Sheinina West: Welcome to Mom Lounge T.V. I am your host Sheinina West. Today as my guest, I have Richard Pass. He is a registered nurse and a health educator. He has been practicing basic and advanced CPR for almost 20 years. When Richard decided to take a simple yet educational program to the community, he founded Save A Little Life. Welcome Richard.
Richard Pass: Thanks for having me.
Sheinina West: Oh! Thank you for coming. The next thing that we are going to approach is what to do in the case of a choking victim where it's for the infant or the toddler, or a young child, has always been hurt from the obstructed airway, and what to do in that circumstance?
Richard Pass: Absolutely, again this is one of the areas that is of such great concern to parents. It's important to now alleviate your fears. We can't live in fear about babies and children choking. We do, however, need to be ready in the event that something unusual happens.
Keep in mind that the conscious victim, who has a full airway obstruction, will generally not be making any sound at all. Generally, the skin color changes bluish-gray or something along those lines. There is often, at least initially, panicky movements. The appearance of the face and eyes is someone who can communicate the critical nature of this without having to say anything.
Now let me just preface what I am going to show you by reminding you that there are a couple of things that I would prefer. We prefer you not do to a baby or a child because they, in fact, increase the risk for further problems. If you suspect something in the throat or in the mouth and you want to check it out, rather than just put your fingers in, it's strongly advised that you pull the jaw open, and take a good look. You need to visualize the mouth and the back of the throat in case there is something you can, in fact, get.
If you are going to go into someone's mouth, that's certainly after you have taken a look. If you see something you think you can get, the recommendation is to go in against the cheek or inside the cheek. So as you are advancing back, you are also pushing in. So you are hopefully going to come around the object, either pop it out, or if your fingers are small enough, you might be able to get a second finger in and grab it; but you need to visualize the item first, before you go in.
Okay, so the first thing to avoid is going in without looking. The other thing that we want you to avoid, the other no, no, if you will, is to avoid striking victims on the back, when they are either upright seated or standing. This is not a safe thing to do. It can cause certain objects to actually move down and that is not something we want to do.
In the case of someone like this, we do use what we call back blows and chest thrusts, but we do it with, the baby in this case, in a gravity-friendly position. The position that I like is to have the baby sitting up, form, kind of, horseshoe like U-shaped grasp or clasping of the jaw, grab their torso from the back. Here the baby is in a gravity-friendly position, body pointed down, but I have got control here. The head and jaw are supported, so that when I strike between the shoulder blades, I am not going to get a lot of this, sort of, whiplash action.
So we strike up to five times, sharp little blows, 1, 2, 3, 4, 5. If the object does not come out and there is still evidence that the baby is obstructed, I am just going to grab the baby's head from the back, turn it over, just very simply, I am going to go directly to the CPR location, and do chest presses, chest thrusts up to five of those, 1, 2, 3, 4, 5. Then I am going to quickly check the mouth to see whether any of these things I have just done has made a difference.
So we are basically attacking whatever object is back there from both sides. We are striking up to five times in this way, pushing up to five times this way, checking the mouth, and we will just go back and forth between those two maneuvers until the object either comes out or hopefully not, the baby passes it out. The recommendation through the back blows and chest thrusts is for the conscious infant. Okay, for the conscious infant.
Sheinina West: Then with that said, what happens if they do go into an unconscious state?
Richard Pass: This is something we certainly hope doesn't happen. An unconscious baby or child with an airway obstruction is a very, very sick person. The new guideline, as of 2006, is if this baby or whenever we are working with small; if this small person looses consciousness, we turn them over on their back and begin CPR the same 30 pumps on the chest followed by breast.
So the Heimlich maneuver, if you will, for the unconscious victim is now CPR. If the person is conscious still, if the baby is still conscious, one of the keys, of course, is whether they make any sound. That would be an indication the airway is no longer blocked, if good sound is coming out. In this case, it will probably be the sound of them screaming and crying which usually is not a good sound.
Sheinina West: No, they are happy to hear.
Richard pass: Yes, it's a great sound.
Sheinina West: I thought it probably would be the first time the mom will be happy to have her baby scream and yell.
Richard Pass: Yes, that's right, that's right. If you would like to see, I can also demonstrate the method for the slightly bigger child.
Sheinina West: Oh! Most certainly. My child is 3, so I am moving right along over to that.
Richard Pass: Well, one of the things, there is a little bit of a difference of opinion on this. I am not sure that we have complete unanimity here, but generally speaking, when at some point we can start to use the more standard Heimlich maneuver on a small child. That's not to say that if you came across someone who was 14 or 15 months, and you were sure, for example, and you saw them in a airway emergency, and you couldn't turn them over. You certainly can and support their head and neck, and strike between the shoulder blades.
However, keep in mind that this sized person also offers another option, and that is, the standard Heimlich maneuver. So if you locate the landmarks on someone like this, the belly button on the low end, the bottom of the breast bone on the high end, you have got this space here. Right between those two is the breathing muscle or the diaphragm. You can find that on yourself between the belly button and the bottom of the breast bone, and if you cough while pushing on that spot, you'll feel it bulge out.
Well, this actually sits just below the lungs. When something is stuck up here, something has blocked the airway, they are often some pockets of air trapped in the bottom of the lungs. So the Heimlich maneuver is simply a matter of putting your part of your hand or your fist, depending on the size of the person, on that spot, on that diaphragm, and driving it up. I would say, sort of, moderately, kind of like this, just shove it up a little bit, give it a little stroke, upward and inward, and that creates what is essentially an artificial cough. That's what the Heimlich maneuver is.
Sheinina West: Exactly, savealittlelife.com, there you will find Richard's online calendar. So if you are in Los Angeles or visiting the LA areas, please go to his website, see the online calendar, and see if you can take one of his classes. Don't forget about his DVD, you can have on that file as a reference, but please, I honestly do recommend taking the course. If you cannot access Richard, research your neighborhood or your community, and find out if there is a place where you can take a CPR, the life saving course that, of course, can save your own children and someone else's. Thank you Richard for joining me this evening.
Richard Pass: Thank you very much, it's my pleasure.
Sheinina West: Well, certainly. Well, thank you for watching Mom Lounge T.V. I hope that you found this as educational as I have. Have a good day.
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