If your infant becomes unconscious, start from the beginning. Open the airway with the head tilt chin lift method then inspect the mouth for the obstruction. If you see the obstruction, then carefully remove it with your fingers. DO NOT PERFORM BLIND FINGER SWEEPS! Since the airway is so narrow, moving your finger around in the infant’s mouth could cause the obstruction to be pushed further down in the airway. If you see nothing or have removed the obstruction, then attempt to ventilate. Ventilate the infant with an infant bag valve mask (ensure you have the right mask and bag for the infant) connected to oxygen running at 10-15 LPM. Ensure you have a tight mask seal and attempt to ventilate. If the breath does not go in, re-position the head and attempt to ventilate once more. If no ventilations make it through, begin the sequence of 30 chest compressions, visualize the airway, and attempting to ventilate. If advanced life supports have not arrived yet, ensure you request them at the scene as soon as possible. A properly equipped paramedic should be able to perform a direct laryngoscopy and attempt to remove the object with a pair of Magill forceps. If all of the above measures have failed, the paramedic may need to perform a needle cricothyroidectomy. Once the airway is clear, determine if there is a pulse by checking for a brachial pulse. If no pulse is present, being CPR, otherwise continue ventilations until the infant spontaneously resumes breathing.
Positive pressure ventilation is performed when the infant is apneic or has insufficient ventilations. This can be seen by a low respiratory rate and/or a falling heart rate. Infants who require positive pressure ventilation will appear limp, unresponsive, or unconscious. You will open the airway with the head tilt or jaw thrust method. Ensure you have a good mask seal and squeeze the bag valve mask attached to oxygen (10 – 15 LPM, basically enough to keep the reservoir bag inflated). Assess the airway by attempting to ventilate, assuming the first breath goes in, deliver a second breath. Deliver enough air to cause the chest to rise (everybody is a little different butt infants require somewhere in the neighborhood of 15 cc of air for chest rise). Ventilate the infant at a rate 12 -20 breaths per minute (and not any faster) or once every three to five seconds. As action oriented people, we tend to hyperventilate everybody we can. Hyperventilation can cause severe arterial blood gas derangements that may take days or weeks to correct in an ICU (assuming there is no permanent damage). The best way to ensure that you are breathing at the appropriate rate is to utilize an end tidal CO2 monitor. Regardless of whether you are utilizing an endotracheal tube or a bag valve mask to deliver your ventilations, the 2 way aperture can fit on top of the endotracheal tube or between the mask and the bag fitting. Attach the probe to the capnometer and check out the reading. You want the capnometer to give you a value between 35 and 45. If the capnometer reads above 45, you need to ventilate a little faster (too much CO2) and if the capnometer reads below 35 (too little CO2), then you need to ventilate slower |