First Responder EMS Curriculum for Training Centers in Eurasia

to establish effective ventilation with 2 rescue breaths, additional breaths may be beneficial inimproving oxygenation and restoring an adequate heart rate for an apneic, brady-cardic infant orchild. There is inadequate data to recommend changing the number of initial ventilationsdelivered during CPR at this time. Therefore, lay rescuers and healthcare providers shouldadminister 2 initial effective breaths to the unresponsive, nonbreathing infant or child (ClassIndeterminate). The rescuer should ensure that at least 2 breaths delivered are effective andproduce visible chest rise.Mouth-to-Mouth-and-Nose and Mouth-to-Mouth BreathingIf the victim is an infant (< 1 year old), place your mouth over the infant's mouth and nose tocreate a seal. Blow into the infant's nose and mouth (pausing to inhale between breaths),attempting to make the chest rise with each breath. A variety of techniques can be used toprovide rescue breathing for infants. A rescuer with a small mouth may have difficulty coveringboth the nose and open mouth of a large infant. Under these conditions, mouth-to-noseventilation may be adequate. There is no convincing data to justify a change from therecommendation that the rescuer attempt mouth-to-mouth-and-nose ventilation for infants up to 1year of age. During rescue breathing attempts you must maintain good head position for theinfant (head tilt-chin lift to maintain a patent airway) and create an airtight seal over the airway.Figure 28. Mouth-to-mouth-and-nosebreathing for small infant victim.The mouth-to-nose rescue breathing technique is a reasonable adjunctive or alternative method ofproviding rescue breathing for an infant (Class IIb). The mouth-to-nose breathing technique maybe particularly useful if you have difficulty with the mouth-to-mouth-and-nose technique. Toperform mouth-to-nose ventilation, place your mouth over the infant's nose and proceed withrescue breathing. It may be necessary to close the infant's mouth during rescue breathing toprevent the rescue breaths from escaping through the infant's mouth. A chin lift will helpmaintain airway patency by moving the tongue forward and may help keep the mouth closed.First Responder EMS Curriculum/AIHA, July 2002 353