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 advance 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. Richard, I did discover your program when I was 8 months pregnant and a friend of mine has said to me, you have to take this program Save A Little Life. Richard, so I am very excited that you are going to do an infant CPR demonstration for us today. Please, I will let you take away and I am so excited to learn now once again from you.
Richard Pass: The 2006 guidelines, that are international guidelines for CPR, have put the focus not so much on the breathing, but much more so on the chest compressions because we found that good quality chest compressions, pumping down and then releasing, of course, I am doing it in slow motion; pumping down and releasing creates a vacuum, specially, upon what we call recoil where the chest snaps back.
That recoil of the chest wall brings oxygen into the body in a much more efficient way than should we just below air in. So previously, prior to 2006, the guidelines were five pumps on the chest and one breath. That's been increased now to 30 pumps. 30 pumps followed by a couple of breaths. That obviously, puts a lot more emphasis on the quality of chest compressions. In fact, when we look at chest compressions, when we look at the body itself, if we look at the depth of the chest wall, the new guideline reminds us that in order to be effective in this pumping format, that we need to pump down at least one-third of the depth of the chest wall and even down to a half and you can still be safe.
So in order to get this done, we need to pump down pretty fast and pretty deep. We keep in mind that all people who are unconscious, usually have something going on with their breathing too and that problem is really the tongue itself in the base of the throat. The tongue is very close to the opening of the breathing tube and when the person is unconscious, the tongue tends to flop down over that.
So after we stimulate the baby to see if there is any response, we tilt the baby's head back and this is true for all victims. This may enable the victim to breath on their own. So we do look at the chest for any rise and fall. We do listen and feel for air. In a few seconds, if there is no response, we are asking you still to blow in a couple of breaths. This is the last and final little act prior to pumping.
We start with a little stimulus, check and see if they can breath on their own. If not, cover as many of these three holes as you like and get the simple response that we are looking for, which is the rise and fall of chest wall, it looks like this.
So now we have got a situation where someone has not responded to the stimulus, they haven't been breathing at all on their own. They receive two breaths from us and they still look off of them. It is time to start pumping, right between the nipples and the middle of the breast bone, pumping down 30 times. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, back and forth, back and forth.
Again, if I were alone, I would do up two minutes or about five cycles of this CPR, before I took off and went to make that phone call. Obviously, if you were here or somebody else was here, you would be off to make the call and preferably getting that telephone and bringing it back, a cordless land-line that we could use.
Okay, so basically, we are doing some simple steps, a little stimulus, check the breathing,a few breaths, and start your CPR. Don't be afraid, CPR does not hurt people. If they need it, this is a life saving act.
Sheinina West: So this is in a case where they have inhaled water. Essentially, that's what happens as water has got into the lungs. So in the case that you do revive them, there is spitting up the water after and what you do to prevent them from choking on that water and there, kind of obviously, coming out of the state of being unconscious?
Richard Pass: It's a good question. I think it's also important that we review and, sort of, revise our thinking about drowning. We use to have different ideas and concepts about this. It turns out that drowning is not, in fact, an airway obstruction per se. Much of the water in drowning victims, at least initially, goes into their stomach.
So CPR of the drowning victims, even though it's identical to CPR for people on dry land, is not intended to get water out of people, but if water comes out, it will usually come out in the form of vomiting. In other words, water gets into the stomach and a spontaneous vomiting often occurs. If that happens, let's say, I am pumping away on this baby and again the same CPR, a dry land or a water related, if the baby starts to vomit, I am going to roll her toward me. I am going to basically support her. I will turn, so you can see what I am doing but I would basically scoop the mouth out of anything that was in it, a couple of times, put her back down, see if I can get a breath in. Then I would go right back to pumping, just like I would otherwise.
Sheinina West: Oh! You wouldn't stop to wait to see if the baby has started breathing on their own.
Richard Pass: No, I wouldn't stop in the course of doing this. At any time, it is possible there could be a spontaneous return of consciousness and breathing which is, of course, our hope. That's why I said earlier that we have to act immediately and quickly, but I think, it will be pretty obvious. People will start to usually cough and spit up some but the breathing will usually start spontaneously. Of course, then we can stop the CPR, if those signs of life return.
It is still a critical situation and in that sort of circumstances, we are waiting for the paramedics while we watch this baby very carefully. You may want to sit them up a little bit, once they return to a state of consciousness but this is still a very critically old person and they need to be taken to the hospital by a paramedic ambulance as quickly as possible.
Sheinina West: We are still talking about drowning victims and now we've moved from an infant to, I would presume, a toddler or a very young child. Again, we are going to be focusing on what's the similarities are but I guess you were mentioning there are slight differences on how you would treat a young child versus obviously an infant. I am looking forward to your demonstration.
Richard Pass: Sure, my word of focus on the fact that those simple steps that I used with the baby are also followed here. If we found somewhere they were cold out of water or found perhaps, in a sleeping space or anywhere, unresponsive and looking very, very ill, we will start with stimulation of the baby, your child in this case and attempt to see if they can breath on their own.
I don't see anything. Now you have an option here, you can either pinch the nose and breath through the mouth, or you can breath through the mouth and not pinch the nose. The key, of course, is getting the chest to rise and fall. If you have done that a couple of times, just like with the baby, and there is no response, then locate the nipple line, middle of the breast bone, I am using this little bone on the side of my hand and I am going to drive straight down 30 times. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, and back again. 30 pumps, two breaths, 30 pumps, two breaths.
If this little one were to vomit, just like the other one did, I would roll them toward me, stabilize them as best I could, scoop the mouth out. I would try to get a test breath in, see how we are here. If need be, continuous CPR. Keeping in mind that if this were drowning victim or just someone who is found this way, our hope and our expectation is the CPR provided to this age group, would actually, hopefully bring them back to life.
Sheinin
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