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Now in this segment, we're gonna be covering infant two rescuer health care provider CPR. And I should talk about some of the different nuances when you add a second trained rescuer to infant CPR. Number one, you have somebody else equally trained that can share the responsibility. Is that true? But the difference between an adult versus an infant is that we are going to change the technique we use to do the compressions if we can. Now, though we are going to be doing circumferential compressions with our thumbs, that does not mean that if you have thumb problems, arthritis, or loss of thumb, that you can't revert back to using the fingers. That's allowable as well. But the difference here is that you have somebody who's gonna be able to do the rescue breaths while you concentrate on the compressions. Now, another difference is that we go from two breaths and 30 compressions down to two breaths and 15 compressions when we have a second rescuer helping us. The rest of the scenario works pretty much the same. If we begin to fatigue and we're unable to continue the compressions, we can call out the switch, change positions, and switch roles as rescuers. But everything else kinda remains that same, so here we go. Our scene is safe, our gloves are on, we have a bag valve mask to do respirations. We're gonna call out to the baby, "hey, baby, are you okay?" Stimulate with tapping to the feet or rubbing the chest. Are you alright? There's no response. You in the plaid shirt, go call 911 and come back. And when you come back, bring an AED if you can find one or call a code. Now that that's done, we're going to assess for normal breathing and we're gonna check for a brachial pulse. We check the brachial pulse for no more than 10 seconds. If the pulse rate is below 60 beats per minute, I'm gonna begin CPR. If the pulse rate is above 60, we're gonna do rescue breathing. But in this case, there is no pulse, no regular breathing, so here we go. We're going right in to chest compressions, finding the nipple line and dropping my two fingers down if I can't use my thumbs. Or I'm gonna come around and actually use my thumbs and wrap my fingers around the chest of the baby. One and two and three and four and five and six and seven and eight, nine and ten, 11, 12, 13, 14, 15. - Breath. Breath. - Both breaths went in so I continue my compressions. Five and six and seven and eight and nine and ten and 11 and 12 and 13 and 14 and 15. - Breath. Breath. - Continue with this cycle. If I start to fatigue, and I will fatigue, I'm gonna say, "Jordan we gotta change after this set." Change, two and three and four and six and seven and eight and nine and ten and 11 and 12 and 13 and 14 and 15. He delivers two more rescue breaths. - Breath. - And then we switch. - One and two and three and four and five and six and seven and eight and nine and ten and 11 and 12 and 13 and 14 and 15. - Baby breath. And another baby breath. - One and two and three and four and five and six and seven and eight... - So we're gonna continue this compression to rescue breath sequence with changes ever so often as we fatigue. Probably every two minutes max so that we're able to stay as strong as we can to do consistent compressions and we're gonna do this until EMS or help arrives and AED arrives or the baby revives.
In this section, we're going to cover two-responder infant CPR for the healthcare professional using a bag valve mask. (If you don't have a bag valve mask, a simple mask with a one-way valve will suffice.)
Also, it's important to have the right size mask. But if you don't have an infant size mask, proceed using an adult size.
Pro Tip #1: There is one variation that can be used when doing compressions on an infant or baby when a second responder is present, which is known as circumferential compressions. To perform circumferential compressions, wrap your fingers around the sides of the infant's chest, placing both thumbs over the compression point just below the nipple line. One of your thumbnails should be resting on the top of the other.
If for some reason you're not able to perform circumferential compressions, then revert back to the normal compression procedure for infants – using your fingers at an angle perpendicular to the chest, meaning your knuckles are directly above your fingers during compressions. Remember that little force will be required when performing compressions on an infant.
Pro Tip #2: The rate of compressions to rescue breaths during infant CPR is the same as with children – 15 compressions for every two rescue breaths.
After making sure the scene is safe, that your gloves are on, and that you have your rescue mask with a one-way valve (or bag valve mask when there are two responders), begin calling out to the victim to assess whether or not the infant is responsive.
Are you OK? Can you hear me? (With infants, shouting their name, if you know it, may help.)
If you don't get an initial response, place your hand on the infant's forehead and tap on the bottom of his or her feet. If you still do not get a response, proceed with the following steps.
Responder one:
1. Draw an imaginary line across the infant's nipples and place your thumbs on top of one another on the lower part of the center of the sternum to perform circumferential compressions.2. Stand or kneel directly over the patient's chest. As less pressure is needed when performing CPR on infants, use only your thumbs to supply the force for the chest compressions, and count as you perform them.3. 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.4. Perform 15 chest compressions.
Responder two:
5. Grab the bag valve rescue mask and seal it over the infant's face and nose.6. If available, place something firm under the infant's shoulders to lengthen the neck a little and create a neutral or slightly sniffing head position.7. When using the bag valve mask, remember not to push down on the mask, but rather, lift the mandible up into the mask – using the CE form to seal the mask – and incorporate the proper head-tilt, chin lift as you do. Also, remember that with infants, the head-tilt, chin lift is neutral or slightly sniffing.8. Compress the bag on the bag valve mask and wait for the chest to rise and fall before administering the next breath.
9. Go right back into your 15 chest compressions.
10. Go right back to delivering two rescue breaths.
Once you reach the two-minute mark, the responder performing chest compressions will call out switch, or the agreed upon word or phrase you'll be using to coordinate a switching of duties.
Responder two, after delivering two more rescue breaths, will hand the bag valve mask to responder one, walk around the patient and get into proper position, and begin performing chest compressions, while responder one prepares to administer rescue breaths using the bag valve mask.
11. Continue to perform 15 chest compressions to two rescue breaths – while switching duties every two minutes – until help arrives, an AED arrives, or the victim is responding positively and breathing normally.
Cardiac emergencies in children and infants are usually secondary to respiratory problems and airway restrictions. While congenital heart conditions are possible, they aren't common. When cardiac arrest occurs in children and infants, it's usually caused by one of the following: