In The Event Of An Emergency
What To Do Until Help Arrives
Change is always upon us, and 2000 brought us evidence based evaluation designed to improve survival from sudden cardiac arrest. In 2005, The International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science published changes that supersede the “Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (ECC)” in the way we resuscitate all victims of sudden cardiac arrest. The evidence evaluation process for these new guidelines was accomplished in collaboration with the international Liaison Committee on Resuscitation (ILCOR). WHY do I tell you this, because as of 2000, experts in ECC must develop consensus based on scientific evidence to make any future changes in CPR techniques and training. So perhaps, continued life-saving improvements maybe on the way in 2011.
Special attention must be paid to produce environments for children that are safe and protective. Young children should be taught respect for matches/lighters and should not be left unsupervised. Toys should be carefully examined for small parts that could be accidentally swallowed or may have been recalled. Beads, small toys, marbles must be kept away from infants and preschool children. More and more children are developing allergies to products like peanuts and infants should not be feed bee honey products without speaking first to a Pediatrician. In automobiles with or without airbags, infant car seats should be used in the rear seats with the safest being placed in the middle rear seat. Children should learn about water safety and be taught to swim as early as possible.
The most important determinant of survival from cardiac arrest is the presence of a trained rescuer who is ready, willing, able and equipped to act. Thus, our greatest challenge continues to be the improvement of lay-rescuer basic life support education. Cardiopulmonary arrest (no breathing or heart beat), in infants differs dramatically from cardiopulmonary arrest in adults. For infants, sudden cardiopulmonary arrest is uncommon. Instead they experience respiratory distress or failure that leads to a progressive deterioration in the respiratory or circulatory function. In infants, respiratory arrest (not breathing but has a heart beat) is far more common than cardiac arrest and if detected and treated while an infant still has a perfusing cardiac rhythm (a heart beat), survival is 60 to 70% higher, and most survivors neurologically recover.
Basic Life Support (BLS)
Basic life support (formerly referred to as CPR) is the second phase of the emergency cardiac care chain of survival that supports or provides ventilation and, if necessary, circulation, to a victim. The number of newborns who require resuscitation is small. It is recommended that BLS education be a major focus offered to certain audiences, including parents of newborn children, day care personnel, and parents of infants at high risk for Sudden Infant Death Syndrome. The chain of survival is a series of steps to start the resuscitation efforts.
The ABCs of Infant BLS (Newborns to one year old)
For the purposes of these guidelines, an “infant” is less than one year of age. Always make sure that the area is safe for you and the victim. If necessary, move the infant to ensure the infant’s safety.
Establish unresponsiveness: Determine whether the infant is unconscious and quickly assess the extent of any injury. Special techniques for infants that have sustained head or neck trauma so as not to cause spinal cord injury are no longer taught to lay-rescuers in an attempt to ease the amount of information that lay-rescuers need to learn/remember and to clarify in formal sessions the most important skills that rescuers need to learn/perform at course completion. Unconsciousness is determined by gently shaking the infant or better yet, flicking the baby’s sole on their feet to elicit a response. After determining unresponsiveness or respiratory difficulty, shout out for help.
Shout for help: (If a second rescuer is available, have him/her contact EMS/911.) If alone with an infant that is not breathing, and there is no phone readily available, complete two minutes of CPR before leaving to phone for help. Fortunately, many EMS/911 centers can offer BLS pre-arrival instruction to would-be rescuers prior to the arrival of EMTs and/or paramedics.
The rescuer calling the EMS system should give the following details:
- Location of the emergency, including address and/or landmarks
- Telephone number from which the rescuer is calling from
- What happened
- Number of victims
- Condition of the victim(s)
- Nature of the first aid/CPR being provided
- Provide any other information requested by the 911 call taker. To ensure this last item, the rescuer calling EMS should hang up last.
After determining unconsciousness position the infant onto his/her back, open the airway using the head-tilt/chin-lift maneuver (figure 1). If the infant is having respiratory difficulty, and is conscious, time should not be wasted on an attempt to open the airway. The infant should be transported to a hospital as rapidly as possible. The small airways of an infant can easily be obstructed by mucus, blood, vomit, or in most unconscious victims, the tongue simply falls back. While opening the airway, check for normal breathing, take no more then 10 seconds to (look, listen, and feel). Basically, look for rhythmic chest movement. Meanwhile; listen for exhaled breath sounds at the infant’s mouth and nose, finally, feel for exhaled air on your cheek which has been positioned closely to the [infant’s] mouth/nose.
If the infant is not breathing, give 2 slow breaths while looking for chest rise from the corner of your eyes. To do this, while continuing to maintain a head-tilt, chin-lift, take a breath and make an airtight seal between your mouth over the infant’s mouth and nose. Despite infant rescue breathing safety, some may have reservations about doing this technique without rescue breathing barrier devices. Barriers are readily available and the rescuer should to be equipped to act if these reservations exist. The volume of air in an infant’s lungs is smaller than that in an adult’s, and an infant’s air passages are also smaller, care should be taken not to over inflate the tiny lungs as the rescuer will be undoubtedly excited.
Lay-rescuers no longer check for signs of circulation (pulse check) after the delivery of two breaths. Immediately begin cycles of 30 chest compressions with the 2-finger technique placed just below the intermammary line (rate of at least 100 compressions per minute, remember too fast is not better), followed by 2 slow breath. Continue performing cycles of 30 compressions and 2 breaths uninterrupted until Advanced Life Support (ALS) [paramedics] arrive, or signs of life are recognized [infant breathing, crying or coughing]. When compressing the infant’s chest, the rescuer should depress 1/3 to ½ the depth of the infant’s chest with the emphasis being, to let the chest totally recoil back to normal before the next compression. (I.e. if the infant’s chest size is 3 inches, the rescuer should compress down 1 to 2 inches when performing CPR)
This overview is not meant to replace an actual recognized AHA Heartsaver Pediatric Course that is recommended for everyone. BLS courses are American Heart Association (AHA) guidelines and offered by local fire departments, private AHA Training Centers (TC) and some college adult education programs.
FYI - you may have heard about the compression-only CPR, this technique is not recommended in infants who are more likely to have no heart-beat because of a breathing issue but something is better then nothing.