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The definition of infant CPR is from age birth to one year old. Now, if we are delivering CPR to an infant, it is going to be a lot different to dealing with an older child or with an adult. Here we are dealing with someone very, very precious, very, very small. So, it is going to be a very tough thing for you to do. But the idea of training and learning about infant CPR is that if you ever were in a situation where you had to deliver CPR to an infant, your training is in your brain, you have been programmed, and you would hopefully be able to deliver that. So, first of all, we are dealing with sort of the initial scene safety and the permission. Now with the infant, obviously they can't answer you back but still communicate with them. You can still ask them and talk to the baby because what we are trying to do is get a response from them. So they are not going to be talking back obviously, they are going to give you other signs, maybe you might see twitches, you might see movement. So when we are assessing for a response, then we can get those sort of responses back. As far as permission goes, if the parent or guardian is there, then you can ask the question, "I am a first aider, may I help your baby?" And they can give you consent to actually help.

Then it gives you consent direct. If you are looking after someone's child and there is no parent or guardian there, you would have what is called implied consent. Because I am sure if that parent knew what was happening, they would want you to deliver CPR. So the first thing we need to do is obviously make sure the scene is safe. Now when we are dealing with CPR, on this example here in the training environment, we are doing it on a tabletop. Now that would work fine, it is on a solid firm surface, but we could also do it on the floor, we can do it in your arm to a certain extent, and because of the weight of the baby it'll be a bit less efficient. But if we needed to then move the baby to the ambulance, we could carry on doing CPR while moving them to the ambulance to save more time. So we are now going to look at the process of delivering CPR to an infant. So the first thing is we have asked the parent, or we have given a little tap. And also tap on the feet, that is a very good way of trying to get a response. Try and ask them if they are okay. You know, and just maybe you get a response. In this example, we have no response. So we need to try and find out whether they are breathing.

When you open the airway on a baby, it is a little bit different from that of an older child or an adult because the airway itself is not fully developed yet. So if you were to open the airway fully and tilt the head right back, like you would on an adult CPR, what actually is going to happen, you will open the airway, but then you are going to close it again. It is like a garden hose. If you take a garden hose, water is flowing, and then you just bend that hose slowly, eventually it is going to crease. And at that point no water is going to come out. And the airway on an infant is very, very similar. So what we do is we need to just move the head back into what is called a neutral position. Not over-extend it, because that is going to stop the airway. Not leave it down, because that will not be open. So we are just keeping that in nice, level form. So with the mannequins like this, if you open them too far, you will find that you can't get the air in there anyway. So the mannequins are also designed to allow the air to go just in when the airway's open correctly. So we need to find out if they are breathing. So it is head tilt, chin lift. So fingers on the top of the forehead, under the boney part of the chin. Tilt the head back into that neutral position.

You pop your ear down there and you are doing a breathing check for 10 seconds. So, one, two, three, four, five, six, seven, eight, nine, 10. We counted to 10. We now know the infant is not breathing. Now if you came across this situation, the first thing you are going to do is shout for help. But let's just assume in this example here we are on our own. So what the idea here is a little bit different from with adult CPR, is we would do one minute of CPR first, and then go for help. The reason for this is, we are dealing with a respiratory problem here, normally with infants and children. So hopefully by delivering CPR for that one minute period, the infant will come around. So we don't really want to waste too much time calling the ambulance at that point. But we must then, after that minute, call the emergency services. Now if somebody else was there, obviously send them to call the emergency services. Tell them exactly what you are dealing with. You have got a non-breathing infant and you are delivering CPR. That will put the call at the absolute maximum priority and hopefully you are help will be there within four to eight minutes. So once we have established that they are not actually breathing, then we need to deliver breaths.

Now with breaths, you can use face shields, you can use pocket masks and things like this, or you can go straight down on to the mouth. Now we will demonstrate going straight down on to the mouth to show you how that happens. But if you are using a pocket mask, then you can pop the mask over. Normally you would put a mask on this way around. But with infants, these masks design to fit the other way round. So if you pop that over and it is going right over the face. So, therefore, you have got a good seal around the whole of the mouth and the nose, and you can put the breaths in there and you can keep a good barrier between yourself and the infant. Now the key thing with doing the breaths is we are putting the breaths in and we are sealing our mouth around the mouth and the nose. Not just the mouth. Now with older children and adults, yes you can squeeze the nose quite easily, but with an infant, you will not be able to do that. So to start with, just tilt the head back into that neutral position.

We are sealing around, and the actual area is right around the mouth and the nose so that we get a good seal, and then you are putting the breath in. Now you are not doing the breath the same as you would with an older child, because the lung size is much smaller. So it is just a gentle puff until you see the chest rise. And we are delivering five breaths. So we are delivering breath, breath, breath, breath, breath. And when you put the air in, allow the air to come out and then put the next breath in. So that way we can flush the baby, their respiratory system as much oxygen as possible. So we are just going to run through that slide and then we will show you how to do the chest compressions.

So each time I am doing the breaths, I am just checking, looking down as in the corner of my eye I can see the chest rising and falling. So I know the breath is going in. Also I will be able to feel the breath coming out on my cheek. So you know that air has gone in. So once you have done the five breaths, we then move down to chest compressions. Now we do this a little bit different, we are just using two fingers. So you can use two fingers on either hand and we are pushing it just in the centre of the breastbone. Exactly in the same place as we would with adults. But with the infants, you can look at it as the line between the nipples on the infant. So we are just literally popping the fingers on and we are pushing down about a third of the depth of the chest. Now pushing down a third of the depth of the chest is quite a severe depth to push down, but we need to do this to compress the heart, and again, it is the same with older children, is we need to ensure that that chest has been risen back up. So we must make sure the heart has refilled with blood.

So we are doing the breaths, we are doing 30 compressions, and we are doing them at the same speed, 100 to 120 compressions per minute. One. Two. Three. Four. Five. Six. Seven. Eight. Nine. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. Once we have delivered the 30 compressions, we then do two breaths. So it will be, two breaths, 30 compressions, two breaths, 30 compressions, two breaths, 30 compressions. And what we are doing that just for one minute. So we are just running that through and then if we are on our own and help has not obviously arrived, then we must make that call.

So put the airway into a neutral position. Deliver two breaths.

So once you have gone through the cycle of 30, two, 30, two, and we have then activated emergency services, then we will continue the CPR process until emergency services arrive and they tell you to stop or they tell you to hand over. So once they get here, they will want you to carry on. Now if it happened inside and you have heard the ambulance outside, then you can carry the baby out to the ambulance. That is possible as well. Or you can wait for the emergency services to come in. If you are carrying them outside, you need to then carefully pick up the infant and you can rest it on your arm and still be able to deliver the CPR compressions and the breaths successfully while walking to the ambulance. But that is something you will need to decide on the time which is best for you in that instance.

So to summarise. Infant CPR is a very, very sensitive and it is a very, very worrying thing to do, even in the simulation environment in the classroom. It is quite upsetting in what you are doing. But, it is a good skill to learn and the information that you have got there is being programmed into your head, but hopefully, you will not ever have to do this. But if you ever did, the information is there for an easy recall.