Caring for Infants and Children

1. 23 Caring for Infants and Children

2. SCAN 23.1PEDIATRIC EMERGENCIES—PRIMARY ASSESSMENT AND BASIC LIFE SUPPORTINFANTS

3. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life Support Infants Birth to One Year • In your primary assessment, establish your general impression from a distance. • Ensure an adequate airway. If needed, provide ventilations. • Protect the head and spine. • Control your emotions and facial expressions to help reduce the child's fear. • Provide care to prevent shock. (A small amount of blood loss can cause shock.)

4. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life Support Infants

5. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life Support Infants Establishing Responsiveness: The infant should move or cry when gently tapped or shaken. Is he alert, responsive to voice or to pain stimulus, or unresponsive? Opening the Airway: Use slight head-tilt/chin-lift. (Use the jaw-thrust for possible spine injury.) Evaluating Breathing: If the infant is responsive but cyanotic and struggling to breathe, or has inadequate breathing, assist ventilations and arrange for immediate transport. If the infant is unresponsive, check for a pulse. If there is no breathing and no pulse, begin CPR. Rescue Breaths: If the infant has a pulse but is not breathing normally, ventilate once every three to five seconds while watching for chest rise and fall. Ventilate with the mouth-to-barrier technique, using an appropriate pediatric-size barrier, mask or a pediatric bag mask. If there is evidence of airway obstruction, clear the airway.

6. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life Support Infants Clearing the Airway • Make certain that you have not overextended or underextended the neck. Place a folded towel under the shoulders to keep the head in a neutral position. If this does not open the airway, then: • For a responsive child, place the infant over the length of your arm face down with the head lower than the trunk. Support the head with your hand placed around the jaw. Support your forearm by placing it on your thigh. • Deliver five back blows between the shoulder blades with the heel of your free hand. • Place your free arm on the infant's back and support the back of his head with that hand. Sandwich him between your arms and hands and turn him over. Support your arm on your thigh. Keep the head lower than the trunk and deliver five chest thrusts. If the airway remains obstructed, but the patient is responsive, continue back blows and chest thrusts.

7. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life Support Infants Clearing the Airway (continued) • If the airway remains obstructed and the patient is unresponsive, open the mouth to look for an obstruction. • Do not attempt blind finger sweeps. You must see the object before you sweep the mouth with your little finger. • Even if you did not see or dislodge an obstruction, attempt to ventilate. If unable to ventilate, begin chest compressions. After 30 compressions, look for and remove visible obstructions, and attempt to ventilate again. Repeat sequence of compressions and ventilations until the object is removed or EMS arrives.

8. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life Support Infants Continuing Rescue Breathing • If patient is still not breathing but you gave two successful breaths, begin CPR. Performing CPR • If the patient is unresponsive and not breathing normally, assess for a pulse for no more than 10 seconds. If there is no obvious pulse, start compressions. For the infant, the compression site is one finger-width below an imaginary line drawn across the nipples. Compress with the tips of two or three fingers approximately one-third the depth of the chest at a rate of at least 100 per minute. For two rescuers, use overlapping or side-by-side thumbs and compress on the middle third of the sternum just below the nipple line. The remaining fingers encircle the chest and support the back. • For a single rescuer, deliver two ventilations following each set of 30 compressions. For two rescuers, deliver two breaths every 15 compressions.

9. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life SupportInfants Controlling Bleeding • Use direct pressure as a primary method to control bleeding. • If bleeding is not controlled, use elevation combined with direct pressure. If bleeding is still not controlled, apply a tourniquet. • A small amount of blood loss (25 milliliters) is serious. Care for shock.

10. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life SupportChildren One year to the onset of puberty • Perform a primary assessment, establish your general impression from a distance. • Ensure an adequate airway. If needed, provide ventilations as you watch for the chest to rise. • Protect the head and spine. • Control your emotions and facial expressions to help reduce the child's fear. • Evaluate blood loss. Provide care to prevent shock.

11. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life SupportChildren

12. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life SupportChildren Establishing Responsiveness: The child should move or cry when gently tapped or shaken. Opening the Airway: Use slight head-tilt/chin-lift or jawthrust maneuver, as appropriate. Evaluating Breathing: If the child is responsive but cyanotic or struggling and failing to breathe, assist ventilations and arrange for immediate transport. If the child is in respiratory arrest, open the airway and provide rescue breaths. Rescue Breaths: If the child has a pulse but is not breathing normally, ventilate once every three to five seconds while watching for chest rise and fall. Ventilate with the mouth-to-mask technique, using an appropriate pediatric-size mask or a pediatric bag mask.

13. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life SupportChildren Clearing the Airway • Make certain that you have the proper head tilt for an unresponsive child. Place a folded towel under shoulders to keep the head in a neutral position. If this does not open the airway, then: • If the airway remains obstructed and the patient is responsive, perform abdominal thrusts. • If the airway remains obstructed and the child is unresponsive, begin CPR. • Do not attempt blind finger sweeps. You must see the object before you sweep the mouth. Use your little finger. • Even if you did not see or dislodge an obstruction, begin chest compressions. After 30 compressions, look for and remove visible obstructions and attempt to ventilate again. Repeat sequence of compressions and ventilations until the object is removed or EMS arrives.

14. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life SupportChildren Performing CPR • If the patient is unresponsive and not breathing normally, assess for a pulse for no more than 10 seconds. • Have someone call 911. If you are alone, do CPR for two minutes before calling. • If there is no obvious pulse, start compressions. For the child, the compression site is on the center of the chest between the nipples. Compress with the heel of one hand approximately one-third the depth of the chest at a rate of at least 100 per minute. Deliver two ventilations every 30 compressions

15. Scan 23.1 Pediatric Emergencies—Primary Assessment and Basic Life SupportChildren Controlling Bleeding • Use direct pressure as a primary method to control bleeding. • If bleeding is not controlled, use elevation combined with direct pressure. If bleeding is still not controlled, apply a tourniquet. • A blood loss of one-half liter (about one pint) is serious. Care for shock.

16. SCAN 23.1RAPID EXTRICATION FROM A SAFETY SEAT

17. 23.2.1 Rescuer 1 stabilizes car seat in upright position and applies manual head/neck stabilization. Rescuer 2 prepares equipment, then loosens or cuts the seat straps and raises the front guard.

18. 23.2.2 Cervical collar is applied to patient as Rescuer 1 maintains manual stabilization of the head and neck.

19. 23.2.3 As Rescuer 1 maintains manual head/neck stabilization, Rescuer 2 places child safety seat on center of backboard and slowly tilts it into supine position. Both rescuers are careful not to let the child slide out of the chair. For the child with a large head, place a towel under area where the shoulders will eventually be placed on the board to prevent head from tilting forward.

20. 23.2.4 Rescuer 1 maintains manual head/neck stabilization and calls for a coordinated long axis move onto the backboard.

21. 23.2.5 Rescuer 1 maintains manual head/neck stabilization. Rescuer 2 places rolled towels or blankets on both sides of the patient.

22. 23.2.6 Rescuer 1 maintains manual head/neck stabilization. Rescuer 2 straps or tapes patient to board at level of upper chest, pelvis, and lower legs. Do not strap across abdomen.

23. 23.2.7 Rescuer 1 maintains manual head/neck stabilization as Rescuer 2 places rolled towels on both sides of head, then tapes head securely in place across forehead and maxilla (jaw bone) or cervical collar. Do not tape across chin to avoid putting pressure on neck.

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