CHAPTER 1-8

Question 1

(CDC)

Answer 1

Centers for Disease Control

Question 2

(BLS)

Answer 2

Basic Life Support

Question 3

Keys for BLS:

Answer 3

• Quickly start the Chain of Survival.
• Deliver high-quality chest compressions to circulate oxygen to the brain and vital organs.
• Know when and how to use an Automated External Defibrillator (AED).
• Provide rescue breathing.
• Understand how to work with other rescuers as part of a team.
• Know how to treat choking

Question 4

Adult Chain of Survival

Answer 4

ACTIVATiON
OF EMERGENCY
RESPONSE

PERFORM
EARLY CPR

DEFIBRILLATE
WITH
AED

ADVANCED
LIFE
SUPPORT

POST-CARDIAC
ARREST
CARE

RECOVERY

Question 5

Pediatric Chain of Survival

Answer 5

PREVENT
ARREST

ACTIVATE
EMS

PERFORM
EARLY CPR

ADVANCED
LIFE
SUPPORT

POST-CARDIAC
ARREST
CARE

RECOVERY

Question 6

(ILCOR)

Answer 6

International Liaison Committee on Resuscitation

Question 7

CPR

Answer 7

cardiopulmonary resuscitation

Question 8

AED

Answer 8

Automated External Defibrillator

Question 9

ECC

Answer 9

(Emergency Cardiac Care)

Question 10

NOTE

Answer 10

. Bystanders should
not be afraid to start CPR even if they are not sure whether the victim is breathing or in
Cardiac Arrest.

Question 11

A sixth link

Answer 11

Recovery, was added to the Chains of Survival for both Pediatric and Adults.

Question 12

(ROSC)

Answer 12

return of spontaneous circulation

Question 13

NOTE

Answer 13

Because recovery from cardiac arrest continues long after the initial hospitalization, patients
should have formal assessment and support for their physical, cognitive, and psychosocial
needs.

Question 14

NOTE

Answer 14

Management of cardiac arrest in pregnancy focuses on maternal resuscitation, with
preparation for early perimortem cesarean delivery if necessary to save the infant and
improve the chances of successful resuscitation of the mother.

Question 15

Simple Adult BLS Algorithm

Answer 15

UNRESPONSIVE: NO
BREATHING OR ONLY
GASPING

ACTIVATE
EMERGENCY
RESPONSE

GET AED &
START CPR

MONITOR RHYTHM
SHOCK IF NEEDED
REPEAT AFTER 2 MIN (Push Hard And Fast)

Question 16

ONE-RESCUER BLS/CPR FOR ADULTS

Answer 16

Be Safe

Assess the Person

Call EMS

CPR

Defibrillate

Question 17

CPR STEPS

Answer 17

1. Check for the carotid pulse on the side of the neck (Figure 4a). Keep in mind not to waste time
   trying to feel for a pulse; feel for no more than 10 seconds. If you are not sure you feel a pulse,
   begin CPR with a cycle of 30 chest compressions and two breaths.
2. Use the heel of one hand on the lower half of the sternum in the middle of the chest (Figure 4b).
3. Put your other hand on top of the first hand (Figure 4c).
4. Straighten your arms and press straight down (Figure 4c). Compressions should be 2 to 2.4” (5 to 6 cm) into the person’s chest and at a rate of 100 to 120 compressions per minute.
5. Be sure that between each compression you completely stop pressing on the chest and allow
   the chest wall to return to its natural position. Leaning or resting on the chest between
   compressions can keep the heart from refilling in between each compression and make CPR
   less effective.
6. After 30 compressions, stop compressions and open the airway by tilting the head and lifting
   the chin (Figure 4d & 4e).
   a. Put your hand on the person’s forehead and tilt the head back.
   b. Lift the person’s jaw by placing your index and middle fingers on the lower jaw; lift up.
   c. Do not perform the head-tilt/chin-lift maneuver if you suspect the person may have a
   neck injury. In that case, the jaw-thrust is used.
   d. For the jaw-thrust maneuver, grasp the angles of the lower jaw and lift it with both hands,
   one on each side, moving the jaw forward. If their lips are closed, open the lower lip using
   your thumb (Figure 4f).
7. Give a breath while watching the chest rise. Repeat while giving a second breath. Breaths should
   be delivered over one second.
8. Resume chest compressions. Switch quickly between compressions and rescue breaths to minimize interruptions in chest compressions.

Question 18

TWO-RESCUER BLS/CPR FOR ADULTS

Answer 18

1. The second rescuer prepares the AED for use.
2. You begin chest compressions and count the compressions out loud.
3. The second rescuer applies the AED pads.
4. The second rescuer opens the person’s airway and gives rescue breaths.
5. Switch roles after every five cycles of compressions and breaths. One cycle consists of 30 compressions and two breaths.
6. Be sure that between each compression you completely stop pressing on the chest and allow
   the chest wall to return to its natural position. Leaning or resting on the chest between compressions can keep the heart from refilling in between each compression and make CPR less effective. Rescuers who become tired may tend to lean on the chest more during compressions; switching roles helps rescuers perform high-quality compressions.
7. Quickly switch between roles to minimize interruptions in delivering chest compressions.
8. When the AED is connected, minimize interruptions of CPR by switching rescuers while the
   AED analyzes the heart rhythm. If a shock is indicated, minimize interruptions in CPR.
   Resume CPR as soon as possible.

Question 19

ADULT MOUTH-TO-MASK VENTILATION

Answer 19

In one-rescuer CPR, breaths should be supplied using a pocket mask, if available.
1. Give 30 high-quality chest compressions.

2. Seal the mask against the person’s face by placing four fingers of one hand across the top
   of the mask and the thumb of the other hand along the bottom edge of the mask (Figure 5a).
3. Using the fingers of your hand on the bottom of the mask, open the airway using the head-tilt/chin-lift maneuver. (Do not do this if you suspect the person may have a neck injury) (Figure 5b).
4. Press firmly around the edges of the mask and ventilate by delivering a breath over one second as you watch the person’s chest rise (Figure 5c).

Question 20

ADULT BAG-MASK VENTILATION IN TWO-RESCUER CPR

Answer 20

If two people are present and a bag-mask device is available, the second rescuer is positioned
at the victim’s head while the other rescuer performs high-quality chest compressions. Give 30
high-quality chest compressions.
1. Deliver 30 high-quality chest compressions while counting out loud (Figure 6a).

2. The second rescuer holds the bag-mask with one hand using the thumb and index finger
   in the shape of a “C” on one side of the mask to form a seal between the mask and the face,
   while the other fingers open the airway by lifting the person’s lower jaw (Figure 6b).
3. The second rescuer gives two breaths over one second each as you watch the person’s chest
   rise (Figure 6c).
4. Practice using the bag-valve-mask; it is essential to forming a tight seal and delivering
   effective breaths. Qu

Question 21

Criteria for high-quality CPR:

Answer 21

• Start chest compressions (hard and fast) within 10 seconds
• Allow for complete chest recoil between compressions
• Minimize interruptions between chest compressions
• Assure that the breaths make chest rise
• Do not over-ventilate
• Assess for shockable rhythm as soon as AED available in witnessed cardiac arrest as it is most likely a shockable rhythm.

Question 22

Adult BLS Algorithm

Answer 22

FIGURE 7. PAGE 12

Question 23

NOTE

Answer 23

In a witnessed cardiac arrest, where the person is observed
to suddenly collapse, the most common cause is likely to be ventricular fibrillation and a
defibrillator should analyze the person’s cardiac rhythm as soon as possible.

Question 24

AED STEPS

Answer 24

1. Retrieve the AED (Figure 8a).
   a. Open the case.
   b. Turn on the AED.
2. Expose the person’s chest (Figure 8b).
   a. If wet, dry chest.
   b. Remove medication patches.
3. Open the AED pads (Figure 8c).
   a. Peel off backing.
   b. Check for pacemaker or internal defibrillator.
4. Apply the pads (Figure 8d).
   a. Apply one pad on upper right chest above the breast.
   b. Apply the second pad on lower left chest below the armpit.
5. Ensure the wires are attached to the AED box (Figure 8e).
6. Move away from the person (Figure 8f).
   a. Stop CPR.
   b. Clear the person to make sure no one is touching any part of the victim
7. Let AED analyze the rhythm.
8. If AED message reads “Check Electrodes,” then:
   a. Ensure electrodes make good contact.
   b. If chest is hairy, pull off pad and replace it.
9. If AED message reads “Shock,”
   a. Be sure the person is “clear” by making sure no one is touching them.
   b. Press and hold the “shock” button until the AED delivers the shock (Figure 8g).
10. Resume CPR for two minutes starting with chest compressions (Figure 8h).
11. Repeat steps 1 to 10.

Question 25

NOTE

Answer 25

. Ensure that the person is not wet (quickly wipe dry) or in close proximity to
water before using the AED. It is safe to use an AED if the person is lying in snow. If the person
has an implanted device, such as a pacemaker, you will see a bulge over their chest. Place the
defibrillator pads as close to the correct position as possible without being directly over the
device. For persons with medication patches, remove the patch, wipe the skin dry, and
apply the AED pad.

Question 26

Many similarities exist between the BLS guidelines for adults and children. Following are the main
differences between the two

Answer 26

For children of all age groups, the compression to breaths ratio is 30:2 for one rescuer and
15:2 for two rescuers.

• The depth of compression may be different. For children, compress the chest at least one-third the depth of the chest. This may be less than two inches for small children (4 -5cm) but will be approximately two inches for larger children (5 cm).
• If you are the only rescuer at the scene and find an unresponsive child, perform CPR for two minutes before you call EMS or before you go look for an AED. The ILCOR emphasizes that cell phones are available everywhere now, and most have a built-in speakerphone, so you can call EMS while being with the child.
• In children, primary cardiac events are not common. Cardiac arrest is most commonly preceded by respiratory problems. Survival rates improve with early intervention for
  respiratory problems. Remember that prevention is the first link in the Pediatric Chain of Survival.
• If you witness a cardiac arrest in a child, call EMS and get an AED as you would in the Adult BLS sequence.

Question 27

ONE-RESCUER BLS FOR CHILDREN

Answer 27

If you are alone with a child at the scene, do the following:
1. Tap and talk loudly to the child to determine if they are responsive.

2. If the child does not respond and is not breathing (or only gasping), yell for help. If someone answers, send them to call 911/EMS and to get an AED.
3. Assess for breathing while simultaneously checking for the child’s carotid pulse (on the side
   of the neck) or femoral pulse (on the inner thigh in the crease between their leg and groin) for
   5 but no more than 10 seconds.
4. If you cannot feel a pulse (or if you are unsure), begin CPR by doing 30 compressions followed by two breaths. If you can feel a pulse but the pulse rate is less than 60 beats per minute, you should begin CPR. This rate is too slow for a child.
5. After doing CPR for about two minutes (usually about five cycles of 30 compressions and two breaths), and if other help has not arrived, call EMS while staying with the child. The ILCOR emphasizes that cell phones are available everywhere now and most have a built-in
   speakerphone. Get an AED if you know where one is.
6. Use and follow AED prompts when available while continuing CPR until EMS arrives or until
   the child’s condition normalizes.

Question 28

TWO-RESCUER BLS FOR CHILDREN

Answer 28

If you are not alone with a child at the scene, do the following:
1. Tap and talk loudly at the child to determine if they are responsive.
2. If the child does not respond and is not breathing (or if only gasping), have the second rescuer call 911/EMS and get an AED. (The ILCOR emphasizes that cell phones are available everywhere now and most have a built-in speakerphone, so you or the second rescuer can
call 911/EMS without leaving the scene).

3. Assess for breathing while simultaneously checking for the child’s carotid pulse (on the side
   of the neck) or femoral pulse (on the inner thigh in the crease between their leg and groin) for
   5 but no more than 10 seconds.
4. If you cannot feel a pulse (or if you are unsure), begin CPR by doing 15 compressions followed by two breaths. If you can feel a pulse but the pulse rate is less than 60 beats per minute, you should begin CPR. This rate is too slow for a child
5. When the second rescuer returns, begin doing CPR by performing 15 compressions by one
   rescuer and two breaths by the second rescuer.
6. Use and follow AED prompts when available while continuing CPR until EMS arrives or until
   the child’s condition normalizes.

Question 29

Criteria for high-quality CPR: FOR PEDIATRIC

Answer 29

• Rate at least 100-120 compressions per minute
• Compression depth to be one-third depth of
  the chest
• Full chest recoil between compressions
• Minimal interruptions during chest compressions
• Do not over-ventilate

Question 30

Pediatric BLS Algorithm

Answer 30

FIGURE 9. PAGE 20

Question 31

CHILD VENTILATION

Answer 31

If masks are available, they should be used in children as in adults; however, you must ensure the
mask is the correct size for the child.

The mask should cover the child’s mouth and nose without
covering the eyes or chin. You will not be able to get a good seal with a mask that is too big.

As with an adult, use the head-tilt/chin-lift maneuver to open the child’s airway. Each breath should last one second and should cause the child’s chest to rise.

As with an adult, avoid giving breaths too quickly, as this may result in distention of the stomach, vomiting, and possible aspiration of stomach contents.

Question 32

Child Ventilation Algorithm

Answer 32

PROPER
POSITION
In the absence of
neck injury, tilt the
forehead back and
lift the chin

TIGHT SEAL
Use the “E-C
clamp,” which is
the letters E and
C formed by the
fingers and thumb
over the mask

VENTILATE
Squeeze the bag
over one second
until the chest rises
Do not over
ventilate

Question 33

BLS for both children and infants is almost identical. Following are the main differences between BLS
for children and BLS for infants:

Answer 33

Check the pulse in the infant using the brachial artery on the inside of the upper arm between the infant’s elbow and shoulder (Figure 11a).

• During CPR, compressions can be performed on an infant using two fingers (Figure 11b), if only one rescuer; or with two thumb-encircling hands (Figure 11c), if there are two rescuers and rescuer’s hands are big enough to go around the infant’s chest.
• Compression depth should be one-third of the chest depth; for most infants, this is about
  1.5 inches (4 cm).
• If you are the only rescuer at the scene and find an unresponsive infant, perform CPR for two minutes before calling 911/EMS or using an AED.
• In infants, primary cardiac events are not common. Usually, cardiac arrest will be preceded by respiratory problems. Survival rates improve when you intervene with respiratory problems as early as possible. Remember that prevention is the first step in the Pediatric Chain of Survival.
• If you witness a cardiac arrest in an infant, call 911/EMS and get an AED as you would in the BLS sequence for adults or children.

Question 34

ONE-RESCUER BLS FOR INFANTS

Answer 34

If you are alone with the infant at the scene, do the following:
1. Tap the heel of their foot and talk loudly at the infant to determine if they are responsive.

2. Assess if they are breathing (Figure 11d) while simultaneously checking for the infant’s brachial pulse for 5 but no more than 10 seconds (Figure 11e). If the infant does not respond and is not breathing (only gasping), yell for help.
3. If someone responds, send the second rescuer to call 911/EMS and get an AED. (The ILCOR emphasizes that cell phones are available everywhere now and most have a built-in speakerphone, so rescuers do not have to leave the scene.)
4. If you cannot feel a pulse (or if you are unsure), begin CPR by doing 30 compressions followed by two breaths. If you can feel a pulse but the rate is less than 60 beats per minute, begin CPR. This rate is too slow for an infant. To perform CPR on an infant, do the following:
   a. Be sure the infant is face-up on a hard surface.
   b. Using two fingers, perform compressions in the center of the infant’s chest (Figure 11f); do
   not press on the end of the sternum as this can cause injury to the infant.
   c. Compression depth should be about 1.5 inches (4 cm) and 100-120 compressions per
   minute.
5. Perform CPR for about two minutes (using cycles of 30 compressions and two breaths). If
   help has not arrived, call 911/EMS and get an AED.
6. Use and follow AED prompts when available while continuing CPR until EMS arrives or until
   the infant’s condition normalizes.

Question 35

TWO-RESCUER BLS FOR INFANTS

Answer 35

If you are not alone with the infant at the scene, do the following:
1. Tap the bottom of their foot and talk loudly at the infant to determine if they are responsive.

2. If the infant does not respond, have the second rescuer call 911/EMS and get an AED. (The
   ILCOR emphasizes that cell phones are available everywhere now and most have a built-in speakerphone, so you can call while at the scene.)
3. Assess if they are breathing while simultaneously feeling for the infant’s brachial pulse for 5 but no more than 10 seconds.
4. If you cannot feel a pulse (or if you are unsure), begin CPR by doing 15 compressions followed by two breaths. If you can feel a pulse but the rate is less than 60 beats per minute, begin CPR. This rate is too slow for an infant.
5. When the second rescuer returns, begin CPR by performing 15 compressions by one rescuer
   and two breaths by the second rescuer. If the second rescuer can fit their hands around the infant’s chest, perform CPR using the two thumb-encircling hands method (Figure 11g). Do not press on the bottom end of the sternum as this can cause injury to the infant.
6. Compressions should be approximately 1.5 inches (4 cm) deep and at a rate of at least 100-120 per minute.
7. Use and follow AED prompts when available while continuing CPR until EMS arrives or until the infant’s condition normalizes.

Question 36

NOTE

Answer 36

An AED can be used on children and infants and should be used as early as possible for the best chance of improving the chance of survival. Check the AED when it arrives at the scene.

Pediatric pads should be used if the person is less than eight years old or less than 55 pounds (25 kg).
Standard (adult) pads may be used if pediatric pads are not available. If using standard (adult) pads, do not let the pads touch. For infants less than a year old, a manual defibrillator should be used if available.

If a manual defibrillator is not available, an AED may be used. Some AEDs have a switch that can be set to deliver a pediatric shock. If available, turn the switch on when using on children younger than eight years old.

If the AED cannot deliver a pediatric shock, an adult shock should be
given. It is important to remember an electric shock may be the treatment for a fatal heart rhythm.

Question 37

AED STEPS FOR CHILDREN AND INFANTS

Answer 37

1. Retrieve the AED (Figure 12a).
   a. Open the case.
   b. Turn on the AED.
2. Expose the person’s chest (Figure 12b).
   a. If wet, dry the chest.
   b. Remove any medication patches.
3. Open the Pediatric AED pads (Figure 12c).
   a. Peel off backing.
   b. Check for pacemaker or implanted defibrillator.
4. Apply the pads (Figure 12d).
   a. Apply one pad on the upper right chest above the breast.
   For infants, apply on front of chest
   b. Apply the second pad on lower left chest below the armpit.
   For infants, apply second pad to back (Figure 12e).
5. Ensure wires are attached to the AED box (Figure 12f).
6. Move away from the child (Figure 12g).
   a. Stop CPR.
   b. Instruct others not to touch the person.
7. Let AED analyze the rhythm.
8. If AED message reads “Check Electrodes,” then:
   a. Ensure electrodes make good contact (Figure 12f).
9. If AED message reads “Shock,” then:
   a. Press and hold flashing shock button until shock is delivered.
10. Resume CPR for two minutes starting with chest compressions (Figure 12h).
11. Repeat steps 1-10.

Question 38

AIRWAY
MANAGEMENT

Answer 38

Until an advanced airway is inserted, the rescue team should use mouth-to-mouth, mouth-to-mask, or bag-mask ventilation. An advanced airway (supraglottic airway, laryngeal mask airway, or
endotracheal tube) provides a more stable way of providing breaths and should, therefore, be inserted as early as possible in a resuscitation effort.

Question 39

The compression rate for?

Answer 39

The compression rate for
all persons is always 100-120
per minute.

Question 40

COMPRESSION TO BREATH
RATIO- ADULT

Answer 40

NO ADVANCED AIRWAY
30 compressions followed
by two breaths

ADVANCED AIRWAY
One breath every 6 seconds
without pauses in compressions

Question 41

COMPRESSION TO BREATH
RATIO- CHILD/INFANT

Answer 41

NO ADVANCED AIRWAY
30 compressions followed
by two breaths for one rescuer
15 compressions followed by
two breaths for two rescuers

ADVANCED AIRWAY
One breath every 6 seconds
without pauses in compressions
One breath every 2-3 seconds
(20-30 breaths per minute)

Question 42

MOUTH-TO-MOUTH RESCUE BREATHING

Answer 42

When a pocket mask or bag-mask is not available, it may be necessary to give mouth-to-mouth breaths during CPR. Mouth-to-mouth breathing is very effective in delivering oxygen into the
person’s lungs without putting the rescuer at a high level of risk. The rescuer’s exhaled air contains
approximately 17% oxygen and 4% carbon dioxide. This is in contrast to the 100% oxygen available with ventilation with 100% high flow oxygen and the 21% oxygen that is available in room air that we
breathe.

Question 43

ADULTS AND OLDER CHILDREN MOUTH-TO-MOUTH

Answer 43

Do not give breaths too rapidly or too forcefully. Doing this may cause air to be forced into the stomach, resulting in distention and less room for lung expansion. It may also cause vomiting.
To deliver mouth-to-mouth breaths, do the following:

1. Open the airway using the head-tilt/chin-lift maneuver (Figure 13a).
2. Pinch the person’s nose closed with your hand on the person’s head (Figure 13b).
3. Create a seal when using your lips to surround the person’s mouth (Figure 13c).
4. Blow into the person’s mouth for one full second and watch for chest to rise (Figure 13d). Tilt the victim’s head further back if the chest does not rise.
5. Give an additional breath for over one second.
6. If you cannot see the chest rise in two breaths, continue giving chest compressions.

Question 44

INFANTS MOUTH-TO-MOUTH/NOSE

Answer 44

When performing rescue breathing on an infant, the rescuer should cover the infant’s mouth and
nose when possible and do the following:
1. Open the airway using the head-tilt/chin-lift maneuver (Figure 14a). Be sure not to hyper-extend the neck. Aim for a neutral position.

2. Create a seal using your lips to surround the infant’s nose and mouth (Figure 14b).
3. Gently blow into the infant’s nose and mouth for one second(Figure 14c). Keep in mind that an infant’s lungs are smaller than an adult’s and need a smaller volume of air. Watch for the infant’s chest to rise. If you cannot see the chest rise, re-adjust the tilt of their head.
4. Give an additional breath and watch for the infant’s chest to rise. If unable to cover both mouth and nose entirely with your mouth, use the following method for rescue breathing:
   a. Open the airway using the head-tilt/chin-lift maneuver.
   b. Pinch the infant’s nose closed.
   c. Create a seal using your lips to surround the infant’s mouth.
   d. Gently blow into the infant’s mouth for one second.
   e. Give an additional breath and watch for the chest to rise.

Question 45

RESCUE BREATHING

Answer 45

In many cases, cardiac arrest is preceded by respiratory arrest. Therefore, it is important to be able to recognize respiratory issues in order to take steps to prevent cardiac arrest.

When a person of any age has a pulse but is not breathing (or is not breathing well), immediately
open the airway using the head-tilt/chin-lift maneuver and begin rescue breathing. See Table 2 for
details on rescue breathing.

Question 46

RESCUE BREATHING- ADULT

Answer 46

HOW OFTEN
Every 6 seconds

BREATHS PER MINUTE
10 to 12 breaths per minute

DURATION
Each breath should last one second

EVALUATION
Check for chest rise and breathing;
Check pulse and begin CPR if necessary

Question 47

RESCUE BREATHING- CHILD/INFANT

Answer 47

HOW OFTEN
One rescuer: Every 6 seconds Two rescuers: Every 2 to 3 seconds

BREATHS PER MINUTE
One rescuer: 10 to 12 breaths per minute Two rescuers: 20 to 30 breaths per minute

DURATION
Each breath should last one second

EVALUATION
Check for chest rise and breathing;
Check pulse and begin CPR if necessary

Question 48

Choking In Adults And Children
Mild Obstruction

Answer 48

PERSON’S RESPONSE
* breathing but may also be wheezing
* coughing and making noise

RESCUER’S ACTION
* stay with the person and try to keep them calm
* encourage them to cough
* call 911/EMS if the person seems to be getting worse

Question 49

Choking In Adults And Children
Severe Obstruction

Answer 49

PERSON’S RESPONSE
* clutching the neck (universal sign
of choking: figure 15)
* weak or no cough
* unable to make noise or talk; may
make high-pitched noise
* little or no breathing
* may be cyanotic (blue around lips
and fingertips)

RESCUER’S ACTION
* use abdominal thrusts to attempt
to remove obstruction
* call 911/EMS
* begin BLS if the person becomes
unresponsive

Question 50

NOTE

Answer 50

If you can see a foreign object in the
individual’s mouth and can easily
remove it, then do it. Watch and
feel for breathing to begin. If the
individual does not begin breathing, continue to provide CPR and
rescue breaths until help arrives.

Question 51

Abdominal Thrusts

Answer 51

These steps should only be used when a person is responsive and older than one year of age.

To properly perform abdominal thrusts, do the following:
1. Stand behind the responsive person. Wrap your arms around their waist under their ribcage.

2. Put the side of your fist above the person’s navel in the middle of their belly. Do not press on the lower
   part of the sternum (Figure 16a).
3. With your other hand, hold the first fist and press forcefully into the person’s abdomen and up
   toward their chest (Figure 16b and 16c).
4. Continue performing these thrusts until the obstruction is relieved or until the person becomes unresponsive.

Question 52

Choking In Infants
Mild Obstruction

Answer 52

INFANT’S RESPONSE
* breathing but may also
be wheezing
* may be coughing and
making noise

RESCUER’S ACTION
* stay with the infant and try to keep
them calm
* do not do a blind finger sweep
* call 911/EMS if infant does not quickly clear the obstruction

Question 53

Choking In Infants
Severe Obstruction

Answer 53

INFANT’S RESPONSE
* weak or no cough
* unable to make noise; may make
high-pitched noise
* little or no breathing
* may be cyanotic (blue around lips
and fingertips)

RESCUER’S ACTION
* use back blows/chest thrusts to attempt to remove obstruction
* call 911/EMS
* begin BLS if infant becomes unresponsive
* assess if obstruction is visible; if so, remove it

Question 54

BACK BLOWS AND CHEST THRUSTS IN INFANTS

Answer 54

In a choking but responsive infant less than one-year-old, back blows and chest thrusts are used instead of abdominal thrusts. See Table 4 for rescue actions for choking in infants. To provide back blows and chest thrusts, do the following:
1. Hold the infant in your lap.

2. Put the infant with their face down and their head lower than their chest; they should be resting
   on your forearm. Put your forearm on your thigh (Figure 17a).
3. Support the infant’s head and neck with your hand and be sure to avoid putting pressure on their throat.
4. Using the heel of your free hand, deliver five back blows between the infant’s shoulder blades
   (Figure 17b).
5. Using both hands and arms, turn the infant face up so they are now resting on your other arm; this arm should now be resting on your thigh (Figure 17c).
6. Make sure the infant’s head is lower than their chest.
7. Using the fingers of your free hand, provide up to five quick downward chest thrusts over the
   lower half of the breastbone (Figure 17d). Perform one thrust every second.
8. If the obstruction is not relieved, turn the infant face down on your other forearm and repeat
   the process (Figure 17b).
9. Continue doing these steps until the infant begins to breathe or becomes unresponsive.