Unconscious Child Choking

This unconscious child choking lesson is for situations where you find a child 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 child 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 child choking victim. The method of care will closely resemble performing CPR on a child, however there are subtle differences to pay attention to.

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 patient 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.
• Locate the area over the heart to begin chest compressions – between the breasts and on the lower third of the sternum.
• Stand or kneel directly over the patient's chest. Lock your elbows and use only your upper bodyweight to supply the force for the chest compressions, and count as you perform them.

Remember that to maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm.

• Conduct compressions that go about 2 inches deep (or 1/3 the depth of the victim's chest) and at a rate of between 100 and 120 compressions per minute, which amounts to two compressions per second.
• Perform 30 chest compressions.

Remember to allow for full recoil of the chest cavity after performing each chest compression. You want to allow the chest to come all the way back to the neutral position before performing another compression.

• Lift the victim's chin and tilt his or her head back slightly – just past perpendicular.
• Look inside their mouth. See if any obstructions came loose from the chest compressions. If you see something, sweep it out using your finger. If you don't, continue with the following steps.
• 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.
• If the rescue breaths go in this time – causing the chest to rise and fall – check for a 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.
• 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 the Differences Between Child CPR and Adult CPR

There are four distinct differences to be aware of.

Opening the Airway

While the same head tilt maneuver is applied to children as it is for adults, make sure there is less hypertension in a child's neck compared to adults. To do that, simply tilt the head back only slightly past neutral. Your goal is a chin angle that's less pronounced and more perpendicular to the ground.

Performing Compressions

The compressions you perform on a child are very similar to those you would perform on an adult. The only difference is in the compression depth. While adult CPR has a depth of 2-2.4 inches, when administering CPR on a child, two inches will usually be the maximum depth. And in very small children, it's better to perform compressions using just one hand.

Compressions to Ventilations Ratio

If there is only a single responder, continue using the 30 compressions to two ventilations ratio. However, if there are two responders, that ratio changes to 15 compressions to two ventilations.

Using AEDs

AEDs work the same regardless of age. However, the pads themselves, as well as pad placement, will vary based on the size of the child.

If the child weighs more than 55 pounds, continue using the adult AED pads. If the child weighs less than 55 pounds, use pediatric AED pads if available.