infant BLS

[a0011010011]

Hi I am doing a EMT I course.
I was given the following in my exam.
An infant 5 months old.
Blue skin tone
Held by the mother.
I took the child preformed a mouth check immediately, I found milk, fluid in the mouth of the child, I flipped the child onto the stomach and preformed a clearing procedure, (cleared all milk and other material,l clearance from the direct airway) This was done twice (the instructor claimed that I was not successful with the first attempt) after 2 attempts, the child continued to cry, had a breath of 6 breathes per 10 seconds, but was still blue was crying. As a EMT I called for paramedic, Then cancelled the call after 60 heart beats per second was found. The child WAS conscious at this stage.
Because the baby was blue, (instructor based call) I decided to use the AMBU (I don’t know what you call it but we call it AMBU, it’s the manual air united forcing air into the child) this unit was connected to O2 providing 10 liters per minute, my call was to manually ventilate the baby with O2 (It was blue)
As an after thought the instructor was planning to test me for foreign airway obstruction.
This threw me totally, how can a child be breathing 60 breaths per minute, conscious be blue. Ok I thought, blue is sign of lack of O2 lets try control the breaths, give the child O2. I applied 1 breath 3-4 seconds. (I failed the exam for using the AMBU) We will not go into the fact that I over squeezed the AMBU, the chief complaint was that I used the AMBU in the first place. I could have used a face mask (passive) instead of using the AMBU (aggressive),
In my opinion the child was wild in panic, chocked on its mother’s milk, this is acceptable, it happens. There is no “solid” martial that the child can choke on, I cleared the mouth and airway 2 times and the child was blue, There was no sign of an obstruction in the airway as the child had 60 breaths per minute, I could have given a mask (passive) but I wanted to be ready for CPR (so I used the AMBO it’s a CPR exam after all)
There is no chance of a solid marital getting stuck in the throat as we are talking about mothers milk. So obviously the only thing we are talking about is drowning, with milk. Without underling medical conditions, (I did not ask as there are to many people to ask ie the examiner the fake mother etc, and this information is generally automatically given by the family at the time of the event) So here is my questions, what do you do in this situation, use AMBU to regulate breathing ? How do you identify chocking of the victim if they have normal breaths 60 + - in an infant ? and how would you have don’t different ?
Thanks for the answers.

 

[Lifeguards For Life]

Hi I am doing a EMT I course.
I was given the following in my exam.
An infant 5 months old.
Blue skin tone [B]cyanosis is a late sign of hypoxia[/B]
Held by the mother.
I took the child preformed a mouth check immediately, I found milk, fluid in the mouth of the child, I flipped the child onto the stomach and preformed a clearing procedure what was your clearing procedure?, (cleared all milk and other material,l clearance from the direct airway) This was done twice (the instructor claimed that I was not successful with the first attempt) after 2 attempts, the child continued to cry, had a breath of 6 breathes per 10 seconds10 seconds is not long enough to accurately gage a RR, but was still blue was crying. As a EMT I called for paramedic, Then cancelled never cancel ALSthe call after 60especially when that is roughly 60 beats below the average for a child that age heart beats per second was found. The child WAS conscious at this stage.
Because the baby was blue, (instructor based call) I decided to use the AMBU (I don’t know what you call it but we call it AMBU, it’s the manual air united forcing air into the child)a bag valve mask? this unit was connected to O2 providing 10 liters per minute, my call was to manually ventilate the baby with O2 (It was blue)
As an after thought the instructor was planning to test me for foreign airway obstruction.
This threw me totally, how can a child be breathing 60 breaths per minute, conscious be blue. Ok I thought, blue is sign of lack of O2 lets try control the breaths, give the child O2. I applied 1 breath 3-4 seconds. (I failed the exam for using the AMBU) We will not go into the fact that I over squeezed the AMBU, the chief complaint was that I used the AMBU in the first place. I could have used a face mask (passive) instead of using the AMBU (aggressive),
In my opinion the child was wild in panic, chocked on its mother’s milk, this is acceptable, it happens. There is no “solid” martial that the child can choke on, I cleared the mouth and airway 2 times and the child was blue, There was no sign of an obstruction in the airway as the child had 60 breaths per minute, I could have given a mask (passive) but I wanted to be ready for CPR (so I used the AMBO it’s a CPR exam after all)
There is no chance of a solid marital getting stuck in the throat as we are talking about mothers milk. partial airway obstruction may lead to stertorous respirations accompanied by wheezing, dyspnea, tachypneaSo obviously the only thing we are talking about is drowning, with milk. Without underling medical conditions,so you did not gather any medical hx.... (I did not ask as there are to many people to ask ie the examiner the fake mother etc, and this information is generally automatically given by the family at the time of the event) So here is my questions, what do you do in this situation, use AMBU to regulate breathing ? How do you identify chocking of the victim if they have normal breaths 60 + - in an infant ? and how would you have don’t different ?
Thanks for the answers.

How do you identify chocking of the victim if they have normal breaths 60 + - in an infant

Inability to cry or make much sound
Weak, ineffective coughing
Soft or high-pitched sounds while inhaling
Difficulty breathing - ribs and chest retract
Bluish skin color
Loss of consciousness if blockage is not cleared

I would:
Know normal vital signs
know about hypoxia
know the clinical signs of respiratory failure
know the PAT(pediatric assessment triangle)
know that cariac arrest is almost always caused by pediatric arrest inpeds
You didn't really give a scenario, for us to tell you what we would of done?

o here is my questions, what do you do in this situation, use AMBU to regulate breathing ?

Positive pressure ventilation should be initiated in the poorly responsive child with respiratory distress or in the child with cyanosis, gasping, or apnea unresponsive to supplemental oxygen.

Begin by opening airway, using jaw thrust if C-spine injurysuspected. Suctioning may be required to clear the airway of blood, vomitus or visible secretions.(or milk?) Ventilations can be initiated with pediatric bag- valve-mask device and 100 percent O2. If spontaneous respiratory effort is present, attempt to coordinate assisted ventilations with child’s own breaths.

And a little organization an objective observations go along way in writing a post.

 

[Lifeguards For Life]

Was the infant coughing or did they cry? If a partial FBAO was the primary problem, either of those actions could dislodge the obstruction, and if that be the case, use of a BVM would not be indicated yet

 

[a0011010011]

the heart beat was 60, with the child being blue with 60 breaths per minute
i suspected hypoxia, but this was strange for a regular child, So i applied AMBU,and this was the problem(acording to the instructor), the fact that I aplied AMBU. I suspected cyanosis and this is the correct thing to do, as far as I know.

Passive O2 Mask would have worked as well but there was obviously a disorder in the respotory system of the infant, so I wanted to control and regulate breathing in the patient.

There was no reason to suspect spinal trauma

I was only told Milk was in the mouth and the baby was crying

 

[a0011010011]

the patient cried

and also co-ordination of breaths on a dummy is a little hard

 

[Lifeguards For Life]

the heart beat was 60, with the child being blue with 60 breaths per minute
i suspected hypoxia, but this was strange for a regular child, So i applied AMBU,and this was the problem(acording to the instructor), the fact that I aplied AMBU. I suspected cyanosis and this is the correct thing to do, as far as I know.

Passive O2 Mask would have worked as well but there was obviously a disorder in the respotory system of the infant, so I wanted to control and regulate breathing in the patient.

Has your EMT-I course not taught you the clinical presentations of cyanosis?

If the child was indeed choking, did you not consider alternating backblows with chest thrusts?

Attached is a link detailing instructions for the lay person to utilize, untill EMS arrives.

 

[a0011010011]

Has your EMT-I course not taught you the clinical presentations of cyanosis?

If the child was indeed choking, did you not consider alternating backblows with chest thrusts?

Attached is a link detailing instructions for the lay person to utilize, untill EMS arrives.

but the child had 60 pulse and 60 breaths countious , a low pulse yes, but no indication of choking, 60 breaths with blue colour skin (cyanosis :a bluish discoloration of the skin and mucous membranes; a sign that oxygen in the blood is dangerously diminished (as in carbon monoxide poisoning)) But I did not suspect CO2 as the cause because the child was feeding and the mother would have had some signs herself, or if there was gas the smell would be prevolent

 

[Lifeguards For Life]

but the child had 60 pulse and 60 breaths countious , a low pulse yes, but no indication of choking, 60 breaths with blue colour skin (cyanosis :a bluish discoloration of the skin and mucous membranes; a sign that oxygen in the blood is dangerously diminished (as in carbon monoxide poisoning)) But I did not suspect CO2 as the cause because the child was feeding and the mother would have had some signs herself, or if there was gas the smell would be prevolent

your definition of cyanosis, copied verbatim from http://dictionary.babylon.com/Cyanosis, and discussion of carbon monoxide, which is not Co2, would lead one to beleieve you are not in an EMT course

 

[medichopeful]

I took the child preformed a mouth check immediately, I found milk, fluid in the mouth of the child, I flipped the child onto the stomach and preformed a clearing procedure, (cleared all milk and other material,l clearance from the direct airway) This was done twice (the instructor claimed that I was not successful with the first attempt) after 2 attempts, the child continued to cry, had a breath of 6 breathes per 10 seconds, but was still blue was crying.

Remember, just because it is a breath does NOT mean it is an ADEQUATE breath. A child can can be breathing "x" times per minute, but if they are not breathing adequately (decreased minute volume, shallow respirations, etc.), than those breaths may not be doing much good.

As a EMT I called for paramedic, Then cancelled the call after 60 heart beats per second was found.

I'm assuming you meant 60 beats per MINUTE (60 beats/sec would equate to 3600 bpm. The heart, as far as I know, could not withstand this). If this is the case, that was approximately HALF of what it should be. You should NOT have cancelled ALS at this point.

Because the baby was blue, (instructor based call) I decided to use the AMBU (I don’t know what you call it but we call it AMBU, it’s the manual air united forcing air into the child) this unit was connected to O2 providing 10 liters per minute, my call was to manually ventilate the baby with O2 (It was blue)

We call it a bag-valve mask, or BVM. I've heard both.

This threw me totally, how can a child be breathing 60 breaths per minute, conscious be blue.

Like I said earlier, QUALITY of the breaths is VERY important too.

Ok I thought, blue is sign of lack of O2 lets try control the breaths, give the child O2. I applied 1 breath 3-4 seconds. (I failed the exam for using the AMBU) We will not go into the fact that I over squeezed the AMBU, the chief complaint was that I used the AMBU in the first place. I could have used a face mask (passive) instead of using the AMBU (aggressive),

You were correct on aggressively managing the airway. I'm guessing that the problem was that your instructor assumed there was more obstructing the airway than you had cleared. In this case, ventilation would have been completely inappropriate, as it could have very easily forced the object farther into the trachea, which could have completely occluded it.

So here is my questions, what do you do in this situation, use AMBU to regulate breathing ? How do you identify chocking of the victim if they have normal breaths 60 + - in an infant ? and how would you have don’t different ?

Get the liquid out of the child's mouth ASAP, using suction (CAREFULLY!) if necessary. Then, if the child is still choking (which cyanosis would definitely hint towards), begin cycles of 5 back thrusts followed by 5 chest thrusts. Continue doing this until one of the following happens: A) the airway is cleared, or B ) the child becomes unresponsive. If the second one happens, open the airway, and give the two breaths. Do everything possible to make sure they go in. Then begin doing the compressions/breaths etc.. Each time you go to give breaths, look in the mouth to look for obstructions. If you see it remove it. (NOTE: this is assuming that it IS, in fact, a choking).

The biggest thing I would have done differently is to do the back thrusts/chest thrusts. I have the feeling your instructor failed you because you ventilated too soon. (See "note" above)

 

[akflightmedic]

Troll.

 

[medichopeful]

but the child had 60 pulse and 60 breaths countious , a low pulse yes, but no indication of choking, 60 breaths with blue colour skin (cyanosis :a bluish discoloration of the skin and mucous membranes; a sign that oxygen in the blood is dangerously diminished (as in carbon monoxide poisoning)) But I did not suspect CO2 as the cause because the child was feeding and the mother would have had some signs herself, or if there was gas the smell would be prevolent

There's something not right about this scenario. How could they be breathing 60x per minute, crying, and have a pulse of 60?

 

[akflightmedic]

Don't stress, this entire thread is bogus. Not surprising with all the recent turmoil...it always happens.

 

[medichopeful]

Don't stress, this entire thread is bogus. Not surprising with all the recent turmoil...it always happens.

True, but I'm hoping that I'll be able to learn something from it somehow. If not from the OP, than from somebody else.

 

[medichopeful]

know that cariac arrest is almost always caused by pediatric arrest inpeds

Did you mean cardiac arrest is almost always caused by RESPIRATORY arrest in peds? :wacko:

 

[akflightmedic]

There is only so much polishing of a turd one can do....I would just read other threads for that glimmer of learnin' you seek.

 

[a0011010011]

your definition of cyanosis, copied verbatim from http://dictionary.babylon.com/Cyanosis, and discussion of carbon monoxide, which is not Co2, would lead one to beleieve you are not in an EMT course

My definition as you stated is correct, is copied from that site, and guess what, I am in an EMT course, I am a South African, In Israel in doing a EMT - I course, But I am doing this course in a laguage that is NOT native to me, with people who have more experiance that any other people with TRAUMA managment. I have already been on live calls with stuff that makes my hair white just thinking about it. Lets take you, you have ALS ? ok by the anwswers you have been giving BLS. lets take you and stick you in Russia, give you basic language skills, and lets see you take a BLS course !!! So you have a choice, help or piss off. I suspect the point of this forum is to improve your skills as an EMT, if you cannot give a answer dont make one up.
or dont get personal with someone who is trying to improve themselves. you have not in the last 7 answers come up with a reason pro or con to use AMBU or not. My problem is i have been given a exam in BLS on pediatric resusetation, I need to prove that I am right, thats all.

 

[medichopeful]

There is only so much polishing of a turd one can do....I would just read other threads for that glimmer of learnin' you seek.

You probably have a fair point.

 

[medichopeful]

My definition as you stated is correct, is copied from that site, and guess what, I am in an EMT course, I am a South African, In Israel in doing a EMT - I course, But I am doing this course in a laguage that is NOT native to me, with people who have more experiance that any other people with TRAUMA managment. I have already been on live calls with stuff that makes my hair white just thinking about it. Lets take you, you have ALS ? ok by the anwswers you have been giving BLS. lets take you and stick you in Russia, give you basic language skills, and lets see you take a BLS course !!! So you have a choice, help or piss off. I suspect the point of this forum is to improve your skills as an EMT, if you cannot give a answer dont make one up.
or dont get personal with someone who is trying to improve themselves. you have not in the last 7 answers come up with a reason pro or con to use AMBU or not. My problem is i have been given a exam in BLS on pediatric resusetation, I need to prove that I am right, thats all.

Look, if you're not right, you CAN'T prove that you were.

And for some of these things, it doesn't matter WHAT country you're in. Vital signs are not something that change with geography.

 

[Lifeguards For Life]

And for some of these things, it doesn't matter WHAT country you're in. Vital signs are not something that change with geography.

good call medichope. I am not sure what the OP is asking of us. I told him how to handle choking(he mentioned something about his instructor and a airway obstruction). and told him about ventilating a severly hypoxic pediatric patient.

Yes, you are correct, in that i meant to say cardiac arrest in pediatrics is almost always caused by Respiratory arrest.

Medichope, you have been around EMS long enough to see several flaws in the postings regarding this "scenario". At this point it should be apparent to you that this posters scenario has no merit what so ever wether it be educational or truthfull.

I will now stop before i get in trouble, FFEMT8978 would be so proud.

 

[a0011010011]

for those of you who are in question if I am doing an EMT course here are my kids

http://www.youtube.com/watch?v=KenqWzYjNJ8

I sugest you look at the whole 7 minutes to see the level that a 9 and 7 year old passes

Just because your reality does not aprove with my reality, it does not disprove the real reality