When an infant is unconscious in bed what procedure should the EMT use to open the airway?

Choking is when someone cannot breathe because food, a toy, or other object is blocking the throat or windpipe (airway).

This article discusses choking in infants.

Choking in infants is usually caused by breathing in a small object that the baby has placed in their mouth, such as a button, coin, balloon, toy part, or watch battery.

Choking may result from a complete or partial blockage of the airway.

  • A complete blockage is a medical emergency.
  • A partial blockage can quickly become life threatening if the baby cannot get enough air.

When a person does not get enough air, permanent brain damage can occur in as little as 4 minutes. Rapid first aid for choking can save a life.

The danger signs of choking are:

  • Bluish skin color
  • Difficulty breathing -- ribs and chest pull inward
  • Loss of consciousness (unresponsiveness) if blockage is not cleared
  • Inability to cry or make much sound
  • Weak, ineffective coughing
  • Soft or high-pitched sounds while inhaling

DO NOT perform these steps if the infant is coughing hard or has a strong cry. Strong coughs and cries can help push the object out of the airway.

If your child is not coughing forcefully or does not have a strong cry, follow these steps:

  1. Lay the infant face down, along your forearm. Use your thigh or lap for support. Hold the infant's chest in your hand and the jaw with your fingers. Point the infant's head downward, lower than the body.
  2. Give up to 5 quick, forceful blows between the infant's shoulder blades. Use the palm of your free hand.

If the object does not come out of the airway after 5 blows:

  1. Turn the infant face-up. Use your thigh or lap for support. Support the head.
  2. Place 2 fingers on the middle of the breastbone just below the nipples.
  3. Give up to 5 quick thrusts down, compressing the chest one third to one half the depth of the chest.
  4. Continue 5 back blows followed by 5 chest thrusts until the object is dislodged or the infant loses alertness (becomes unconscious).

IF THE INFANT LOSES ALERTNESS

If the child becomes unresponsive, stops breathing, or turns blue:

  • Shout for help.
  • Give infant CPR. Call 911 or the local emergency number after 1 minute of CPR.
  • If you can see the object blocking the airway, try to remove it with your finger. Try to remove an object only if you can see it.

  • DO NOT perform choking first aid if the infant is coughing forcefully, has a strong cry, or is breathing enough. However, be ready to act if the symptoms get worse.
  • DO NOT try to grasp and pull out the object if the infant is alert (conscious).
  • DO NOT do back blows and chest thrusts if the infant stops breathing for other reasons, such as asthma, infection, swelling, or a blow to the head. Do give the infant CPR in these cases.

If an infant is choking:

  • Tell someone to call 911 or the local emergency number while you begin first aid.
  • If you are alone, shout for help and begin first aid.

Always call your doctor after a child has been choking, even if you successfully remove the object from the airway and the infant seems fine.

To prevent choking in an infant:

  • Do not give children under 3 years old balloons or toys with small parts that can break off.
  • Keep infants away from buttons, popcorn, coins, grapes, nuts, and other small items.
  • Watch infants and toddlers while they are eating. Do not allow a child to crawl around while eating.
  • The earliest safety lesson is "No!"

Atkins DL, de Caen AR, Berger S, et al. 2017 American Heart Association focused update on pediatric basic life support and cardiopulmonary resuscitation quality: an update to the American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2018;137(1):e1-e6. PMID: 29114009 pubmed.ncbi.nlm.nih.gov/29114009/.

Rose E. Pediatric respiratory emergencies: upper airway obstruction and infections. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 167.

Thomas SH, Goodloe JM. Foreign bodies. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 53.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.


  • Although you hope you'll never use cardiopulmonary resuscitation (CPR) for a child or infant, it's important to know the steps so that you can help in the event of a cardiac or breathing emergency. And although you may have taken a class in child CPR, it's a good idea to keep the steps handy so that the information stays fresh in your memory. With our printable step-by-step guide, you can access the child and baby CPR steps anytime, anywhere. Simply print them up and place them in your car, your desk, your kitchen or with your other first aid supplies, then read over them from time to time to help maintain your skills.

    Before Giving Child or Baby CPR

    1

    Check the scene for safety, form an initial impression, obtain consent from the parent or guardian, and use personal protective equipment (PPE)


    2

    If the child or baby appears unresponsive, check the child or baby for responsiveness (shout-tap-shout)

    • For a child, shout to get the child’s attention, using the child’s name if you know it. If the child does not respond, tap the child’s shoulder and shout again while checking for breathing, life-threatening bleeding or another obvious life-threatening condition
    • For a baby, shout to get the baby’s attention, using the baby’s name if you know it. If the baby does not respond, tap the bottom of the baby’s foot and shout again while checking for breathing, life-threatening bleeding or another obvious life-threatening condition
    • Check for no more than 10 seconds

    3

    If the child or baby does not respond and is not breathing or only gasping, CALL 9-1-1 and get equipment, or tell someone to do so

    Performing Child & Baby CPR

    1

    Place the child or baby on their back on a firm, flat surface

    • For a child, kneel beside the child
    • For a baby, stand or kneel to the side of the baby, with your hips at a slight angle

    2

    Give 30 compressions

    • For a child, place the heel of one hand in the center of the child’s chest, with your other hand on top and your fingers interlaced and off the child’s chest
      • Position your shoulders directly over your hands and lock your elbows
      • Keep your arms straight
      • Push down hard and fast about 2 inches at a rate of 100 to 120 per minute
      • Allow the chest to return to normal position after each compression
    • For a small child, use a one-handed CPR technique
      • Place the heel of one hand in the center of the child’s chest
      • Push down hard and fast about 2 inches at a rate of 100 to 120 per minute
    • For a baby, place both thumbs (side-by-side) on the center of the baby’s chest, just below the nipple line
      • Use the other fingers to encircle the baby’s chest toward the back, providing support
      • Using both thumbs at the same time, push hard down and fast about 1 ½ inches at a rate of 100 to 120 per minute
      • Allow the chest to return to its normal position after each compression
    • Alternatively, for a baby, use the two-finger technique
      • Use two fingers placed parallel to the chest in the center of the chest
    • For a baby, if you can’t reach the depth of 1 ½ inches, consider using the one-hand technique

    3

    Give 2 breaths

    • For a child, open the airway to a slightly past-neutral position using the head-tilt/chin-lift technique
    • For a baby, open the airway to a neutral position using the head-tilt/chin-lift technique
    • Blow into the child or baby’s mouth for about 1 second
      • Ensure each breath makes the chest rise
      • Allow the air to exit before giving the next breath
    • If the first breath does not cause the chest to rise, retilt the head and ensure a proper seal before giving the second breath. If the second breath does not make the chest rise, an object may be blocking the airway

    4

    Continue giving sets of 30 chest compressions and 2 breaths until:

    • You notice an obvious sign of life
    • An AED is ready to use
    • Another trained responder is available to take over compressions
    • EMS personnel arrive and begin their care
    • You are alone and too tired to continue
    • The scene becomes unsafe
    • You have performed approximately 2 minutes of CPR (5 sets of 30:2), you are alone and caring for baby, and you need to call 9-1-1

    Be prepared for moments that matter by taking a CPR class and you could help save a life.

  • What airway technique will you use to open his airway?

    The simplest way of ensuring an open airway in an unconscious patient is to use a head-tilt/chin-lift technique, thereby lifting the tongue from the back of the throat. The maneuver is performed by tilting the head backwards in unconscious patients, often by applying pressure to the forehead and the chin.

    What position is used to open the airway in an unconscious patient quizlet?

    The head-tilt, chin-lift maneuver should be used to open the airway of a patient with a suspected neck injury. When using the head-tilt, chin-lift maneuver to open a patient's airway, place your fingertips on the body part of the chin, not the soft tissues under the lower jaw.

    When inserting an oropharyngeal airway in an infant or child you should?

    Select correct size of airway. Place padding under baby's shoulders. Open baby's mouth. Using a tongue depressor to assist with insertion, insert airway with curved end facing down, following natural curvature of baby's airway.

    When should I use OPA?

    OPA is used in persons who are at risk for developing airway obstruction from the tongue or from relaxed upper airway muscle. If efforts to open the airway fail to provide and maintain a clear, unobstructed airway, then use the OPA in unconscious persons.