First Responder EMS Curriculum for Training Centers in Eurasia

ventilation after every fifth compression. The actual number of compressions delivered perminute will vary from rescuer to rescuer and will be influenced by the compression rate andthe speed with which the second rescuer can position the head, open the airway, and deliverventilation.5. After 5 compressions, pause briefly for the second rescuer to open the airway with a head tiltchinlift (or, if trauma is suspected, with a jaw thrust) and give 1 effective breath (the chestshould rise with the breath). Compressions and ventilations should be coordinated to avoidsimultaneous delivery and ensure adequate ventilation and chest expansion, especially whenthe airway is unprotected.Continue compressions and breaths in a ratio of 5:1 (for 1 or 2 rescuers). Note that this differsfrom the recommended ratio of 3:1 (compressions to ventilations) for the newly born orpremature infant in the neonatal ICU (see "Part 11: Neonatal Resuscitation"). This difference isbased on ease of teaching and skills retention for specific trained providers in the delivery roomsetting, with increased emphasis on effective and frequent ventilation needed for resuscitation ofthe newly born.The 2 thumb-encircling hands technique may generate higher peak systolic and coronaryperfusion pressure than the 2-finger technique, and healthcare providers prefer this technique tothe alternative. For this reason the 2 thumb-encircling hands chest compression technique is thepreferred technique for 2 healthcare providers to use in newly born infants and infants ofappropriate size (Class IIb). This technique is not taught to the lay rescuer and is not practical forthe healthcare provider working alone, who must alternate compression and ventilation.Chest Compression Technique in the Child (Approximately 1 to 8 Years of Age):Figure 36. One-hand chest compressiontechnique in child.1. Place the heel of one hand over the lower half of the sternum, ensuring that you do notcompress on or near the xiphoid process. Lift your fingers to avoid pressing on the child'sribs.2. Position yourself vertically above the victim's chest and, with your arm straight, depress thesternum approximately one third to one half the depth of the child's chest. This corresponds toa compression depth of approximately 1 to 1 1/2 inches, but these measurements are notprecise. After the compression, release the pressure on the sternum, allowing it to return tonormal position, but do not remove your hand from the surface of the chest.3. Compress the sternum at a rate of approximately 100 times per minute (this corresponds to arate that is slightly less than 2 compressions per second during the groups of 5 compressions).The compression rate refers to the speed of compressions, not the actual number ofcompressions delivered per minute. Note that this compression rate will actually result inprovision of < 100 compressions per minute because you will pause to provide 1 ventilationafter every fifth compression. The actual number of compressions delivered per minute will366 First Responder EMS Curriculum/AIHA, July 2002