NEWBORN RESUSCITATION Zhallene Michelle E. Sanchez,RN

WHAT IS CPR? -CPR stands for Cardiopulmonary Resuscitation – an emergency procedure of pushing on the chest above the heart and breathing into the mouth of a person who is unconscious and not breathing. This technique attempts to restore blood circulation which prevents death or brain damage due to lack of oxygen.

CPR IS EASY TO LEARN You do not need to worry about making mistakes; doing something is better than nothing. It takes a spark to reignite an infant or a child. If you retain only 20% of what you learn and apply that to a child in crises you have an 80% chance of saving their life. It is very rare for diseases to be transmitted by mouth to mouth especially in children because of their limited exposure in life. If you opt not to do mouth to mouth still give compressions, which keeps the blood oxygenated, and circulating.

BEFORE ADMINISTERING INFANT AND CHILD CPR Look, Listen & Feel (Shake & Shout) for Infant and Child Tap or shake the infant or child while saying "Can you hear me? Are you okay?" Look, Listen & Feel for signs of life (pulse/circulation, breathing and or movement) Delegate someone to call 911/EMS or call yourself after providing repeated cycles of 2 breath and 30 compressions for at least 1 minute. Tilt chin back, place your mouth over the infant/child’s mouth and nose creating a seal and provide 2 slow rescue breaths. If there is no response, start chest compressions and repeat this cycle until help arrives. You must use a land line (not a cell phone) when calling 911 for the EMS to be able to trace your location, otherwise you will have to give them your exact address.

HOW TO ADMINISTER CPR ON AN INFANT AND CHILD Infant (under one year old) 1.Tilt head back by lifting the chin gently while pushing down on the forehead with the other hand (if there is no head or neck injury, if so, open airway by lifting the jaw) 2.Draw an imaginary line between the nipples on the breast bone of the infant, take two fingers and place them in the middle of the imaginary line below the sternum of infant. 3.Compress the infant’s chest downward, about 1/3 to 1/2 the depth of the chest downward, 30 times. 4.Seal your lips securely over the infant’s nose and mouth and give two breaths (1 to 1 ½ seconds each) after every 30 chest compressions. Step One: Pushing on the Chest (Compressions for Infant and Child)

HOW TO ADMINISTER CPR ON AN INFANT AND CHILD Step One: Pushing on the Chest (Compressions for Infant and Child) Child (ages 1 to 8 years old) 1.Maintain held tilt with one hand 2.Draw an imaginary line between the nipples on the breast bone of the child, take the palm of the hand and place it in the middle of the imaginary line below the sternum of a child, keep elbow straight and pump with just one arm. 3.Compress the child ’ s chest about 1/3 to 1/2 the depth of the chest downward, 30 times. 4.Give 2 breaths after every 30 compressions. 5.Do not be afraid to press hard because this increases the blood flow to the brain.

HOW TO ADMINISTER CPR ON AN INFANT AND CHILD Step Two: Rescue Breathing (mouth to mouth for infant and child) Infant (under one year old) 1.Place your hand on the forehead of the infant and gently tilt the head back, use your other hand to tilt chin upward. 2.Seal your lips securely over the infant’s nose and mouth and give one breath until the chest rises. 3.When the chest falls begin another breath for a total of 2 breaths. Keep hands away from neck. 4.Check for signs of circulation (including normal breathing, coughing or movement) 5.If the infant is not breathing, give 20 rescue breaths per minute (1 breath every 3 seconds) PLEASE REMEMBER Permanent brain damage or death can occur within minutes if a child ’ s blood flow stops and the brain is deprived of oxygen. You must, therefore, continue these procedures until the child has a pulse and is breathing or trained medical help arrives.

Clinical death- when breathing and circulation stop. 0-4 min. – brain damage not likely 4-6 min. – damage probable Biological death – when the brain has been deprived of oxygenated blood min. – irreversible brain damage probable 10 or more – irreversible brain damage is certain Respiratory Arrest Breathing stops, pulse, and circulation may continue for sometime Cardiac Arrest Circulation stops, the pulse disappears and breathing stops at the same time

Three conditions that describe Cardiac Arrest 1.Cardiovascular Collapse the heart is still beating but its action is too weak that blood is not being circulated through the vascular system to the brain body tissues. Result from hemorrhage or various drugs 2.Ventricular Fibrillation individual fascicles of the heart beat independently rather than the usual coordinated, synchronized manner that produce rhythmic heartbeat. 3.Cardiac Standstill The heart has stopped beating. This condition is terminal and is usually due to lack of oxygen (anoxia) of the heart muscle.

Stages of Life Support: 1.Basic Life Support (BLS) An emergency procedure that consist of recognizing respiratory and cardiac arrest or both and the proper application of CPR to maintain life or until a. Victim recovers or advanced life support is available b. A-B-C steps A-airway opened B- Breathing restored C- Circulation restored c. Use of supplementary techniques 2.Advance Cardiac Life Support (ACLS) a. Definitive therapy - diagnosis - drugs - defibrillation b. Cardiac monitoring stabilization c. Transportation d. Communication 3.Prolonged Life Support (PLS) for post resuscitative and long term resuscitation.

1. SURVEY THE SCENE “ THE SCENE IS SAFE THERE IS ONLY 1 VICTIM” I’M (NAME) A TRAINED FIRST AIDER, MAY I HELP ( WAIT FOR RESPONSE) CHECK FOR RESPONSIVENESS -Gently tap the shoulders - Shout “ Hey Sir or Ma’am, are you okay?” 2x 2. ACTIVATE MEDICAL ASSISTANCE OR TRANSFER FACILITITES “ Help Ma’am or Sir, Please activate Medical Assistance and Report back to me as I assess the victim” or (Call 911/117) 3. PRIMARY SURVEY OF THE VICTIM CHECK FOR AIRWAY: ( IF THERE IS SPINAL CORD INJURY – DO JAW THRUST MANEUVER) ADULT – Maximum head tilt- chin lift position CHILD - neutral plus position INFANT – neutral plus position Note: check for the mouth and nose for any obstruction

3. PRIMARY SURVEY OF THE VICTIM CHECK FOR BREATHING: LOOK LISTEN AND FEEL FOR 5 SECONDS (COUNT 1, 1002, 1003, 1004, 1005) ( IF PATIENT IS BREATHLESS GIVE 2 INITIAL VENTILATIONS) CHECK FOR SIGNS OF CIRCULATION: Locate for the pulse Look Listen and Feel for 10 seconds ( COUNT 1, 1002, 1003, 1004, 1005, 1006, 1007, 1008, 1009, 1010) ADULT- Carotid Pulse CHILD- Carotid Pulse INFANT- Brachial Pulse IF VICTIM HAS NO SIGNS OF CIRCULATION AND NO BREATHING: “ PLEASE FOLLOW UP MEDICAL ASSISTANCE AND REPORT BACK TO ME AS I DO CPR TO THE VICTIM”

ADULT/CHILD/INFANT CPR: 5 CYCLES (30 COMPRESSION, 2 BREATHS) 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20 & 1,2,3,4,5,6,7,8,9 & 1 – 2 BREATHS AFTER GIVING CPR RECHECK THE PULSE AND BREATHING FOR 10 SECONDS. COUNT 1, 1002, 1003, 1004,1005, 1006, 1007, 1008, 1009, ,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20 & 1,2,3,4,5,6,7,8,9 & 2 – 2 BREATHS 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20 & 1,2,3,4,5,6,7,8,9 & 3 – 2 BREATHS 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20 & 1,2,3,4,5,6,7,8,9 & 4 – 2 BREATHS AFTER GIVING CPR RECHECK THE PULSE AND BREATHING FOR 10 SECONDS. COUNT 1, 1002, 1003, 1004,1005, 1006, 1007, 1008, 1009, 1010 AFTER GIVING CPR RECHECK THE PULSE AND BREATHING FOR 10 SECONDS. COUNT 1, 1002, 1003, 1004,1005, 1006, 1007, 1008, 1009, 1010 AFTER GIVING CPR RECHECK THE PULSE AND BREATHING FOR 10 SECONDS. COUNT 1, 1002, 1003, 1004,1005, 1006, 1007, 1008, 1009, 1010 AFTER GIVING CPR RECHECK THE PULSE AND BREATHING FOR 10 SECONDS. COUNT 1, 1002, 1003, 1004,1005, 1006, 1007, 1008, 1009, 1010

IF THE VICTIM NO BREATHING BUT WITH SIGNS OF CIRCULATION: “ PLEASE FOLLOW UP MEDICAL ASSISTANCE AND REPORT BACK TO ME AS I DO RESCUE BREATHING TO THE VICTIM” ADULT: RESCUE BREATHING 24 CYCLES BREATH 1, 1002, 1003, – 1 BREATH 1, 1002, 1003, – 1 BREATH 1, 1002, 1003, – 1 BREATH UP TO 1, 1002, 1003, – 1 BREATH AFTER GIVING RESCUE BREATHING, RECHECK THE PULSE AND BREATHING FOR 10 SECONDS CHILD/INFANT : RESCUE BREATHING 40 CYCLES BREATH 1, 1002, 1003, – 1 BREATH 1, 1002, 1003, – 1 BREATH 1, 1002, 1003, – 1 BREATH UP TO 1, 1002, 1003, – 1 BREATH AFTER GIVING RESCUE BREATHING, RECHECK THE PULSE AND BREATHING FOR 10 SECONDS

4. SECONDARY SURVEY OF THE VICTIM THE VICTIM HAS SIGNS OF CIRCULATION AND BREATHING Place the victim to recovery position and stabilize him/her and care for other injuries as indicated When to STOP CPR: S - T - O - P - SPONTANEOUS BREATHING AND PULSE RESTORE Victim is Turned over to medical services or properly trained and authorized personnel Operator (rescuer) is already exhausted and cannot continue CPR. Physician assumes responsibility (declares death, takes over, etc.

Instructions: 1 Check the infant's airway to be sure it is unobstructed. If the airway is obstructed, clear the obstruction. If the airway is unobstructed, ever-so-slightly tilt the infant's head back to create an open airway. 2 Check for signs of breathing by watching. See if the chest is rising and falling. Sometimes the chest does not appear to be moving, but the infant may still be breathing. Listen at the infant's nose and mouth for breathing sounds. If the infant is not breathing, perform infant CPR using the appropriate techniques. If the infant is breathing independently, go to Step 3. 3 Hold the infant in your arms with your forearms supporting the infant's belly and chest. Support the infant's head and neck. 4 Tilt the infant so that her head is slightly lower than the rest of her body. Make sure you do not block the infant's mouth and nose. 5 Continue to monitor the infant's condition while she is in the recovery position until help arrives. Pay attention for signs of breathing. If at any time the infant ceases breathing, begin performing infant CPR immediately.

1.Position the infant face-down along your forearm. 2. Support the head and neck with your other hand while keeping the mouth and nose clear. 3. Keep the head and neck slightly lower than the chest. Filter 1 answers by contributor: 1. American Red CrossAmerican Red Cross Answered: 1.Position the infant face-down along your forearm. 2.Support the head and neck with your other hand while keeping the mouth and nose clear. 3.Keep the head and neck slightly lower than the chest.