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So let's take a closer look at the anatomical landmarks of a baby. Now, a baby is normally categorized as any child that’s under one year of age, but there's some important things to think about when we're talking about babies. This is a nice, healthy baby. You can tell because her lips are nice and pink. Her mucous membrane is nice and pink. Her nail beds are nice and pink, she's moving around, and she doesn't seem to be in distress whatsoever. A baby who might be in distress, especially respiratory-wise, would maybe have some circumoral cyanosis-blue around the lips and around the mucous membrane. Her nail beds might also be blue. Don't confuse that with a cold hand on the baby because that can turn blue as well, pretty easily. But I really want to pay special attention to the anatomical landmarks that are going to be really important to identify when we’re actually treating a baby with CPR or with chest compressions for a choking baby unconscious. So let's take a little closer look at some of those important landmarks that we talked about. As we open up the onesie we can see the mid-nipple line. It's important for us to note that we need to put our two thumbs on the center of the chest right on the sternum, just barely below that mid-nipple line. That's when we're gonna do that one-third of the depth of the full chest for our compressions at a rate of 100 to 120 times per minute. You can also see now that I have that open, this brachial artery location is right here, right between the bicep and tricep against their little humerus bone, because they really don't have much of a neck to find a carotid artery, so we have to actually use the brachial artery for that location. Another thing to keep in mind is that they've got such a big head compared to the rest of their body, that it tends to put their chin down on their chest. So we're gonna want to just get something a little bit underneath their shoulder blades- is a nice shortcut that still firm and won't let them sink into the mattress when we’re doing compressions, but that helps to hold their head in that sniffing position. We're also going to take note that this baby's airway is literally only the size approximately of their little pinky. That's a pretty small airway, and so, as opposed to a child and an adult, where we do a head tilt, chin lift to open the airway, a strong head tilt, chin lift, or a chin to the chest sometimes is enough to actually occlude the airway and make it difficult for a baby to breathe. So that's why we put them into a slightly sniffing position, not a full head tilt, chin lift. Now you can see too that the size of their fists is pretty small, that's approximately the size of their heart. And it's located right under the sternum in the center of their chest. These are all important anatomical landmarks as we move into the actual training segments of how to give effective CPR and chest compressions for the unconscious choking patient.
Since the anatomical proportions of a baby are significantly different than that of children and adults, this section will focus on those differences as they relate to performing CPR on an infant.
An infant is considered any child under the age of one. When assessing and treating an infant who is in cardiac or respiratory distress, there are a few things to first consider.
First, let's look at the signs of a healthy baby. The lips are nice and pink, as is the mucous membrane. The nail beds are also pink. The baby is moving around and appears to be physically fine and healthy.
A baby in respiratory distress would likely be agitated or if it becomes even worse - lethargic and have some signs of circumoral cyanosis – blue around the lips – as well as the mucous membrane. The nailbeds might also appear blue.
Pro Tip #1: Don't confuse cold hands with signs of respiratory distress. When an infant's hands are cold, they might also appear bluish.
As you open an infant's clothing to expose the chest, you'll want to find the nipple line. Put two thumbs on the center of the infant's chest, directly on the sternum, and slightly below the nipple line. Your fingers will reach around to the baby’s back.
The depth of compression for infants is about 1½ inches (or 1/3 the anterior-posterior diameter of the chest). However, the rate of compressions is the same as adults and children – 100-120 compressions per minute.
Since infants don't have much of a neck, finding the carotid artery can be difficult, which is why we have to use the brachial artery instead.
To find the brachial artery, remove the infant's clothing enough to expose one arm. The brachial artery is located on the inside of the arm between the bicep and tricep against the humerus bone. Place your two fingers on the artery to check for a pulse, just as you would for other victims.
Pro Tip #2: The reason we don't use our thumbs to check for a pulse is that a thumb has its own detectable pulse, which could easily give a false reading.
There's another thing to keep in mind. Babys have large heads that are disproportionate to the rest of their bodies. Combined with a lack of a neck, this results in a chin that rests on the chest.
Before performing compressions, place something firm under the infant's shoulder blades to lift the neck and help tilt the head into a neutral or slightly sniffing position. It's important that this be a firm enough object so the infant doesn't sink down and the head is held in the correct position as you perform compressions.
Warning: An infant's airway is only about the size of one of their pinky fingers, which makes the airway much tighter than children and adults. If using the standard head tilt, chin lift, this could actually occlude the airway, making it much more difficult for the baby to breathe. This can also happen when an infant's chin is resting on their chest.
When performing compressions, the infant's head and neck should be in a slightly sniffing position. In other words, just a slight upturn of the nose; very close to neutral. (Imagine walking into a room and smelling a fresh apple pie and how your head rises ever so slightly as you sniff.)
There is one variation that can be used when doing compressions on a baby, which is using the heel of one hand in the center of the chest.
The size of an infant's heart is approximately the size of one of their fists. It's located right under the sternum in the center of their chest. Because of its small size, finding the right compression point is critical.
When assessing the level of consciousness in a baby, tap them on the bottom of the feet rather than the shoulder, as part of your shout-tap-shout sequence.
Also, rather than use AVPU (Alert, Verbal, Pain, Unresponsive) to measure and record a patient's level of consciousness, when treating an infant, it's more accurate to use the pediatric assessment triangle:
As recognizing an unresponsive infant is your first priority to providing treatment, the assessment triangle should provide you with a better reading of the infant's condition.