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  1. Unconscious Infant Choking

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Show full transcript for Unconscious Infant Choking video

This unconscious infant choking lesson is for situations where you find an infant who is unconscious, and you suspect they became unresponsive due to an airway obstruction.

Ideally, either you or a bystander witnessed the victim choking before they went unconscious. Through further assessment, you find that the infant has a pulse but isn't breathing normally. Any attempts to deliver a rescue breath have failed, most likely due to an obstruction.

In this scenario, you would treat this patient as an unconscious infant choking victim. The method of care will closely resemble performing CPR on an infant, however there are subtle differences to pay attention to.

When performing rescue breaths on an infant who has a pulse but isn't breathing normally, perform one rescue breath every three seconds for two minutes, just as you would for a child.

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.

  • Assess the infant to make sure he or she is not breathing normally and is unconscious.
  • 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. Then go right into chest compressions.
  • Draw an imaginary line across the infant's nipples and place two fingers on the lower part of the sternum in the center of the infant's chest. Your fingers should be perpendicular to the chest, meaning your knuckles are directly above your fingers during compressions.
  • Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, use only your fingers to supply the force for the chest compressions, and count as you perform them.
  • Conduct compressions that go to a depth of 1/3 of the infant's chest cavity, which should be around 1.5 inches deep, and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
  • Perform 30 chest compressions.
  • Grab the rescue mask and seal it over the victim's face and nose.

Pro Tip #1: It's important to have a properly sized rescue mask. In other words, one that fits the size of the victim's face. If you have an infant mask, use that. If you don't, there are some tricks to fitting an adult mask onto an infant, such as turning the mask upside down.

  • If you can, place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position.
  • Breathe into the rescue mask and wait for the chest to rise and fall. If the chest doesn't rise, reposition the head and chin and try again. If the second breath also doesn't result in a chest rise, go right back into your 30 chest compressions.
  • Look in their mouth again after the 30 chest compressions. If you see an object, sweep it out and try two more rescue breaths.

Pro Tip #2: Because infants' mouths are small, it's best to use your pinky finger combined with a hooking motion to sweep out obstructions.

  • If the rescue breaths go in this time – causing the chest to rise and fall – check for a pulse using the brachial artery, located on the inside of the arm between the bicep and tricep against the humerus bone. Use the flat parts of your index and middle fingers and press on that artery. Spend no more than 10 seconds looking for a pulse.

Pro Tip #3: For infants/neonates with a pulse rate lower than 60 beats per minute, you are instructed to override with chest compressions in CPR. But if you're only allowing 10 seconds to check a pulse, how do you know the rate per minute? Multiply the 10-second rate by six, and this will give you the number of beats per minute.

  • If you detect a pulse but there are still no signs of normal breathing, continue to perform one rescue breath every three seconds for two minutes.
  • After two minutes, reassess for a pulse and check again for normal breathing.
  • If you still detect a pulse and the patient still isn't breathing normally, continue with one rescue breath every three seconds for two minutes. If you do not detect a pulse, go into full CPR – 30 chest compressions followed by two rescue breaths.
  • Continue until help arrives, an AED arrives, or the victim is responding positively and breathing normally.

A Word About Vital Signs (By Age)

Assessing a patient's vital signs is a crucial first step in providing care. Therefore, it's important to know what range is normal when it comes to pulse rates and respirations.

For Adults (12 years and older)

Pulse rate – 60 to 100 beats per minute
Respirations – 12 to 20 breaths per minute

For Children (1 year to 12 years old)

Pulse rate – 80 to 100 beats per minute
Respirations – 15 to 30 breaths per minute

For Infants (1 month to 12 months old)

Pulse rate – 100 to 140 beats per minute
Respirations – 25 to 50 breaths per minute

For Neonates (full term to 30 days)

Pulse rate – 120 to 160 beats per minute
Respirations – 40 to 60 breaths per minute

Pro Tip #4: Infants/neonates in distress – not breathing normally – will likely be tachycardic. It's not unusual for them to range between 120-180 beats per minute on the high end, depending on their exact age. It's also not abnormal to feel a fast, slightly thready (or thin) pulse that's becoming weaker.