7-4

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7-4. REMOVE UPPER AIRWAY OBSTRUCTION IN AN UNCONSCIOUS INFANT

The steps given below assume the infant lost consciousness while you were administering rescue thrusts [paragraph 7-3f(2)] or you discovered an airway obstruction while performing rescue breathing [paragraph 6-4c(2)]. If a head or spinal injury is suspected, administer chest thrusts and finger sweeps, but do not administer backblows. The procedures given in the following paragraphs assume that no head or spinal injury is present.

a. Call for Help. Call for help if you have not done so and determine unresponsiveness.

b. Position Infant for Foreign Body Check.

(1) Small infant. Turn the infant face up with your arm under the infant's back so your hand is supporting the back of his head and your forearm is under his spine. Rest your forearm on your thigh so the infant's head is lower than his trunk.

 

(2) Large infant. If the infant is too large to straddle your arm, lay the casualty's body across your thighs with his face up and his head lower than the trunk of his body. Position the arm that will not be used to remove the object under the infant's body with the hand supporting the infant's head and neck.

c. Open the Infant's Mouth. Open the infant's mouth using a tongue-jaw lift technique.

(1) Place the thumb of one hand (the hand not supporting his head) into his mouth and over his tongue.

 

(2) Wrap the fingers of the hand around his lower jaw.

 

(3) Lift the jaw and tongue forward.

d. Remove Any Visible Foreign Matter. If you see any foreign matter in the infant's mouth or throat, remove the obstruction with a finger sweep (paragraph 5-6c). Do not perform a blind finger sweep since this action could force the obstruction deeper into the infant's throat.

e. Check for Breathing. Tilt the infant's head back slightly and lift the infant's chin to open the airway. Look, listen, and feel for signs of breathing (chest or abdomen rising and falling, sounds of breathing, exhaled air blowing on cheek).

(1) If spontaneous breathing occurs, maintain the airway and check for other injuries.

 

(2) If spontaneous breathing does not occur, attempt to administer ventilations.

f. Administer Two Ventilations. If the infant is not breathing on his own, administer two ventilations using the mouth-to-mouth-and-nose method. Even if the obstruction has not been removed, your efforts may have caused it to shift enough so rescue breathing can now be administered.

(1) Maintain the airway by lifting the infant's chin with the free hand. Do not hyperextend the neck.

 

(2) Take a breath. (Do not take a deep breath since you will not need to blow much air into the infant's smaller lungs.)

 

(3) Place your mouth over the infant's mouth and nose. Make sure that your mouth forms an airtight seal so that air will not escape when you blow air into his mouth and nose.

 

(4) Blow a small puff of air (only enough to make the chest rise) into the infant's mouth and nose. Observe the chest out of the corner of your eye as you administer the breath.

 

(5) After blowing into the infant's mouth and nose, break the seal over his face and allow air to escape. His chest should fall somewhat as air escapes after you break the seal. You may be able to hear or feel the exhaled breath.

 

(6) Take another breath, seal your mouth over the infant's mouth and nose again, and administer a second puff of air. It should take 3 to 5 seconds to administer both breaths.

g. Evaluate Your Efforts.

(1) If your ventilations were successful (chest rose and fell), check the infant's pulse (paragraph 6-5).

(a) If the pulse is absent, administer CPR (paragraph 6-6).

 

(b) If a pulse is present, administer ventilations at the rate of one ventilation every 3 seconds (20 ventilations per minute). Check the pulse again every few minutes. Also check for spontaneous breathing when you check the pulse. If the pulse is absent, administer CPR.

 

(c) Continue your efforts until the infant is breathing spontaneously or until you are relieved by a physician or other medical authority. If possible, evacuate the casualty to a medical treatment facility as you perform rescue breathing/CPR.

(2) If your ventilations were not successful (air did not go in and the chest did not rise), perform backblows (if no spinal or head injury), chest thrusts, finger sweeps (when appropriate), and ventilations as given in the following paragraphs until the obstruction is removed.

h. Call for Help. Call for help again. If a second rescuer is available, have him seek medical assistance.

i. Position Infant for Backblows. Position the infant for backblows using the procedures given in paragraph 7-3b(1) if the casualty is a small infant and in paragraph 7-3b(2) if the casualty is a large infant.

j. Administer Backblows. Administer five backblows by striking the infant on the spine between his shoulder blades with the heel of your free hand. The five blows should be delivered within 3 to 5 seconds.

k. Position Infant for Chest Thrusts. Position the infant for chest thrusts using the procedures given in paragraph 7-3d(1) if the casualty is a small infant and in paragraph 7-3d(2) if the casualty is a large infant.

l. Administer Chest Thrusts. Perform chest thrusts in the manner described in paragraph 7-3e. Continue until the obstruction has been expelled or until you have administered five chest thrusts.

m. Continue Efforts to Expel Obstruction. If the chest thrusts did not expel the object, continue your efforts until the object is expelled or you are ordered to stop by a medical authority. If possible, evacuate the casualty as you continue your efforts.

(1) Open the infant's mouth using a tongue-jaw lift technique and remove any visible foreign matter with a finger sweep.

 

(2) Open the infant's airway and check for signs of breathing. If spontaneous breathing occurs, maintain the airway.

 

(3) If the infant does not resume breathing on his own, administer two ventilations using the mouth-to-mouth-and-nose method.

(a) If your ventilations were successful, check the infant's pulse. If a pulse is absent, administer CPR (paragraph 6-6). If a pulse is present, administer rescue breathing at the rate of one ventilation every 3 seconds and recheck the pulse again every few minutes.

 

(b) If your ventilations were not successful (air did not go in and chest did not rise), continue with your efforts to expel the obstruction.

(4) If your ventilations were not successful, position the infant for backblows and administer five back blows.

 

(5) If the backblows did not expel the obstruction, position the infant for chest thrusts and administer five chest thrusts.

 

(6) If the chest thrusts did not expel the obstruction, continue with your efforts to expel the obstruction [paragraph 7-4m(1) through (6)].

 

NOTE: Public education is vital to alleviate fear of risk of disease transmission during

CPR. Use barriers as recommended by the Centers for Disease Control and the Occupational Safety and Health Administration.

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