent• Continuetomonitorinfant’spulseandbreathingeveryfewminutesasthiscan

stopsuddenly• ActivateEMSifitisnotdoneearlier

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Notes

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Inform

ationcorrecta

satA

pril2011

SingaporeGeneralHospitalInstitute for Medical Simulation & Education167JalanBukitMerah,ConnectionOneTower5,#03-10,Singapore150167Tel : 6326 6885 / 6326 6884 /63213651Fax : 68780495Email :imse@sgh.com.sg