First Responder EMS Curriculum for Training Centers in Eurasia

perform abdominal thrusts until the foreign body obstruction is removed. Only use a fingersweep if you can visualize the foreign body.If a patient (infant, child, or adult) is initially responsive with a foreign body airwayobstruction, but becomes unresponsive while you are treating them, gently lower thepatient to the floor. Open and position the airway using the head –tilt-chin lift maneuverand attempt to ventilate the patient. If the patient is not breathing and ventilation isunsuccessful, go directly to the appropriate technique: back blows, chest thrusts, orabdominal thrusts.a. Airway AdjunctsAirway adjuncts are not used for initial ventilation efforts in infants and children. Oralairways, however, are used to help maintain an open airway when the head –tilt-chin liftor jaw-thrust maneuvers are ineffective. First Responders do not generally use nasalairways in the pediatric population.Use an oral airway only if the patient is unresponsive and has no gag reflex. If thepatient has a gag reflex, he/she may vomit or gag, causing further respiratorycompromise. Size the oral airway by measuring from the corner of the mouth to thelower tip of the ear. Using a tongue depressor, push down on the base of the tongue andinsert the oropharyngeal airway following the anatomic curve of the oropharynx. Do notrotate the oral airway, as this may damage the soft palate.5. Pediatric AssessmentWhenever caring for a pediatric patient, always attempt to involve the parents in yourassessment and management of the patient. They can often provide necessary healthinformation and emotional support and comfort for the patient. Inform the parents of anyinterventions you believe are necessary.When assessing an infant or child for illness or injury, first note the overall appearance ofthe patient. This visual assessment will often give you a general impression of the patientas a well versus sick child. Assess the patient’s mental status (talking, crying, agitated,lethargic, unresponsive). Note the patient’s effort of breathing. Look for signs of airwayobstruction (nasal flaring, chest wall retractions, accessory muscle use). Note if the skincolor is pink, pale, or blue (cyanotic). Listen for the quality of the patient’s cry or speech.Also observe the child’s interaction with the environment and parents. Is the child’sbehavior normal for the child’s age? Is the child playing, moving around, attentive, makinggood eye contact, crying, upset, or scared? Is the child responding to the parents or you?General observations such as these will enhance your ability to assess an ill or injuredinfant or child.Begin the First Responder assessment from across the room, observing the generalappearance of the surroundings and the patient. Attempt to identify any mechanism ofinjury. Note the patient’s body tone and position. The first priority is the respiratoryassessment. Observe the presence or absence of symmetrical chest wall expansion. Notethe effort of breathing and respiratory rate. Look for nasal flaring, accessory muscle use, orchest wall retractions. Listen for inspiratory stridor or grunting. After the respiratoryassessment, assess the circulation by palpating the brachial or femoral pulse. Comparecentral and distal pulses. Assess skin temperature and color. Comfort, calm, and reassurethe patient and parents.208 First Responder EMS Curriculum/AIHA, July 2002