This lesson focuses on how to perform rescue breathing on an unconscious child for the healthcare provider. As you'll soon see, there's one important distinction compared with rescue breathing for adults.
As you learned in the last lesson, what you find during your patient assessment will determine whether you'll perform full CPR or only rescue breathing. During your assessment, use your eyes and ears – is the chest rising and falling? Is the patient making any sounds that may indicate normal breathing? Is the patient showing signs of oxygen deprivation, like blue around the lips?
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive.
Are you OK? Can you hear me?
Pro Tip #1: There are two different sizes of rescue masks with one-way valves. There's an adult/child size and an infant size. You should always carry both, but if you don't and the mask you do have is too big, try turning it upside down. What you're aiming for is a good seal over both the nose and mouth.
If you don't get an initial response, place your hand on the child's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps.
- Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc.
- Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse.
- Look one more time for signs the patient is breathing normally.
- If you've determined at this point that the child is unresponsive, not breathing normally but does have a pulse, continue immediately with rescue breathing.
Pro Tip #2: So, you know that agonal respiration isn't normal breathing. But do you know what it looks like? Have you ever seen a fish out of water gasping for air? It's similar to that. However, the important thing to remember is that while it really does look like breathing, it really isn't.
Rescue Breathing Technique for Children
- Grab an appropriately-sized rescue mask and seal it over the child's face and nose.
- Lift the victim's chin and tilt his or her head back slightly – just past perpendicular.
- Breathe into the rescue mask and count out loud – one one-thousand, two one-thousand …
- On three one-thousand, breathe into the rescue mask again.
- Continue using the rescue breathing technique until help arrives or the patient revives. If you have an AED, consider preparing it for use just in case the patient loses his or her pulse.
Pro Tip #3: The sequence has changed. With children, you're going to perform one rescue breath every three seconds for two minutes. At that time, reassess the patient. If you still detect a pulse but the patient isn't breathing normally, continue with one rescue breath every three seconds for two more minutes. And so on.
Remember to make sure the patient's chest rises as you perform your rescue breaths. If it doesn't, this could indicate an airway obstruction.
Remember, if at any point you discover that the patient's pulse is gone, go immediately into full CPR and use an AED if you have one available.
A Word About Respiratory Emergencies
Identifying a respiratory emergency quickly and providing high-quality care is essential, as we humans cannot survive long without oxygen.
The human brain is quick to be impacted by oxygen deprivation. After 4-6 minutes, brain damage is possible. Between 6-10 minutes, brain damage is likely. And after 10 minutes, it's all but certain.
Reasons for breathing difficulties are numerous and include:
- An obstruction
- Low oxygen environment
- The presence of poisonous gases
- Infection
- Trauma
- Poor circulation
- Other health issues
There are two types of respiratory emergencies – respiratory distress and respiratory arrest. During respiratory distress, breathing is difficult, labored, and/or restricted in some way. During respiratory arrest, breathing stops entirely.
Respiratory distress is often a sign of more serious health conditions and should be taken seriously. As for the causes of respiratory distress, they include:
- A partially obstructed airway
- Illness
- Chronic conditions such as asthma
- Electrocution, including lightning strikes
- Heart attack
- Injury to the head, chest, lungs, or abdomen
- Allergic reactions
- Drugs
- Poisoning
- Emotional distress
When assessing a patient for respiratory distress, listen, watch, and ask.
Does their breathing look and sound labored? And how does the patient feel? Ask them to see if the optics are as bad as their symptoms. And as for the signs and symptoms of respiratory distress, they include:
- Slow or rapid breathing
- Unusually deep or shallow breathing
- Gasping for breath
- Wheezing, gurgling, or high-pitched noises
- Unusually moist or cool skin
- Flushed, pale, ashen, or bluish skin color
- Shortness of breath
- Dizziness or light-headedness
- Pain in the chest or tingling in the hands, feet, or lips
- Apprehensive or fearful feelings