First Responder EMS Curriculum for Training Centers in Eurasia

Figure 29. Mouth-to-mouth breathing forchild victim.If the victim is a large infant or a child (1 to 8 years of age), provide mouth-to-mouth rescuebreathing. Maintain a head tilt-chin lift or jaw thrust (to keep the airway patent), and pinch thevictim's nose tightly with thumb and forefinger. Make a mouth-to-mouth seal and provide 2rescue breaths, making sure that the child's chest rises visibly with each breath. Inhale betweenrescue breaths.Evaluation of Effectiveness of Breaths DeliveredRescue breaths provide essential support for a nonbreathing infant or child. Because childrenvary widely in size and lung compliance, it is impossible to make precise recommendations aboutthe pressure or volume of breaths to be delivered during rescue breathing. Although the goal ofassisted ventilation is delivery of adequate oxygen and removal of carbon dioxide with thesmallest risk of iatrogenic injury, measurement of oxygen and CO 2 levels during pediatric BLS isoften not practical. Therefore, the volume of each rescue breath should be sufficient to cause thechest to visibly rise without causing excessive gastric distention. If the child's chest does not riseduring rescue breathing, ventilation is not effective. Because the small airway of the infant orchild may provide high resistance to air flow, particularly in the presence of large or smallairway obstruction, a relatively high pressure may be required to deliver an adequate volume ofair to ensure chest expansion. The correct volume for each breath is the volume that causes thechest to rise.If air enters freely and the chest rises, the airway is clear. If air does not enter freely (if the chestdoes not rise), either the airway is obstructed or greater volume or pressure is needed to provideadequate rescue breaths. Improper opening of the airway is the most common cause of airwayobstruction and inadequate ventilation during resuscitation. As a result, if air does not enterfreely and the chest does not rise during initial ventilation attempts, reposition the airway andreattempt ventilation. It may be necessary to move the child's head through a range of positionsto obtain optimal airway patency and effective rescue breathing. The head should not be movedif neck or spine trauma is suspected; the jaw thrust should be used to open the airway in thesevictims. If rescue breathing fails to produce chest expansion despite repeated attempts at openingthe airway, an FBAO may be present (see "Foreign-Body Airway Obstruction" below).The ideal ventilation rate during CPR and low circulatory flow states is unknown. Currentrecommended ventilation (rescue breathing) rates are derived from normal respiratory rates forage, with some adjustments for the time needed to coordinate rescue breathing with chestcompressions to ensure that ventilation is adequate.354 First Responder EMS Curriculum/AIHA, July 2002