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7-2. Remove Upper Airway Obstruction in an Unconscious Child

The steps given below assume the child is conscious and lying down [paragraph 7-1b(2)] or lost consciousness while you were administering abdominal thrusts [paragraph 7-1b(1)]. If you discovered an airway obstruction while performing rescue breathing [paragraph 6-4c(2)], you will have already performed the steps given in paragraphs a through c below.

a. Call for help if you have not done so or if help has not arrived.

b. Lay the child on his back on a firm, flat surface, open his airway, and check for breathing (paragraph 6-2).

c. If the child is not breathing, attempt to administer two ventilations (paragraph 6-3). If the airway is blocked, reposition the head and attempt to administer two ventilations again.

d. If the airway is still blocked, administer modified abdominal thrusts to expel the object.

NOTE: Abdominal thrusts are preferred for clearing the airway of a child. If abdominal thrusts cannot be administered due to abdominal injuries, perform chest thrusts by locating the compression site (paragraph 4-1d) and administering thrusts with the heel of one hand sufficient to depress the lower half of the sternum 1 to 1 1/2 inches. Make each thrust separate and distinct.]

(1) Abdominal thrust--large child. If the child is large, administer abdominal thrusts using the same procedures as for an adult [paragraph 5-6f(1)].

(2) Abdominal thrust--small child.

(a) If the child is small, position yourself at the child's side. Striding the casualty's thighs is not recommended for small children. If the child is on a table, you may prefer to stand at his feet and deliver the thrusts.

(b) Place the heel of your hand that is closest to the child's feet on his abdomen. The heel should be on the midline slightly above the navel and well below the rib cage and xiphoid process. Turn your hand so your fingers are straight out and pointing toward the child's head.

(c) Place the heel of your hand on top of the first hand.

(d) Administer quick, but gentle, inward and upward thrusts.

e. If the obstruction has not been expelled after five thrusts, open his mouth using jaw-tongue lift [paragraph 5-6c(3)] and look for the obstruction. If you see the obstruction, perform a finger sweep [paragraphs 5-6c(5), (6), and (7)] and remove the obstruction. Do not perform a blind finger sweep since you may push the obstruction deeper into the child's throat.

f. Attempt to administer two ventilations again (paragraph 6-3). If the airway is still blocked, perform up to five abdominal thrusts and visually check for the obstruction again. Once the obstruction is removed, perform rescue breathing or CPR (Lesson 6) as needed if the child does not begin breathing again on his own.

8-1. Indications for Early Defibrillation

Very few patients who experience sudden cardiac arrest outside of a hospital survive unless a rapid sequence of events takes place. The chain of survival (figure 8-1) is a way of describing the ideal sequence of events that can take place when such an arrest occurs.


Figure 8-1. Cardiopulmonary resuscitation chain of survival.

a. Recognition of early warning signs and immediate activation of emergency medical support. Few patients benefit from defibrillation when more than 10 minutes elapse before administration of the first shock and/or CPR is not performed in the first 2 to 3 minutes.

b. Immediate bystander CPR. Cardiopulmonary resuscitation helps prolong the time during which defibrillation can be effective.

c. Early defibrillation. This may be the most important link in the chain of survival. Rapid defibrillation has successfully resuscitated many patients with cardiac arrest from ventricular fibrillation. Figure 8-2 shows how an automated external defibrillator (AED) works.

d. Early advanced cardiac life support.


Figure 8-2. How the AED works.

David L. Heiserman, Editor

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All Rights Reserved

Revised: June 06, 2015