Choking Adult or Child: Foreign Body Airway Obstruction
If the victim is able to cough, encourage them to continue to cough it up and out while you call 911. Once they lose the ability to cough, perform the Heimlich Maneuver:
1. Get behind them, and wrap your arms around their body. Using the finger on one of your hands, find their belly button and stick your finger in it. With your finger in the belly button, place the fist of your other hand thumb side in above the belly button. Take you finger out fo the belly button, and cup your fisted hand.
2. In the shape of a "J," pull in and go up repeatedly until pop out or pass out.
3. If the object pops out, they will now begin to move air on their own. Sit with them until medics arrive.
4. If the victim passes out, you will feel them get heavy in your arms. Bend your knees, and help them to the ground. Make sure 911 has been called, and you will now begin CPR.
5. Begin CPR using the 30:2 compression ratio, but after you get done with the 30 compressions but before you breathe, look in their mouth. If you see the object and think you can reach it, put your index finger into a "hook" position, and try to sweep it out. But if you can't see it or don't think you can reach it, deliver two breaths. Your compressions are trying to pop the object out, and your breaths are trying to blow the object in. Either direction gets you air.
A FEW NOTES: First, if the person is quite a deal taller than you, have them get on their knees. You will then be able to bend your knees as much as you need to to adjust your height behind them. Second, if they have a larger frame or your arms are a bit on the short side, wrap your arms under their armpits, place one fist on the sternum in between the nipples, and cup your fist with your other hand. Do a compression movement pulling their sternum into the direction of their spine quickly and with force (you are trying to squeeze air out of the lungs to create enough force to pop the object out). This is also the position used for pregnancy. Third, make sure you begin the Heimlich Maneuver, ask if the person wants your help. If they say no or don't answer, wait for them to go unconscious to begin CPR--at this point you are now covered by the United Stated of America.
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Adult CPR: C-A-B
1. Make sure your scene is safe before approaching the victim. Look around, above, and below you.
2. Tap the victim's collar bone firmly and shout, "Are you okay?"
3. If there is no response, call 911 and tell someone to go get an AED and come back to you.
4. Check to see if the person is breathing and has a pulse. Look at the chest for chest rise and fall, and feel for a pulse at the carotid on the side closest to you. These steps are performed simultaneously and should not take more than ten seconds.
5. If there is no response, no breathing, and no pulse (or not breathing normally/gasping), raise the shirt up and begin compressions. Clasp your hands together and compress the chest directly between the nipples 2-2.4 inches deep at the rate of 100-120 compressions per minute (think of the song "Stayin' Alive" to get your speed). Do 30 compressions and 2 breaths. Go fast and hard!
6. After you have completed 30 compressions, give 2 breaths. Tilt the head back using the head-tilt, chin-lift technique and give 2 breaths. Breathing should not take longer than ten seconds combined.
7. After you give 2 breaths, return to 30 compressions. Keep repeating this 30:2 compression-to-breath ratio until one of three things happens: The victim regains consciousness; you feel like you are going to die, hyperventilate, or pass out; or until the medics arrive.
8. Once an AED arrives on scene, compressions will continue to be performed while a second rescuer applies the AED and follows directions provided by the machine. If a shock is indicated, clear the victim before pushing the button. Once the shock has been delivered, you will become a two-person rescuing team--one person will do compressions, and the other person will give the breaths. Switch jobs every two minutes or after every five sets to avoid fatigue.
A FEW NOTES: First, if you do not have a barrier to perform breaths with, you will only do compressions. You will not need to count at this point as there will not be any rest periods until a barrier arrives on scene. This is called "Hands Only," and this is covered under the Good Sumaritan Law. Second, it doesn't matter if you are a one-rescuer or a two-rescuer on an adult, you are ALWAYS 30:2 when it comes to compressions and breathing...always. Same goes if you are by yourself: If you are by yourself, regardless of the age of the victim, you are ALWAYS 30:2.
Choking Infant: Foreign Body Airway Obstruction
If you have a conscious choking infant at the age of one and under, follow these steps:
1. With you in a seated position, place the back of the infant's head in the palm of your hand while resting their body on your forearm. Support their jaw bone with your opposite hand. Roll them face down into the forearm of your opposite arm while you rest your forearm on your thigh. Using the heel of your hand, give them five back slaps across the back of the shoulder blades. Remember, you have to hit them hard enough to get it out.
2. After you deliver five back slaps, roll them face up into your other forearm while resting your forearm on your thigh, and give them five chest thrusts.
3. Continue to roll them onto their back and face up until pop out or pass out.
4. If they pop it out, roll them face down so they can't suck it back in. Provide comfort and seek medical attention in case you hurt their spine or bruised a lung.
5. If they pass out, put them on a table and begin CPR. Deliver 30:2 compression to breath ratio or 15:2 for two-rescuers. After your compression but before you breathe, look in the mouth. If you see the object and think you can reach it, put your pinky finger into a "hook" position, and try to sweep it out. But if you can't see it or don't think you can reach it, deliver two breaths. Your compressions are trying to pop the object out, and your breaths are trying to blow the object in. Either direction gets you air.
NOTE: If CPR is needed, put the infant up on something high like a table or a counter. If you as the rescuer is comfortable, you will rescue better. The floor works just as well, but it will be harder for you to get into the breathing position. Get them up high and be comfortable.
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Are you taking one of our Heartsaver courses soon which includes First Aid CPR AED, Pediatric First Aid CPR AED, and First Aid by iteself? We've put together a quick Study Guide to help you prepare. If you have any questions about the material, please call us at 877-760-5600 or text us at 909-543-8768.
AED: Automated External Defibrillator
An AED is used on adults, children, and infants. All AED's perform the same steps, but they are sometimes in a different order. Listen to the machine that is on scene. Just turn it on and follow the steps in the order provided. The order below is what you will be practicing and be tested on at CPR Cindy's.
1. Open the bag or case, and turn on the AED. Listen and follow the directions.
2. Lift the victim's shirt high enough to expose the shoulders and collar bones. The pads have pictures on them and location directions. Place one pad on the victim's right upper chest above the nipple and below the collar bone, and place the second one just below the final rib on the left side.
3. Plug the connector on the AED pads to the machine.
4. Wave your hand over the victim's body and tell everyone to clear.
5. If a shock is indicated, announce that you are going to shock and keep everyone clear. When the light on the machine is flashing and ready to deliver a shock, hit the button to defibrillate the victim.
6. After the shock has been delivered, resume CPR using the 30:2 compression ratio for a single rescuer or a two-rescuer on an adult, or 15:2 if you have two rescuers working on a child or infant.
7. The AED has a timer inside of it, and every two minutes it will tell you to clear. If a shock is indicated, the machine will chage so you can defibrillate the patient. If no shock is indicated, it will tell you to resume CPR, if necessary. When it says this, check for a response from the victim, check for breathing and a pulse. If there is no response, no breathing, or no pulse (no normal breathing/gasping), resume CPR.
A FEW NOTES: First, if you do not have a barrier to perform breaths with, you will only do compressions. You will not need to count at this point as there will not be any rest periods until a barrier arrives on scene. This is called "Hands Only," and this is covered under the Good Sumaritan Law. Second, attenuated pads are recommended for infants, and they will be placed in the same position as an adult or child--right shoulder, left rib. Third, get Baby up on a high hard surface such as a counter, a table, on the hood of a car--anywhere that puts you in a more comfortable rescuing position. The floor will work just fine, but you will work harder when bending down to breathe. Last, there are a few special considerations to keep in mind when using an AED, and your AED should come with a Prep Kit.
If the victim has a hairy chest, grab the razor from the prep kit and shave him quickly in a few strikes. Don't worry about razor burn--it's not important in this moment. If there is not a razor on scene, go ahead and place your pads. The AED may say that you have poor pad placement. Push the pads down firmly one more time. If the machine continues to tell you that you have poor pad palcement, give the victim a wax job and RIP those pads off, taking the hair with it. Place a new set of pads and continue.
If the victim has wet skin for any reason, grab the towel out fo the prep kit and wipe the areas where you are going to place your pads--you don't have to wipe the entire chest.
If the victim has a pacemaker (it looks like a pork chop sitting under the skin), DO NOT put your AED pads on top of it. Place your pads a little to the left or right or a little above or below. Also, if you see a plastic tube sticking out of the skin where you need to place your pad, it's usually a port-a-cath. You cannot place your pads on top of it. So again, move a little to the side or up or down.
If you see a medication patch in the area where you need to place your AED pads, DO NOT touch it with your bare fingers. Use gloves or a towel. After you remove the patch, clean the skin before placing the pads.
Child CPR: C-A-B
A child is considered a person who has not yet reached puberty. Males will not have hair on their chest or in the armpits, and females will not have breast development.
1. Make sure your scene is safe before approaching the victim. Look around, above, and below you.
2. Tap the victim's collar bone firmly and shout, "Are you okay?"
3. If there is no response and you are by yourself, immediately begin CPR and perform compressions and breaths for two minutes (five sets). After two minutes, call 911 and tell someone to go get an AED and come back to you. If you have somebody else near you, tell them to call 911 immediately and go get an AED while you begin compressions.
4. Check to see if the person is breathing and has a pulse. Look at the chest for chest rise and fall, and feel for a pulse at the carotid on the side closest to you. These steps are performed simultaneously and should not take more than ten seconds.
5. If there is no response, no breathing, and no pulse (or not breathing normally/gasping), raise the shirt up and begin compressions. Clasp your hands together and compress the chest directly between the nipples 2-2.4 inches deep at the rate of 100-120 compressions per minute (think of the song "Stayin' Alive" to get your speed). Do 30 compressions and 2 breaths if there is only one rescuer, but if there are two rescuers, do 15 compressions and 2 breaths. Go fast and hard!
6. After you have completed 30 compressions, give 2 breaths. Tilt the head back using the head-tilt, chin-lift technique and give 2 breaths. Breathing should not take longer than ten seconds combined.
7. After you give 2 breaths, return to 30 compressions. Keep repeating this 30:2 compression-to-breath ratio until one of three things happens: The victim regains consciousness; you feel like you are going to die, hyperventilate, or pass out; or until the medics arrive.
8. Once an AED arrives on scene, compressions will continue to be performed while a second rescuer applies the AED and follows directions provided by the machine. If a shock is indicated, clear the victim before pushing the button. Once the shock has been delivered, you will become a two-person rescuing team--one person will do compressions, and the other person will give the breaths. Switch jobs every two minutes or after every five sets to avoid fatigue.
A FEW NOTES: First, if you do not have a barrier to perform breaths with, you will only do compressions. You will not need to count at this point as there will not be any rest periods until a barrier arrives on scene. This is called "Hands Only," and this is covered under the Good Sumaritan Law. Second, on a child you are welcome to use one hand or two hands when doing compressions. One hand is not better than two, and two is not better than one. Whatever one you like and can do best, save the child. Third, the AED pads cannot touch each other or overlap. In the case of a smaller child, place one AED on the center of the chest, and place the second one on the back in the center. This will create a "sandwich" type position.
Infant CPR: C-A-B
An infant is considered a person who has not yet reached their first birthday. A neonate is under 28 days old.
1. Make sure your scene is safe before approaching Baby. Look around, above, and below you.
2. Using your fingernails, scratch the bottom of the baby's foot firmly and shout, "Baby, Baby, are you okay?"
3. If there is no response and you are by yourself, immediately begin CPR and perform compressions and breaths for two minutes (five sets). After two minutes, call 911 and tell someone to go get an AED and come back to you. If you have somebody else near you, tell them to call 911 immediately and go get an AED while you begin compressions.
4. Check to see if Baby is breathing and has a pulse. Look at the chest for chest rise and fall, and feel for a pulse at the brachial on the side closest to you. These steps are performed simultaneously and should not take more than ten seconds. Make sure you are checking for a pulse on bare skin.
5. If there is no response, no breathing, and no pulse (or not breathing normally/gasping), raise the shirt up and begin compressions. With the hand closest to the head, draw an imaginary line across their nipples. Using your other hand, place two fingers just below the nipple line you just drew, tilt the head slightly backwards to maintain an open airway, and begin compressions using your two fingers. You will go 1 1/2" deep or 1/3 the depth of the body (hint: Look for bulk. If they are thinner, go 1 1/2" deep, but if they are a little more chunky, go 1/3 the depth of the body). You will still got he rate of 100-120 compressions per minute (think of the song "Stayin' Alive" to get your speed). Do 30 compressions and 2 breaths if there is only one rescuer, but if there are two rescuers, do 15 compressions and 2 breaths. For comfort of the rescuers, one person should stand above the head or to the side while the compressor is at the feet. Go fast and hard!
6. After you have completed 30 compressions, give 2 breaths. Tilt the head back using the head-tilt, chin-lift technique and give 2 breaths. Breathing should not take longer than ten seconds combined.
7. After you give 2 breaths, return to 30 compressions. Keep repeating this 30:2 compression-to-breath ratio until one of three things happens: Baby regains consciousness; you feel like you are going to die, hyperventilate, or pass out; or until the medics arrive.
8. Once an AED arrives on scene, compressions will continue to be performed while a second rescuer applies the AED and follows directions provided by the machine. If a shock is indicated, clear Baby before pushing the button. Once the shock has been delivered, you will become a two-person rescuing team--one person will do compressions, and the other person will give the breaths. Switch jobs every two minutes or after every five sets to avoid fatigue.
A FEW NOTES: First, if you do not have a barrier to perform breaths with, you will only do compressions. You will not need to count at this point as there will not be any rest periods until a barrier arrives on scene. This is called "Hands Only," and this is covered under the Good Sumaritan Law. Second, attenuated pads are recommended for infants, and they will be placed in the same position as an adult or child--right shoulder, left rib. Third, get Baby up on a high hard surface such as a counter, a table, on the hood of a car--anywhere that puts you in a more comfortable rescuing position. The floor will work just fine, but you will work harder when bending down to breathe. Last, if you do not have a barrier and you know Baby well (ie--it's your baby or a baby you know well), you can perform a version of mouth-to-mouth, but it will be mouth-to-nose. Because an infant's features are so close together, plac eyour mouth over the mouth and nose to give breaths.
CPR Cindy