How do you deliver rescue breaths to a child that is not breathing but has a pulse?

In this section you will learn the emergency action steps to follow to safely assess and care for a victim or patient.

First, assess the scene for safety. If the scene is not safe or at any time becomes unsafe, GET OUT! You will be of no use to that person or anyone else if you become a victim too. If you cannot safely care for the victim…CALL 9-1-1.

If the scene is safe, assess the patient. Quickly observe the victim. Is he/she lying still or moving around. Is the skin color normal or is it bluish or ashen, especially around the lips. Kneel down by the patient and tap or squeeze, not shake, the patient's shoulder and ask, "Are you ok?" In an infant, you may tap the foot. If the patient responds but is badly hurt, or appears to be very ill, call 9-1-1.

If you are alone and the patient does not respond to your tap and shout, you must act quickly. If the patient is an adult, which is anyone from the approximate age of puberty on up, you must first call 9-1-1, then check for breathing and pulse and if neither is present, begin CPR. If the patient is a child, which is anyone from the approximate age of one year to puberty, or if the patient is an infant, birth to one year and breathing and pulse are absent, you must first give 5 cycles of CPR, (about two minutes), before making your call to 9-1-1. Children and infants are much more likely to respond to early CPR so it is very important to follow these guidelines.
When two or more rescuers are present, procedures should occur simultaneously. One or more rescuers remain with the patient and begin the steps of CPR, while another is alerting EMS, and if possible gets an AED and/or oxygen.

Beginning CPR
The first step in beginning CPR is to look for no breathing or no normal breathing (such as gasping). FOR ADULTS AND CHILDREN: If breathing is absent, palpate for a carotid pulse in the neck for no more than 10 seconds. If there is no sign of breathing or pulse, begin CPR starting with compressions. FOR INFANTS: If breathing is absent, palpate for a pulse, using the brachial artery located in the upper inside aspect of the infant's arm. If there is no sign of breathing or pulse, begin CPR starting with compressions. If the patient definitely has a pulse but is not breathing adequately, provide ventilations without compressions. This is also called "rescue breathing." Adults: give 1 breath every 5 to 6 seconds. Children/Infants: give 1 breath every 3 to 5 seconds. Reassess the pulse every 2 minutes.

External Chest Compressions
Chest Compression Techniques (adults and children) Single Rescuer
To make blood flow to the heart and brain effective, the patient must be face up and lying on a firm surface. It is best to remove clothing from the chest area. Place the heel of one hand in the center of the chest on the lower half of the breastbone. Place the other hand on top of the first. Fingers should be interlaced and should be kept off the chest. Position your body so your shoulders are directly over your hands. Straighten your arms and lock your elbows. Use your upper body weight to help compress the chest. Push straight down on the chest at least 2 deep inches for a normal sized adult. Use either one or two hands to compress the child's chest about 1/3 the diameter of the chest or about 2 inches in depth. Give 30 compressions at a speed of at least 100 per minute. After 30 compressions, open the patient's airway by tilting the head and lifting the chin then give 2 rescue breaths. Use the jaw thrust for a suspected neck injury. Quickly resume chest compressions. To help create the best blood flow possible, you must "Push Hard, Push Fast" and minimize interruptions between compressions and rescue breathing.

When adult compressions are given properly, you may hear popping and cracking sounds. This is caused by cartilage or ribs cracking and occurs frequently during adult CPR. In infants and toddlers, CPR may not cause such injuries. However, as unpleasant as this may seem, it is important to remember that a person in cardiac arrest is dead. You cannot make them any worse.

Chest Compression Technique (Infants)
Compress the breastbone with 2 fingertips placed just below the nipple line. Press down on the breastbone about 1/3 the diameter of the infant's chest or about 1 ½ inches in depth. Give 30 compressions at a speed of at least 100 per minute. After 30 compressions, open the infant's airway and give 2 rescue breaths. Quickly resume chest compressions. When more than one rescuer is present, use two thumbs with your fingers encircling the chest and supporting the back for chest compression.

CPR with Two or More Rescuers
When more than one healthcare provider or other professional rescuer is available to perform CPR, one gives chest compressions while the other keeps the airway open and performs rescue breathing. The rescuer compressing the chest should pause briefly to allow the two breaths to be given by the other rescuer. For adults the ratio of compressions to breaths stay the same 30:2, but interruption between compressions and breaths is lessened as there are two rescuers. In children and infants, the ratio of compressions to breaths is 15:2. Rescuers should change positions every couple of minutes to avoid fatigue and maintain effective chest compressions.

Defibrillation

Before attaching an AED, make sure the patient has been moved out of any freestanding water.  Also if the patient’s chest is wet, sweaty or dirty, quickly clean and dry it before attaching the AED.  If the patient has a hairy chest it may interfere with the effectiveness of the AED.  If there is no razor available to shave the chest area, a set of pads may be applied then ripped off quickly to remove hair.  Quickly apply a second set of pads and proceed with attaching the AED.  Remove any medication patches and watch for pacemakers and implantable cardioverter defibrillators.  Place the electrode pad at least 1 inch away from an implantable device.  And remember, oxygen should not be used when shocks are being delivered with an AED.  It is possible for oxygen to ignite if it is too close to an AED that is being used.  Oxygen should be shut off and placed several feet away from the patient.

Three Simple AED Steps

There are many different brands of AEDs, but the same basic steps apply to all of them.  If the patient is unresponsive and not breathing adequately, follow these steps. 

1. Turn on the AED. This activates the voice prompts.  Bare the patient’s chest.
2. Follow the voice and visual prompts.  Remove the disposable electrode pads from the packaging, making sure to choose the correct ones, (adult or child).  Do not use child pads on an adult.  Look at the picture on the electrode that will show where to correctly place the pad.  Remove the adhesive backing and attach electrodes to the patient’s bare chest. Most AEDs wil automatically begin to analyze a patient’s heart rhythm when the electrodes are placed. Some will prompt you to push a button to analyze.  Do not touch or move patient while the AED is analyzing the heart rhythm.
3. Shock/ No Shock.  If a shock is indicated, check to make sure no one is touching the patient.  Loudly say “CLEAR” .  Push the shock button and immediately resume CPR.  If no shock is indicated, immediately resume chest compressions.

Perform 5 cycles of 30 compressions and 2 breaths and then very briefly reassess the rhythm. Continue as directed by the AED.

AEDs may be used for children older than 1 year who have no signs of life.  Always look at the pictures on the pads and place them as shown.  Some AED pads for children may require the rescuer to place one pad on the child’s chest and one on the back.  The rescuer may also be required to insert a key or turn a switch to deliver a lower, child sized amount of electricity.  If a child specific AED is not available, use a standard AED.

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