# rescue breathing



## emt seeking first job (Aug 30, 2010)

Adults 1 breath every 5-6 seconds.

Children 1 breath every 3-5 seconds.

Is their an infant rate? A neo-natal rate?

There was nothing in my orange text book or class notes.

Thank you.


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## MrBrown (Aug 30, 2010)

What is this, first aid class in the fifties?

If you are doing CPR it's 30:2 no matter who

If you are manually ventilating with a bag mask adults is 8-10 breaths a minute and children 16-20 .... or if you have an asthmatic patient then six breaths a minute and not more.


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## emt seeking first job (Aug 30, 2010)

Thank you for the reply, however, I think protocols may be different in your nation.

I am just going through my notes as I bide my time for my next interview.

I was reviewing everything.

I just noticed in the CPR guidelines for American College of Orth Surgeons a/k/a Orange Book, there was no numbers for children.


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## emt seeking first job (Aug 30, 2010)

MrBrown said:


> What is this, first aid class in the fifties?
> 
> .



This is the BLS forum. I posted a BLS question.


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## MasterIntubator (Aug 30, 2010)

Neonate resp range that we use in the NICU is 20-60.  40 is about the norm.  Textbook answers are out there in Google.  Real world... I know we look at the whole picture, color, EtCO2, sats and titrate from there.  We start about about 1 breath q 3 sec and go from there.

Biggest thing... control your efforts, it is way to easy to cause barotrauma by an over-enthusiastic hyped up provider.:-/


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## emt seeking first job (Aug 30, 2010)

MasterIntubator said:


> Neonate resp range that we use in the NICU is 20-60.  40 is about the norm.  Textbook answers are out there in Google.  Real world... I know we look at the whole picture, color, EtCO2, sats and titrate from there.  We start about about 1 breath q 3 sec and go from there.
> 
> Biggest thing... control your efforts, it is way to easy to cause barotrauma by an over-enthusiastic hyped up provider.:-/



Thank you, do you know of an EMS link that addresses that.

In an NICU, or on a specialty ambulance for neo-nats, I assume there is a machine doing the respirations ?


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## emt seeking first job (Aug 30, 2010)

*Please be aware.*

My question is re: BLS protocols, preferably in New York State and New York City.


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## Sasha (Aug 30, 2010)

http://lmgtfy.com/?q=new+york+state+ems+protocols


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## emt seeking first job (Aug 30, 2010)

Thank you for your reply.

I hoped that satisified yourself to invoke the lmgtfy, but the textbook for the CPR cert I have does not adress rescue breathes for infants, only adults or children.


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## Sasha (Aug 30, 2010)

It's simply showing you that many answers to your questions could be found by googling.

P.S- In school I rarely opened my textbook. If there was something I didn't know, I took to google. I learned a lot more than the textbook would teach about the subject. It often baffled my classmates how I could forget to bring my book to class on a regular basis but still had the highest grade in the class, and google is why. It's a valuable resource.


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## emt seeking first job (Aug 30, 2010)

Google is a search engine, it is not a source, I did read through the protocols for NYS/NYC and it was not adressed.

I was just seeing if someone was aware of it.

I am sorry to take up your time.

Don't you have any gum snapping, face-booking or sticker placing you need to catch up on ?


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## Sasha (Aug 30, 2010)

emt seeking first job said:


> Google is a search engine, it is not a source, I did read through the protocols for NYS/NYC and it was not adressed.
> 
> I was just seeing if someone was aware of it.
> 
> I am sorry to take up your time.



Google is a source to link you to other sources.  That linked you to more than one webpage. Just because you're looking for a specific answer doesn't mean you can't learn things you weren't looking for.



> Don't you have any gum snapping, face-booking or sticker placing you need to catch up on ?



Nope, just gotta finish washing my work uniforms for my next shift  Ahhh it's nice to be a working, paid "sun god"


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## emt seeking first job (Aug 30, 2010)

*getting back on topic........*

Under New York State or City Protocols, and for CPR under the Academy of Surgeons/Ortho a/k/a Orange Book, can anyone refrence a source for rescue breathing for infants and neo-nats, while doing professional rescuer CPR ?

Thank you as always.


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## reaper (Aug 30, 2010)

You know, Two different people have told you how to find the answer. Look it up and stop being lazy. If you obtained a CPR card, you learned this already.


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## emt seeking first job (Aug 30, 2010)

Thank you for writing.

Be aware if a post offends you there is the option to ignore it.

You can say that for any post here, look it up, particularly the ones for names of ambulance compnaies (listed on DOH website).

It was not in my notes, the textbook, the website for the CPR organization, the NYS or NYC protocols.

It is possible that one is, for professional CPR, merely use the #'s of a child...?

It is not the biggest deal, I have enough verifyable sources and topics to study anyway as I bide time studying and working out until mid Sept  when FDNY hires and there will be openings at the NYC privates.....


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## reaper (Aug 30, 2010)

Be aware that when people tell you how to find the answer, then find it. Asking a question on the forums is perfectly fine. When people take the time to tell you how to find it and you ignore it, then that is being lazy.

Did you not learn how many times a minute an infant and neonate breath? break that down into seconds and you have your answer


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## emt seeking first job (Aug 30, 2010)

reaper said:


> Be aware that when people tell you how to find the answer, then find it. Asking a question on the forums is perfectly fine. When people take the time to tell you how to find it and you ignore it, then that is being lazy.
> 
> Did you not learn how many times a minute an infant and neonate breath? break that down into seconds and you have your answer



I already have in my notes how often they breathe. That was not the question.

I realize in the field, whatever needs to be done to ventialate them will be done....I had a specific question if it was adressed in a written protocol....specific numbers, as in the protocol a child is 1 every 3-5 seconds, yet in the field if more or less are warranted it is done that way....


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## Aidey (Aug 30, 2010)

In your area there may not be a protocol for an exact number, as they expect the provider to use their knowledge and judgment. I suggest you dig out your CPR book and look it up. The number of times a patient of a certain age is relevant, since that is the range you want to shoot for.


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## emt seeking first job (Aug 30, 2010)

Aidey said:


> In your area there may not be a protocol for an exact number, as they expect the provider to use their knowledge and judgment. I suggest you dig out your CPR book and look it up.



That is my best guess.

It is not adressed in the book, everything is adult or child, yet for compressions, there is an infant and neo-nat #....

The CPR organization has a website, with a chart, and the rescue breathing #'s are not adressed.

Unless someone corrects me, I will assume those numbers are not adressed. If it ends up being a question on a test, I wil make my best guess, and if not have to eat that question.

Thank you everyone who replied.


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## MasterIntubator (Aug 30, 2010)

Ok... now you gone and done it... made me do work..... in my book, "Paramedic Practice Today, Barbara Aehlert, Mosby, Dated 2010".  Volume 2, Page 52 ( ch. 36 ) Neonatology:   States, Ventilation 40-60 breaths a minute.  When compressions are being done, its 30 breaths a minute.  With a minimum volume of 450ml and maximum volume of 750ml. with a pop off set to 35 cm H2O. ( Ref .p 51 )

I paraphrased, but its in there.
 I deserve a cookie..... no?


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## emt seeking first job (Aug 30, 2010)

*thank you*

http://cdn-i.dmdentertainment.com/funpages/cms_content/11745/images/cookie.gif


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## MasterIntubator (Aug 30, 2010)

AHHHHhhh... and I even clicked on it.....


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## FreezerStL (Sep 1, 2010)

In my area we use AHA guidelines,

Here's a link to all the PALS info ( little dated @ 2005 )

http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-167

Something to note:

*Precautions*
Victims of cardiac arrest are frequently overventilated during resuscitation.12–14 Excessive ventilation increases intrathoracic pressure and impedes venous return, reducing cardiac output, cerebral blood flow, and coronary perfusion.13 Excessive ventilation also causes air trapping and barotrauma in patients with small-airway obstruction and increases the risk of stomach inflation, regurgitation, and aspiration.

Minute ventilation is determined by the tidal volume and ventilation rate. Use only the force and tidal volume needed to make the chest rise visibly.


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## Melclin (Sep 1, 2010)

I'm quite confused about what you want. 

--> Are you talking about ventilating an apneic pt. If so:
Neonates: 40-60 pretty much anywhere you look. There is no specific number of 1-2 seconds or anything like that kicking around anywhere as far as I know. 
Infants and Children - depends how you break it down and group people into age blocks. You won't find a number set in stone for venting "children" because its changes based on age and how much you need to achieve with the ventilation. In general, you ventilate usually with a target rate of somewhere near the normal resp rate range for that age. Particular agencies probably set numbers in stone in protocols and it would simply depend on that agency. Memorise it when you start working for them. If you want a rough idea of resp rates for ages, then any number of googlable web pages can help you out. 

*OR*

-->Are you talking about ventilations during CPR? You keep mentioning compressions. If so whats wrong with the ratio? You won't be ventilating "every number-number" during CPR. You simply follow your ratio of compression to ventilations unless you have an advanced airway and you were quite clear that this is a BLS question. If you really want a number, figure it out from your CPR ratio over two minutes, but I can't see any benefit in doing that. 



Ultimately though, if you're just after a number to make you feel better, then surely whatever nearby agency that you want to work for can provide you with protocols.


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## VirginiaEMT (Sep 23, 2010)

MrBrown said:


> What is this, first aid class in the fifties?
> 
> If you are doing CPR it's 30:2 no matter who
> 
> If you are manually ventilating with a bag mask adults is 8-10 breaths a minute and children 16-20 .... or if you have an asthmatic patient then six breaths a minute and not more.



It nust be the 50's because you are wrong. Our local protocols dictates a 3:1 ratio for newborns.


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## the_negro_puppy (Sep 23, 2010)

VirginiaEMT said:


> It nust be the 50's because you are wrong. Our local protocols dictates a 3:1 ratio for newborns.



Indeed, ours are 3:1 for 0-27 days, then > 28 days 30:2


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## CAOX3 (Sep 24, 2010)

emt seeking first job said:


> Don't you have any gum snapping, face-booking or sticker placing you need to catch up on ?



Wow,

Someone needs a timeout.


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## emt seeking first job (Sep 24, 2010)

Melclin said:


> I'm quite confused about what you want.
> 
> --> Are you talking about ventilating an apneic pt. If so:
> Neonates: 40-60 pretty much anywhere you look. There is no specific number of 1-2 seconds or anything like that kicking around anywhere as far as I know.
> ...




Thank you.

I was refering to an apnic patient, ie, a pulse but no breathing.

I am in New York City. Unless I missed it, the protocols for the city or the state of New York do not adress it. Nor did my emt-b class.

My class taught 1:5-6 adult, and 1:3-5 for children but did not address infants or neo-nates. 

I will certainly ask that question when employed, just using the forum for some thoughts.

I realize the street and book are two different things....


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## emt seeking first job (Sep 24, 2010)

VirginiaEMT said:


> It nust be the 50's because you are wrong. Our local protocols dictates a 3:1 ratio for newborns.



I was asking about rescue bretahes only. Patient has a pulse.


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## jms81 (Sep 25, 2010)

Keep in mind that it's highly unlikely you'll see an infant/neo nate that is apneic with a pulse.


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## jms81 (Sep 25, 2010)

Also, the compression:breath rate should be 30:2 for everyone, the only exception being infants during 2 rescuer cpr. Your local protocols may dictate otherwise. If, consider trying to change them.


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## reaper (Sep 25, 2010)

jms81 said:


> Keep in mind that it's highly unlikely you'll see an infant/neo nate that is apneic with a pulse.



Really? Where are you getting this from?


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## jms81 (Sep 25, 2010)

reaper said:


> Really? Where are you getting this from?



Field experience, and the system that has the highest percentage of SCA saves in the United States. I'm not saying it's not possible, just that in an infant, once breathing stops, cardiac arrest is typically almost imminent.


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## reaper (Sep 25, 2010)

jms81 said:


> Field experience, and the system that has the highest percentage of SCA saves in the United States. I'm not saying it's not possible, just that in an infant, once breathing stops, cardiac arrest is typically almost imminent.



That must be a big head! Do you truly believe the percentages? I have worked dozens of resp arrest neonates and infants, that still had pulses.


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## jms81 (Sep 25, 2010)

reaper said:


> That must be a big head! Do you truly believe the percentages? I have worked dozens of resp arrest neonates and infants, that still had pulses.



Sorry, I had no intention of offending you if that's what I did. I would think everyone could be respectful of each other here. Guess I was wrong.

BTW, like I said, I was speaking from experience, and yes, statistics. If you don't believe in statistics, I won't try to convince you.


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## MasterIntubator (Sep 26, 2010)

I believe that would statistically be incorrect, just sounds not correct.  Matter of fact.... 9 out of 10 adults who are apneic for more than 4 minutes often suffer cardiac arrest.


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## jms81 (Sep 26, 2010)

MasterIntubator said:


> I believe that would statistically be incorrect, just sounds not correct.  Matter of fact.... 9 out of 10 adults who are apneic for more than 4 minutes often suffer cardiac arrest.



Good point that it applies to adults too.


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## EMSslick536 (Nov 23, 2010)

*50's?*



MrBrown said:


> What is this, first aid class in the fifties?
> 
> If you are doing CPR it's 30:2 no matter who
> 
> If you are manually ventilating with a bag mask adults is 8-10 breaths a minute and children 16-20 .... or if you have an asthmatic patient then six breaths a minute and not more.



Per the new BLS protocalls, Two - Person CPR on an Infant will be 15:2. (Someone correct me if im wrong)


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## 18G (Nov 23, 2010)

From the American Heart Association



> *CPR for Newborns*
> Recommendations for the newborn are different from recommendations for infants. Because most providers who care for newborns do not provide care to infants, children, and adults, the educational imperative for universal or more uniform recommendations is less compelling. There are no major changes from the ECC Guidelines 2000 recommendations for CPR in newborns28:
> 
> The rescue breathing rate for the newborn infant with pulses is approximately 40 to 60 breaths per minute.
> ...


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## abckidsmom (Nov 23, 2010)

VirginiaEMT said:


> It nust be the 50's because you are wrong. Our local protocols dictates a 3:1 ratio for newborns.



True, but that's ONLY neonatal resuscitation, a limited application.  Every other category of patient gets 15:2 or 30:2, and I'd use those rates, based on the patient's heart rate range to get a judgment of what a good respiratory rate would be.  

And then, if I was manually ventilating the patient, I'd use every ounce of myself to slow down a little further.  

People bag too fast, and cause barotrauma.


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## CAOX3 (Nov 24, 2010)

We do 3:1 ratio for neonates.

After a month old its 15:2.

As Reaper stated it very possible you could be doing compressions on a neonate/infant with a pulse, many are non perfusing rates and compressions should be initiated.


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## DarkStarr (Nov 24, 2010)

my service had a call for a 24 yo f not breathing, not sure of the specifics, but reminded me of this thread.  if I had been up earlier I would have gone to assist.


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