Respiratory Arrest and Rescue Breathing Rescue Breathing

Respiratory Arrest Is a technique of breathing air into a person’s lungs to

supply him or her with the oxygen needed to survive
Is the condition in which breathing stops or is
inadequate Given to victims who are not breathing or inadequate
but still have pulse.
Causes of Respiratory Arrest:
Crucial tool to revive the individual or keep him or her
Obstruction
until the help comes.
1.1 Anatomical- foreign object

1.2 Mechanical- tongue or soft tissues

Diseases

2.1 Bronchitis

4th is mouth to stoma

Special Considerations

 Rescuer to avoid pressing soft tissue under the

chin - this might obstruct the airway
2.2 Pneumonia  Rescuer not to use the thumb to lift the chin
 Rescuer not to close the victim’s mouth
2.3 COPD completely (unless mouth to nose is the
technique)
 Each rescue breath should give enough air to
make the chest rise and be given at 1 second;
 Rescuer should avoid delivering more breaths
(more than the number recommended) or
breaths that are too large or too forceful
 Rescuers should take a normal breath (not a
deep breath) mouth to mouth or mouth-to-
barrier device rescue breaths.

Other causes

3.1 Electrocution

3.2 Circulatory Collapse

3.3 Strangulation- hanging,

3.4 Chest Compression (by other physical force)

3.5 Drowning

3.6 Poisoning
CARDIOPULMONARY RESUCITATION
3.7 Suffocation
is an emergency procedure that combines chest
compressions and ventilation in an effort to manually
preserve intact brain function until further measures
are taken to restore spontaneous blood circulation and
breathing in a person who is in cardiac arrest. It is
recommended those who are unresponsive with no
breathing or abnormal breathing.
It is a simple inexpensive procedure that can be learned
by anyone and consists of 4 main parts: Chest
compressions, Airway, Breathing, and Defibrillation
•It requires no special medical skill and training is
available for the ordinary person
•If effectively done immediately after cardiac arrest, it
can double a victim’s chance of survival
5 EMERGENCY ACTION PRINCIPLES
1.SCENE SAFETY
2.ACTIVATE MEDICAL ASSISTANCE
3.INITIAL/PRIMARY ASSESSMENT OF THE VICTIM
4.SECONDARY ASSESSMENT OF THE VICTIM
5.REFERRAL FOR FURTHER EVALUATION AND
MANAGEMENT
I. SCENE SAFETY –SURVEY THE SCENE
Once you recognized that an emergency has
occurred and you decide to act, you must
make sure the scene of the emergency is
safe for you, the victim’s, and any
bystander/s.
Always make sure the area is safe. You
don’t want to be a victim yourself or add
more injury to the scene.
Elements of the Survey the Scene
✓Scene safety.
✓Mechanism of injury or nature of illness.
✓Determine the number of patients and
additional resources.
II.ACTIVATE MEDICAL ASSISTANCE(AMA)OR
TRANSFER FACILITY
Both trained and untrained bystanders should be
instructed to Activate Medical Assistance as soon as
they have determined that an adult victim requires
emergency care “Call First”.
While for infants and children a “Care First
“approach is recommended.
Adults- cardio
Infants- cause is respiratory, still have time
WHAT TO REPORT
✓What happened?
✓Location
✓Information of person/s involved; age, gender
✓Number of Persons Injured
✓Extent of Injury and First Aid given
✓The telephone number from where you are
calling?
✓Person who activated Medical Assistance must
identify him/herself and drop the phone last.
II. INITIAL/PRIMARY ASSESSMENT OF THE
VICTIM
Response.
Check if the victim is responsive or
unresponsive. As you approach them,
introduce yourself and ask them questions
to see if you can get a response. Kneel next
to their chest and gently shake their
shoulders, asking, ‘What has happened?’,
‘Open your eyes!’ “hey, hey, are you okay?”
WHAT TO DO IN GIVING EMERGENCY CARE
✓Do obtain consent when possible
✓Do think of the worst
✓Do remember to identify yourself
✓Do provide comfort and emotional support
✓Do respect the victim(modestyandprivacy)
✓Do be as calm and direct as possible
✓Do care for the most serious injuries first
✓Do assist the victim on medication
✓Do keep onlookers away from the injured person ✓Do
handle the victim to a minimum
✓Do loosen tight clothing
-ask consent if responsive
DON’TS IN GIVING EMERGENCY CARE
×Do not leave the victim alone except to get help
×Do not assume that the victim’s obvious injuries are
the only one
×Do not make any unrealistic promises
×Do not trust the judgment of a confused person
×Do not let the victim see his/her injuries
×Do not revive a victim with valid DNR(do not
resuscitate)order
III. IV. SECONDARY ASSESSMENT OF THE
VICTIM
It is a methodical check to assess a
responsive casualty for any other injuries or
illnesses.
•Once you have completed a primary
survey and treated any life-threatening
conditions, move on to a secondary survey.
Ask a responsive victim and those around
them questions about any incident that may
have occurred. Your aim is to find out more
about the casualty’s history, signs and
symptoms. If possible, take note of their
answers.
•Leave the victim in the position found until
you are satisfied that it is safe to move
them into a position more suitable for their
injury or illness.
History Taking–find out more about the victim’s
history. SAMPLE
➢Signs–look, listen, feel and smell for any signs of
injury such as swelling, deformity, bleeding,
discoloration or any unusual smells. When checking
them you should always compare the injured side of
the body with the uninjured side. Are they able to
perform normal functions such as standing or
moving their limbs? As you check, make a note of
any superficial injuries to treat once you’ve finished
your examination.
➢Symptoms–ask the casualty short, simple
questions about any symptoms and sensations they
may be feeling. They should answer in as much
detail as possible. For example, ask them:
•Do you have any pain?
•Where is the pain?
•When did the pain start?
•Can you describe the pain, is it constant or
irregular, sharp or dull?
Allergy–Do they have any allergies? For example,
nuts or any medication such as penicillin or aspirin?
➢Medication–are they taking any medication?
➢Previous medical history –do they suffer from any
medical condition such as diabetes, epilepsy or
heart disease? Have they had any previous injuries
or surgery?
➢Last meal –when did they last eat or drink?
➢Event history –what happened and where? Is the
incident due to an illness or an accident? Ask any
people nearby what happened and look for any
clues that may give you more information.
IV. REFERRAL FOR FURTHER EVALUATION &
MANAGEMENT
It refers to the transfer of a victim to a hospital or
health care facility if necessary for definitive
treatment.
The original four links of the chain of survival
comprised:
1.EARLY ACCESS
2.EARLY HIGH-QUALITY CPR
3.EARLY DEFIBRILLATION
4.EARLY ADVANCED LIFE SUPPORT (ALS)
5.RECOVERY –new update Oct 2020
❖EARLY ACCESS —It is the event initiated after the
patient’s collapse until the arrival of Emergency
Medical Services (EMS) personnel prepared to
provide care.
❖EARLY HIGH-QUALITY CPR —It is most effective
when started immediately after the victim’s
collapse. The probability of survival approximately
doubles when it is initiated before the arrival of
EMS.
It aims to slow the rate of deterioration of the brain
and heart, and buy time to enable defibrillation
❖EARLY DEFIBBRILLATION —It is most likely to
improve survival by restoring a perfusing rhythm It
is the key intervention to increase the chances of
survival of patients with “out-of-hospital” cardiac
arrest.
❖EARLY ADVANCED LIFE SUPPORT(ALS) —Early life
support provided by paramedics is another critical
link in the chain of survival. In communities with
survival rates > 20%, a minimum of two of rescuers
should be trained to the advanced level.
❖RECOVERY —In October 2020, the American
Heart Association added the recovery phase as the
sixth link in the chain of survival. Recovery consists
of cardiac arrest survivors receiving treatment,
surveillance, and rehabilitation at a hospital. It also
includes an assessment for anxiety, depression, and
post-traumatic stress, which can all lead to future
repeated events.
EMERGENCY RECOGNITION Response.
Check if the victim is responsive or unresponsive. As
you approach them, introduce yourself and ask
them questions to see if you can get a response.
Kneel next to their chest and gently shake their
shoulders, asking, ‘What has happened?’, ‘Open
your eyes!’ “hey, hey, are you okay?”
•If the victim opens their eyes, or gives another
gesture, they are responsive.
•If they do not respond to you in any way they are
unresponsive and should be treated as quickly as
possible.
DONE SIMULTANEOUSLY
Breathing.
check if the victim is breathing normally. Place your
ear above their mouth, looking down their body.
Listen for sounds of breathing and see if you can
feel their breath on your cheek. See if their chest
moves. Pulse Check. Locate the carotid artery pulse
–slide 2 or 3 fingers into the groove between the
trachea and the muscles at the side of the neck
•take at least 5 seconds but no more than 10
seconds to minimize delay or interruptions.
If you are alone and victim is unresponsive, shout
for help. If no one responds, activate the EMS
(emergency response system), and get an AED
(Automated External Defibrillator) if available.
•If victim is unresponsive, you do not definitely feel
a pulse, not breathing or breathing abnormally,
within 10seconds, perfom5 cycles of compressions
and breaths 30:2ratio, starting with compressions
(C-A-B sequence)
❑COMPRESSIONS
❑AIRWAY
❑BREATHING
•When in doubt feeling a pulse; start CPR! -it is
better to start a false code.
CHEST COMPRESSIONS
•Position yourself at the victim’s side
•Make sure that the victim is lying face up on a firm
surface. If the patient is facedown, carefully roll him
faceup. If head or neck injury is suspected, do
logrolling keeping the head, neck, and torso in line
while repositioning the victim.
•Place the heel of your hand on the breastbone at
the Centre of the person's chest. Place your other
hand on top of your first hand and interlock your
fingers.
Position yourself with your shoulders above your
hands and straighten your arms.
•Using your body weight (not just your arms), press
straight down by 5 to 6cm (2 to 2.5 inches) on their
chest.
Keep those arms as straight as possible. Arm
muscles tire a lot more quickly than your body
weight. Keeping the arms straight helps body
weight drive the compression down and maintain
proper depth.
•The rescuer’s hands need to stay in contact with
the patient’s chest during compressions. Avoid
being a bouncer by maintaining hand contact with
the chest wall. Remember to avoid “leaning” on the
victim.
Do not ‘crisscross’ your hands. To maximize the
force of compressions, the rescuer’s hands need to
be straight over each other.
•Repeat these compressions at a rate of at least 100
to 120 times a minute until an ambulance arrives or
you become exhausted. Minimize interruptions.
•Keeping your hands on victim’s chest, release the
compression and allow the chest to return to its
original position. Chest recoil allows blood to flow
into the heart and is necessary for chest
compressions to create blood flow. Incomplete
chest recoil is harmful because it reduces the blood
flow created by the chest compressions.
Compressions and recoil should be equal.
Airway.
you need to check that the airway is open and clear.
Open the airway by placing one hand on the
forehead to tilt the head back and use two fingers
from the other hand to lift the chin. If head or neck
injury is suspected, perform Jaw-thrust Maneuver.
Breathing.
check breathing along with pulse check always;
every after 5 cycles of 30 compressions: 2 breaths
(2minutes)
•After 30 compressions, open the airway and give
two breaths.
•Keep alternating 30 compressions with two
breaths (30:2) until:
* emergency help arrives and takes over
* the victim starts showing signs of life
* an AED or defibrillator is ready to be used.
AED –AUTOMATED EXTERNAL DEFIBRILLATOR
it is a portable medical device designed to analyze
the heart rhythm and deliver an electric shock to a
victim experiencing sudden cardiac arrest and
expected to restore the heart rhythm to normal.
Ventricular Fibrillations the uncoordinated heart
rhythm most often responsible for sudden cardiac
arrest.
•When the helper returns with a defibrillator, ask
for it to be switched on and to take the pads out,
while you continue CPR. They should remove or cut
through clothing to get to the casualty's bare chest.
They also need to wipe away any sweat. The
defibrillator will give you voice prompts on what to
do.
Do not stop cpr when defib arrives, continue while
they are preparing the AED
Manual defib, cardiac sync, pacemaker
•They should attach the pads to the victims ‘chest,
by removing the backing paper.
•The first pad should be on the upper right side
below the collar bone.
•The second pad should be on the victims ‘left side
below the arm pit.
•The defibrillator will analyze the heart’s rhythm.
Stop CPR and make sure no one is touching the
victim. It will then give a series of visual and verbal
prompts that should be followed.
•If the defibrillator tells you that a shock is needed,
tell people to stand back. The defibrillator will tell
you when to press the shock button. After the shock
has been given the defibrillator will tell you to
continue CPR for two minutes before it re-analyses.
•If the defibrillator tells you that no shock is needed
continue CPR for two minutes before the
defibrillator re-analyses.
SPECIAL CONSIDERATIONS
•VICTIM HAS A HAIRY CHEST –let the pads stick
firmly, if the AED prompts “check pads” or “check
electrodes” quickly pull off the pads, this should
remove large amount of chest hair and stick new set
of pads to the skin. If a razor is available, shave the
area where you will put your pads.
•WATER–water is a good conductor. Do not use
AED in water. Reposition the victim away from the
water and wipe the chest dry before applying the
pads.
•IMPLANTED DEFIBRILLATORS & PACEMAKERS –the
device may block the delivery of the shock to the
heart. If possible, avoid placing the pads directly on
the implanted device
•TRANSDERMAL PATCHES –Do not place AED pads
directly on top of the medication patch as it may
block the transfer of energy and may cause burn to
the skin.
HOW TO DO CPR ON A CHILD
•Child –1 year of age to age of Puberty
•Performed a primary survey similar to the adults
•If you witnessed that the child is unresponsive and
not breathing you should ask help to call for
emergency help while you start CPR. Ask a helper to
find and bring an AED if available. If you are alone,
perform 2mins of CPR first before leaving the child
to CALL
First! Then get back to the child as soon as possible.
•If you did not witness the arrest or you are on your
own, you need to give two minutes of CPR before
calling help. CARE First!
•Start CPR. Place them on a firm surface and open
their airway.
•Give five initial rescue breaths.
•Take the hand from the forehead and pinch the
soft part of the nose closed, allowing the mouth to
fall open.
•With the head still tilted, take a breath and put
your mouth around the child’s, to make a seal.
•Blow into their mouth gently and steadily for up to
one second, until the chest rises.
•Remove your mouth and watch the chest fall.
•That’s one rescue breath. Do this five times.
you will then need to give 30 chest compressions.
•Kneel by the child and put one hand in the center
of the child’s chest.
•Push down a third of the depth of the chest,
approximately 5cm (2inches) for children and
approximately 4cm (1.5inches) for infants.
•May use 1 to 2-handed chest compression
•Release the pressure allowing the chest to recoil.
•Repeat this 30 times at a rate of at least 100 to 120
compressions per minute.
•If two rescuers are present, do 15:2 compression-
ventilation ratio
After 30 compressions, open the airway and give
two breaths.
•It is vital that you perform rescue breaths as
cardiac arrest in a child is likely caused by a
respiratory problem.
•Keep alternating 30 compressions with two
breaths (30:2) until: * emergency help arrives and
takes over* the child starts showing signs of life and
starts to breathe normally* an AED or defibrillator is
ready to be used.
•If the helper returns with a defibrillator, ask them
to switch it on and follow the voice prompts while
you continue with CPR.
•If the child shows signs of becoming responsive
such as coughing, opening eyes, speaking, and starts
to breathe normally, put them in the recovery
position.
•Monitor their level of response and prepare to give
CPR again if necessary.
•If you have used a defibrillator, leave it attached.
HOW TO DO INFANT CPR
•Infant –0 to 1year of age (12months) excluding
newly born baby in the delivery room.
•Perform a primary survey, check infant’s pulse in
brachial artery pulse as shown in the picture.
•if you witnessed that the baby is unresponsive and
not breathing, you should ask a helper to call for
emergency help while you start CPR. If you are
alone, perform 2mins of CPR first before leaving the
infant to CALL First! Then get back to the infant as
soon as possible.
•If you did not witness the arrest or you are on your
own, you need to give two minutes of CPR before
calling help. CARE First!
•Start CPR. Place them on a firm surface and open
their airway. To do this, place one hand on their
forehead and very gently tilt their head back. With
your other hand, use your fingertip and gently lift
the chin.
•Give five initial puffs. Take a breath and put your
mouth around the baby’s mouth and nose to make
a seal, and blow gently and steadily for up to one
second. The chest should rise. Remove your mouth
and watch the chest fall. That’s one rescue breath,
or puff. Do this five times.
•If their chest doesn't rise, check the airway is open.
•It is vital that you perform rescue breaths as
cardiac arrest in a baby is likely caused by a
respiratory problem.
You will then need to give 30 pumps.
•Put two fingers in the center of the baby’s chest or
two thumb-encircling the baby’s chest and push
down a third of the depth of the chest,
approximately 4cm (1.5inches)
•Release the pressure allowing the chest to come
back up.
•Repeat this 30 times at a rate of at least 100 to 120
pumps per minute.
•If two rescuers are present, do 15:2 compression-
ventilation ratio
•After 30 pumps, open the airway and give two
puffs. Keep alternating 30 pumps with two puffs
(30:2) until:
*emergency help arrives and takes over*the baby
starts showing signs of life and starts to breathe
normally.
•If the baby shows signs of becoming responsive,
such as, coughing, opening their eyes, making a
noise, or starts to breathe normally, put them in the
recovery position.
•Monitor their level of response and prepare to give
CPR again if necessary.
HOW TO DO CPR IN THIS PANDEMIC: COVID-19
•If you find someone collapsed, you should first
perform a primary survey. Do not place your face
close to the victim during the survey.
•If you have established from this that they are
unresponsive and not breathing, you should ask a
helper to call for emergency help while you start
CPR. Ask a helper to find and bring an AED, if
available.
•If there is a helper ask him to put the phone on
speaker and hold it out towards you, so they can
maintain a 2m distance
•If you are on your own, use the hands-free speaker
on a phone so you can start CPR while speaking to
ambulance control.
•Do not leave the victim to look for help or AED.
Leaving the patient and looking for help may spread
the virus if the arrested patient is Covid19 positive.
•Before you start CPR, use a towel or piece of
clothing and lay it over the mouth and nose of the
victim. Victim’s covering must be maintained
securely.
•Start Hands only CPR. Do chest compression as
previously stated.
•Do not give rescue breaths.
•Continue to performing Hands only CPR until: *
emergency help arrives and takes over* the person
starts showing signs of life and starts to breathe
normally* you are too exhausted to continue* an
AED is ready to be used.
•If the helper returns with a defibrillator, ask them
to switch it on and follow the voice prompts while
you continue with CPR.
•Wherever possible, the helper should keep a
distance of 2m.
•If the victim shows signs of life and starts to
breathe normally, put them in the recovery position
with facial covering in place.
•Monitor their level of response and prepare to give
CPR again if necessary.
•If you have used a defibrillator, leave it attached.
HIGH QUALITY CPR
❑Compress the chest hard and fast
❑Allow complete chest recoil after each
compression
❑Minimize interruptions in compressions
(10seconds or less)
❑Avoid excessive ventilation
❑Switch compressor about every 2minutes or
earlier if fatigued. *switch should take 5seconds or
less
RECOVERY POSITION AFTER CPR
•If a person is unconscious but is breathing
normally and has no other life-threatening
conditions of suspected facture, victim should be
placed in the recovery position.
•Putting someone in the recovery position will keep
their airway clear and open. It also ensures that any
vomit or fluid won't cause them to choke.
HOW TO PUT A VICTIM IN THE RECOVERY POSITION
•Kneel by the victim’s and straighten their legs.
•If they are wearing glasses, or have any bulky
items in their pockets, remove them.
•Do not search their pockets for small items.
•Place the arm that is nearest to you at a right angle
to their body, with the elbow bent and their palm
facing upwards.
•Bring their other arm across their chest and place
the back of their hand against the cheek nearest to
you, and hold it there.
•With your other hand, pull victim’s far knee up so
that their foot is flat on the floor.
•Keeping the back of the victim’s hand pressed
against their cheek, pull on the far leg to roll the
child towards you on to their side. You can then
adjust the top leg so that it is bent at a right angle.
•You then need to gently tilt the victim’s head back
and lift their chin to make sure their airway stays
open. You can adjust the hand under their cheek to
help keep the airway open.
•If they remain in the recovery position for 30
minutes, roll them into the recovery position on the
other side.
•Call for emergency help if it hasn’t already been
done. Monitor their level of response while waiting
for help to arrive.
•If the victim is a child, the procedure of positioning
into a recovery position is similar to as of an adult.
•If the victim is an infant, cradle the victim in your
arms, with their head tilted downwards to prevent
them from choking or inhaling vomit.
•Call for emergency help if it hasn’t already been
done and monitor their level of response until help
arrives.
WHEN TO STOP CPR
•Victim shows signs of life and starts to breathe
normally, put the m in the recovery position.
•Patient has signs of irreversible death (Rigor
Mortis, Decapitation ,Dependent Lividity).
•Responsibility is assumed by a more senior
emergency medical professional–paramedics
arriving on the scene or a physician in the
emergency room.
•No physiological benefit can be expected because
the vital functions have deteriorated as in septic or
cardiogenic shock.
•Rescuer is unable to continue resuscitation due to
exhaustion, the scene is no longer safe, or when
continued resuscitation may place other lives at
risk.
•Presentation of a valid DNAR order to the rescuer.
FOREIGN BODY OBSTRUCTION
1.DEFINITION
Is a condition when solid materials like chunked
foods, coins, vomitus, small toys, etc. are blocking
the airway.
CAUSES OF AIRWAY OBSTRUCTION
•Improper chewing of large pieces of food
•Excessive alcohol intake.
 Relaxation of tongue back into the throat.
 Aspirated vomitus (stomach content)
 The presence of loose upper and lower
dentures
 For children- running while eating
 For smaller children of hand-to mouth stage
left unattended.
2 types of Obstructions
1. Anatomical Obstructions
 Happens when tongue drops back and obstructs h. Movement of air is absent
the throat. Other causes are acute asthma,
•RESCUER ACTION
croup, diphtheria, swelling, and cough
whooping a. Ask the victim if he or she is choking
2. Mechanical Obstruction
when foreign objects lodge in the pharynx or b. If the victim nods and cannot talk, severe airway
airways; fluids accumulate in the back of the obstruction is present and you must activate the
throat. emergency response system and AED once the victim
becomes unconscious.
CLASSIFICATION OF OBSTRUCTION
Heimlich Maneuver
1. MILD
HM or abdominal thrusts is recommended for relieving
2. SEVERE foreign body airway obstruction.
1. MILD OBSTRUCTION ABDOMINAL THRUSTS (AT) Is an emergency procedure
for removing a foreign object lodged in the airway that
•Signs
is preventing a person from breathing.
a. Good air exchange
REMEMBER This procedure should not be used in
b. Responsive and can cough infants under 1 year of age due to risk of causing injury.

c. May wheeze between coughs Universal Sign of Choking

d. Has increased respiratory difficulty and possibly Is a sign where in the victim is clutching his/her neck
cyanosis with one or both hands and gasping for breath.

•Rescuer Action Foundation Facts: Complications from Abdominal

Thrusts
As long as good air exchange continues:
1. Incorrect application of the Abdominal Thrust can
a. Encourage the victim to continue spontaneous
damage the chest, ribs and internal organs.
coughing and breathing efforts.
2. May also cause vomiting after being treated with the
b. Do not interfere with the victim’s own attempts to
Abdominal thrust.
expel the foreign body, but stay with the victim and
monitor his or her condition. 3. They should be examined by the Physician to rule out
any life-threatening complications.
c. If mild airway obstruction persists, activate the
emergency response system. Self-Administration of Abdominal Thrusts

2. SEVERE OBSTRUCTION 1.To apply the Abdominal Thrust maneuver to oneself:

Make a fist with one hand and place it in the middle of
•SIGNS
the body at a spot above the navel and below the
a. Poor or no air exchange breastbone, then grasp the fist with the other hand and
push sharply inward and upward.
b. Weak or ineffective cough or no cough at all
2. If this fails, the victim should press the upper
c. High-pitched noise while inhaling or no noise at all abdomen over:
d. Increased respiratory difficulty -the back of a chair-edge of the table-porch railing or
e. Cyanotic (turning blue) something similar and thrust up and inward until the
object is dislodged.
f. Unable to speak
Performing Abdominal Thrusts under special
g. Clutching the neck with the thumb and fingers making circumstances
the universal sign of choking
PREGNANT AND VERY OBESE PEOPLE
•The main difference in performing the Abdominal
Thrust on this group of people is in the placement of the
fists.
•Instead of using abdominal thrusts, chest thrusts are
used.
•The fists are placed against the middle of the
breastbone and the motion of the chest thrust is in and
downward, rather than upward.
•If the victim is unconscious, the chest thrusts are
similar to those used in CPR.
A. For child/ adult: Ask the client “Are you choking?”
Assess airway for severe airway obstruction. Hands
clutching the throat is the universal choking sign
B. Infant: ineffective cough, weak or absence of cry, if
so, tell parents/guardian that you are there to help.
(may I help) If there is a good air exchange and the
client is able to forcefully cough, you should not
intervene or interfere with the client’s attempt to expel
the foreign body. Encourage attempts to cough and
breathe, as attempts to cough will provide a more
forceful effort. If severe airway obstruction is apparent,
the Heimlich maneuver or alternative method of
subdiaphragmatic thrusts should be performed
immediately

6. Press fist into abdomen with a quick upward thrust;

each thrust should be separate and distinct.

This subdiaphragmatic thrust can produce an artificial

cough by forcing air from the lungs.7. Repeat this
process until the client either expels the foreign body or
loses consciousness.

Attempts to dislodge food or a foreign body to relieve

•Caution: Pregnant and Obese Victims
•If the victim is pregnant or obese, perform chest
thrusts instead of abdominal thrusts.
II. EQUIPMENT
An individual with training to perform this procedure
Standard precaution supplies:
airway obstruction should be continued as long as
necessary because of the serious consequences of
hypoxia.8. If client is obese or in later stages of
pregnancy, perform chest thrusts:
a. Stand behind the client
b. Wrap your arm pits around the client’s chest Rescuer
may not be able to wrap arms around the client’s waist.
Performing abdominal thrusts in late stages of
pregnancy can cause injury. Proper positioning is
necessary to provide effective thrusts. Proper
positioning is necessary to provide effective thrusts.

1. Gloves 6. Press fist into abdomen with a quick upward thrust;

each thrust should be separate and distinct.
2. Masks
This subdiaphragmatic thrust can produce an artificial
3. Gown cough by forcing air from the lungs.
4. Protective eyewear 7. Repeat this process until the client either expels the
III. PLANNING AND IMPLEMENTATION ACTION foreign body or loses consciousness. Attempts to
RATIONALE dislodge food or a foreign body to relieve airway
obstruction should be continued as long as necessary
1. Determine scene safety. Introduce yourself to because of the serious consequences of hypoxia.8. If
patient, guardian and /or bystander client is obese or in later stages of pregnancy, perform
chest thrusts:
2.Determine the level of breathing by checking:
a. Stand behind the client
b. Wrap your arm pits around the client’s chest Rescuer
may not be able to wrap arms around the client’s waist.
Performing abdominal thrusts in late stages of
pregnancy can cause injury.
Proper positioning is necessary to provide effective
thrusts.
14. Every time you give breaths, open the mouth if you
see an object remove it. To remove object blocking the
airway.
15. Continue to provide CPR until emergency response
arrives or the client begins to move. To perform life-
saving procedures.

Proper positioning is necessary to provide effective
thrusts.
c. Make a fist with one hand. Place thumb side of fist in
the middle of the sternum. Grasp fist with other hand.
16. If patient has sign of spontaneous circulation and
breathing, properly place in recovery position. (Do log
roll.)

Proper hand placement is necessary to avoid damage to

internal organs.

d. Press fist into chest and deliver thrusts back and

upward.

To create pressure to force object out. Chest thrusts

may not be effective on the first attempts.

e. Repeat this process until the client either expels the

foreign body or loses consciousness.

Unconscious Client –Adult and Children > 1 Year of Age

9. When the client becomes unconscious, lower client

to floor. Protect the client’s head. Place in supine
position.

To avoid injury to head. Places the client in the most

effective position to apply intervention.

10. Activate emergency medical system (EMS), if not

previously done. To activate assistance from personnel
trained in advanced life support.

11. Open client’s mouth. Use one hand to grasp the

lower jaw and tongue between your thumb and finger.
Lift the jaw. If you see an object, remove it. To draw he
tongue away from any foreign body lodged in the back
of the throat.

12. Open the airway and provide 2 breaths and look for
chest to rise. If chest does not rise, reposition client’s
head, reopen the airway and provide 2 breaths. The
brain can suffer irreversible damage if it is without
oxygen for 4-6 minutes.

13. If unable to ventilate, begin CPR To perform life –

6-10 thrusts- AMA
saving procedure
5 back slaps- Red cross, can also be done for adults
 notes and in the emergency procedure notes if
needed:

a. Time and date of onset of symptoms

b. Presentation including onset and type of

symptoms

c. Type (complete or partial) and cause of

obstruction, if known.

d. Intervention used to alleviate obstruction

e. Results of interventions

2. if the airway obstruction occurs in an alternate

setting (e.g. restaurant, home), provide the
following information to the responding health care
providers for documentation:

a. presentation including onset and type of

symptoms.

. Type (Complete or Partial) and cause of

obstruction, if knownc

. Intervention used to alleviate obstruction

d. Length of time with airway obstruction

e. Results of intervention3. Document on

appropriate flow sheet or electronic medical record
V. EVALUATION AND DOCUMENTATION (EMR).

1. The client demonstrates improved clinical status AED

as evident by airway clearance or establishment of
AEDs are sophisticated, computerized devices that can
a patent airway
analyze heart rhythms and generate high voltage
2. The client demonstrate improved gas exchange electric shocks.
as evident by absence of signs and symptoms of
Treatment
partial or complete airway obstruction (e.g. cough,
wheezing, stridor, loss of consciousness, cyanosis). Automated External Defibrillator (AED)
3. The client experiences minimal discomfort during
the Heimlich maneuver or other method of airway –Controlled electrical shock
clearance.
–May restore an organized rhythm
4. The client did not experience complication
related to airway obstruction/hypoxia.
–Enables heart to contract & pump blood

Use AED only when victims have the following 3 clinical

DOCUMENTATION
findings
1. If the airway obstruction occurs in the health care  No response
setting, document the following in the narrative  No breathing
 No Pulse
Safety Considerations

 Make sure the electricity injures no one.

 Do not defibrillate a patient lying in pooled
water.
 Dry a soaking wet patient’s chest first.
 Do not defibrillate someone who is
touching metal that others are also
touching.
 Remove any transdermal medication
patches from the patient before using the
Attach AED
AED.
 Do not defibrillate over an implanted Power on
pacemaker.
Follow voice prompts
 qAEDs should not be used on children
younger than age 8 because the default Cut suit
energy level of AEDs is too high for them.
Dry skin/shave if necessary

 
 Make sure the electricity injures no one.
 Do not defibrillate a patient lying in pooled Attach AED pads
water. Adult pads vs Child pads
 Dry a soaking wet patient’s chest first.
 Do not defibrillate someone who is Giving a shock
touching metal that others are also Be sure no one is touching the victim
touching.
 Remove any transdermal medication Press Shock button if instructed
patches from the patient before using the Resume CPR immediately after giving 1 shock
AED.
 Do not defibrillate over an implanted Follow voice prompts
pacemaker.
Record events
 qAEDs should not be used on children
younger than age 8 because the default
energy level of AEDs is too high for them.
