Infants Part I (1 Hour)

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One topic that people really struggle with is foreign airway obstruction.  It goes without saying that unless you have an airway, you don’t have a patient (any patient).   Multiply the airway philosophy times 100 for the infant.  Generally speaking, the infant has a fairly simple medical history (like no medical history) so by utilizing simple modalities; you can literally make the difference between life and death.  It’s easy to miss a foreign body airway obstruction, therefore it’s important to know what you are looking for.   Let’s say you respond to the scene of a patient with difficulty breathing, assess the patient from the room and discover the child is demonstrating increased work of breathing.  Move in closer and look for the following clues:

• Stridor
• Signs of hypoxia such as cyanosis or poor muscle tone
• Distress
• Ineffective coughing
• History of sudden onset difficulty breathing
• History of recent meal
• Missing toy

Before we go any further, let’s take a moment to make something perfectly clear.  If the infant appears to be successfully coughing the obstruction out, then by all means don’t get in the way.  Just let the infant do his/her job, encourage the infant to continue doing so, and keep an eye on the infant in case things take a turn for the worse.  If the infant continues to cough for an extended period of time, consider transporting the patient while continuing these supportive measures.  If the infant removes the obstruction on his/her own, go ahead and transport anyway so the patient can be evaluated for any laryngeal trauma.  Now that that is covered, let’s move on.
If the infant is conscious and showing the signs of distress listed above, perform five back blows and five chest thrusts.  The back blows are performed by supporting the weight of the baby in your non-dominant hand (supporting the head in a neutral position and keeping the head at an elevation less than the body) then administering five firm and distinct blows with the heel of your dominant hand.  If this measure is unsuccessful, place your free hand on the back of the baby’s head with your forearm over the infant’s back and carefully turn the infant over so the infant is facing up with the weight of the infant resting on your forearm.  Next, administer chest compressions by placing two fingers in the middle of the intramammary line to a depth of 1/3 – ½ the diameter of the depth of the chest.  If this measure is unsuccessful and the airway is not relieved, then turn the infant over and perform more back blows.  If the infant becomes limp or stops crying or choking, then assume the patient is unconscious.