Impacts in the inter-shoulder area
To correctly apply inter-shoulder blades in infants, begin by placing the child on his or her forearm with the child's abdomen facing the forearm. The child must be facing down. Then the force of gravity helped us remove the foreign body. A sitting or kneeling rescuer should be able to safely support a child on his knee. ︎ Belaying of the infant's head is important. Place the thumb of one hand on the corner of the jaw on one side, and one or two fingers of the same hand on the corner of the jaw on the other side. Another commonly used method is to support a child's head with the second and third fingers of one hand by supporting the zygomatic bones. The zygomatic bones are the two bones that are palpable on both sides of the nose. ︎Remember that you must not apply pressure to the soft tissues under the jaw, as this may increase the obstruction of the airways. ︎ Then make up to five strong bangs with your second hand's wrist on your back to the inter-shoulder area. For children over 1 year of age, inter-shoulder blows are more effective if the child is head down. ︎ A small child (like an infant) can be placed across the thighs of the rescuer. This is not always possible due to the child's size, but keep the child tilted forward and strike backwards between the shoulder blades. If the impacts between the shoulder blades have not led to the removal of the foreign body, and the child is still conscious, give the infant chest compressions, and larger children epigastric compressions. Remember to never compress the epigastric region (commonly known as the Heimlich Maneuver) in infants and young children, as this may lead to rupture of very delicate abdominal wall or diaphragm damage as the abdominal cavity is forced inside the chest.
Assessment of cough effectiveness to implement appropriate procedures
Our behavior in the event that a child chokes will largely depend on the extent to which the child's airway is blocked and whether his defense mechanism in the form of coughing is effective. The important features of coughing that will allow you to assess it correctly are discussed below. The first feature we try to observe when helping a child who is choking is the ability to make sounds. In the case of effective cough, the child will cry loudly or in the event of blockage of the smaller caliber bronchus, it may even respond verbally to our commands. If a child is unable to make a sound, it should suggest to us that airway obstruction is serious. Another symptom that is easy to assess is the intensity of the acoustic sensations associated with the extraction of air during coughing. It's about its volume. In the case of ineffective cough, the increasing pressure cannot overcome the resistance of the foreign body in the respiratory tract. Therefore, a small amount of air may escape from these airways. We observe this as a voiceless shallow cough. Another thing that allows us to assess the degree of airway obstruction is the possibility of a choked child drawing in air. In the event of blockage of the smaller caliber bronchus, air may enter some lung lobes, maintaining gas exchange at an appropriate level. In this case, a series of coughs that recur most likely after some time will allow the foreign body to be removed from the respiratory tract. If not, the doctor may need to have the foreign body outpatiently removed. However, in both of these situations there is no immediate threat to the child's life. However, if a child is not able to draw in air, it is information that over time, hypoxia of the body will progress, leading directly to death in the mechanism of suffocation. With the increase in hypoxia of the child's body, his central nervous system will manifest it by symptoms of the hypoxic brain cortex. Hypoxia of the bark will be observed by you (as a lifeguard) through a child's consciousness disorder. It is advisable to constantly observe it and try to maintain contact with the choked child. In addition, cyanosis will progress with hypoxia, which may be observed by the blue-purple coloration of the distal limbs first, followed by the earlobe, oral mucosa and tongue.
As you already know how to correctly assess the effectiveness of coughing in a choked child, you can correctly assess what procedures you should implement by providing further first aid. When a choked child coughs effectively, the proceedings should be carried out in accordance with the principle of harmlessness. This means that if your child is breathing and coughing, even with difficulty, encourage them to make these spontaneous efforts. In such circumstances, do not intervene, as this may lead to foreign body displacement or exacerbation of problems, e.g. complete airway obstruction. No additional action is needed if the child coughs effectively. Encourage them to cough and constantly monitor your child's condition. Remember that even if the injured child coughs effectively and is in good general condition, the condition may change. Therefore, if the cough is or becomes ineffective, immediately call for help and assess the child's state of consciousness! If the child is still conscious but not coughing or coughing is ineffective, proceed with procedures related to physically assisting the child with the resurrection of a foreign body.We are talking here about the impacts between the shoulder blades. ︎ If blows to the inter-shoulder area are ineffective, chest compressions in infants or epigastric compression in children may be performed. These treatments cause a sudden increase in chest pressure, which can be compared to "artificial coughing". This is to pneumatically remove the foreign body from the respiratory tract, which is a mechanism identical to coughing.
Epigastric or chest compressions
Subject of chest compressions in infants. The infant should be turned on its back. Place the child on the inner surface of the forearm. The head should be directed downwards, thanks to which we use the additional force of gravity to displace a foreign body that is in the airways. We will safely carry out this activity if we put the child on a free forearm and embrace his occiput for the purpose of its protection. Support the child on the forearm leaning down or across your thigh. Determine the place of pressure in the same way as it did during cardiopulmonary resuscitation (lower half of the sternum about one finger wide above the xiphoid process).
Perform 5 chest compressions (similar to cardiopulmonary resuscitation), but this time these compressions should be more rapid and performed at a much lower frequency. This situation is not about pumping blood from the heart into the vessels, but about rapid changes in pressure that prevail in the chest. Now a few words about compressing the chest in a large child. ︎ Depending on the size of the child, stand or kneel behind the child, embrace his torso, place your arms under the child's arms. Place the clenched fist between the navel and the xiphoid process. Remember that the longest axis of the clenched fist should be perpendicular to the axis of the victim's body. Grasp your clenched fist with your other hand and pull your hands firmly towards you and up. This is a classic Heimlich maneuver, whose strength should be adapted to the child's body build. This maneuver should be repeated up to 5 times. ︎ Make sure you do not squeeze the xiphoid process or the lower ribs, as this can lead to unnecessary injuries and significantly reduce the effectiveness of the maneuver itself. After chest or epigastric compressions, we need to re-assess the child's condition. If the object has not been removed and the child is still conscious, perform a sequence of strokes between the scapulae and chest compressions (in infants) or epigastric compressions (in larger children). Then call or send someone for help if they still haven't received it. Remember that you should not leave your child alone at this stage of action! If the item has been removed, assess the child's condition. Foreign matter fragments can remain in the respiratory tract and cause life-threatening complications. If in doubt, consult a doctor. Even properly applied epigastric compressions can cause serious internal injury. Every injured person treated in this way should be examined by a doctor. Remember, however, that the risk of injury is not a reason to stop using the Heimlich maneuver when choking on adults or older children!
What to do if you are unsuccessful
If the child is unconscious, loses consciousness with airway obstruction caused by a foreign body or our previous actions did not remove the foreign body from the respiratory tract and as a result of hypoxia there was a sudden cardiac arrest, put them on a hard, flat surface. When it comes to babies or toddlers, it is advisable to place a soft object under the shoulder blades, e.g. a towel. The next step is to make a phone call or send someone for help if they still haven't arrived. The next steps in this situation are:
Open the child's mouth and look for visible foreign matter. If you see any, make a one-time attempt to remove by snapping your finger. Do not remove anything blindly or repeat the attempt to pull out, as this may push the foreign body deeper into the throat and cause injury.
At first, open the airway. Tilt your head back and extend your lower jaw, then attempt 5 rescue breaths. It is important to assess the effectiveness of each breath. If it does not cause the chest to rise, change the position of the head before making the next attempt.
Chest compressions and CPR
Make 5 attempts to rescue breaths. If they do not cause any reaction (coughing, movement, spontaneous breathing), go to chest compressions without first assessing your circulation. ︎ Follow the cardiopulmonary resuscitation algorithm for one rescuer for about a minute or 5 cycles of 15 compressions and 2 rescue breaths before you call an ambulance (if no one has done it before).
Clearing the airway for further rescue breaths, check the mouth for any foreign matter. ︎ If a foreign body is seen, try to remove it. The attempt is to grab a finger once. ︎ If the cause of the obstruction appears to have been resolved, clear the airway and assess if the child is breathing properly. If the child is still not breathing, give rescue breaths. If the child begins to regain consciousness and performs spontaneous, effective breaths, place them in a safe position, observe breathing and state of consciousness until the arrival of emergency services.
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