First Responder EMS Curriculum for Training Centers in Eurasia

jaw lift, for use in unresponsive victims of FBAO. Healthcare providers are taught a sequence ofactions to attempt to relieve FBAO in the unresponsive victim. If FBAO is suspected, open theairway using a tongue-jaw lift and look for the foreign body before attempting ventilation. If yousee the foreign body, remove it carefully (under vision).BreathingAssessment: Check for BreathingHold the victim's airway open and look for signs that the victim is breathing. Look for the riseand fall of the chest and abdomen, listen at the child's nose and mouth for exhaled breath sounds,and feel for air movement from the child's mouth on your cheek for no more than 10 seconds.It may be difficult to determine whether the victim is breathing. Care must be taken todifferentiate ineffective, gasping, or obstructed breathing efforts from effective breathing. If youare not confident that respirations are adequate, proceed with rescue breathing.If the child is breathing spontaneously and effectively and there is no evidence of trauma, turn thechild to the side in a recovery position. This position should help maintain a patent airway. Althoughmany recovery positions are used in the management of pediatric patients, no single recoveryposition can be universally endorsed on the basis of scientific studies of children. There is consensusthat an ideal recovery position should be a stable position that enables the following: maintenance ofa patent airway, maintenance of cervical spine stability, minimization of risk for aspiration,limitation of pressure on bony prominences and peripheral nerves, visualization of the child'srespiratory effort and appearance (including color), and access to the patient for interventions.Figure 27. Recovery position.Provide Rescue BreathingIf no spontaneous breathing is detected, maintain a patent airway by head tilt-chin lift or jawthrust. Carefully (under vision) remove any obvious airway obstruction, take a deep breath, anddeliver rescue breaths. With each rescue breath, provide a volume sufficient for you to see thechild's chest rise. Provide 2 slow breaths (1 to 1 1/2 seconds per breath) to the victim, pausingafter the first breath to take a breath to maximize oxygen content and minimize carbon dioxideconcentration in the delivered breaths. Your exhaled air can provide oxygen to the victim, but therescue-breathing pattern you use will affect the amount of oxygen and carbon dioxide deliveredto the victim. When ventilation adjuncts and oxygen are available (i.e., bag-mask) to assist withventilation, provide high flow oxygen to all unresponsive victims or victims in respiratorydistress.The 1992 guidelines recommended that 2 initial breaths be delivered. The current ILCORrecommendations suggest that between 2 and 5 rescue breaths should be delivered initially toensure that at least 2 effective ventilations are provided. There is no data to support the choice ofany single number of initial breaths to be delivered to the unresponsive, nonbreathing victim.Most pediatric victims of cardiac arrest are both hypoxic and hypercarbic. If the rescuer is unable352 First Responder EMS Curriculum/AIHA, July 2002