Choking Infant at a Family Barbecue
You are at a family barbecue. A 10-month-old infant is sitting on a blanket gumming a piece of hot dog. Suddenly the infant is silent, has a wide-eyed look, and is making no sound. The infant's face is turning red, then slightly blue around the lips. The infant is conscious but not coughing or crying. The mother is panicking and screaming. You are the only one with first aid training. The infant is small (about 8 kg) and is wearing a onesie. There is no one else to help. You have a phone but no first aid kit nearby.
1. What is the appropriate sequence of actions for this choking infant?
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The infant has a severe airway obstruction (silent, unable to cough or cry, cyanosis). Call 911 immediately (or have someone call) and start back blows and chest thrusts. Do not perform abdominal thrusts (Heimlich maneuver) on an infant. Place the infant face-down along your forearm, supporting the head and jaw, with the head lower than the chest. Deliver 5 back blows between the shoulder blades with the heel of your hand. Then turn the infant face-up and deliver 5 chest thrusts using two fingers on the lower half of the breastbone (same location as infant CPR compressions). Repeat cycles of 5 back blows and 5 chest thrusts until the object is expelled or the infant becomes unresponsive. If the infant becomes unresponsive, begin CPR (30 compressions to 2 breaths for one rescuer) and continue to check for the object.
2. After several cycles, the infant becomes unresponsive and limp. What do you do now?
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If the infant becomes unresponsive, carefully place them on a firm flat surface. Begin CPR immediately: 30 chest compressions (two fingers, depth about 1.5 inches or 4 cm, rate 100-120/min) followed by 2 rescue breaths. Because you suspect a foreign body, open the airway and look in the mouth before giving breaths; if you see the object, remove it with a finger sweep only if it is visible and easily graspable. Do not perform blind finger sweeps. Give 2 breaths, each lasting about 1 second, and watch for chest rise. If the chest does not rise, reposition the head and try again. Continue CPR until the object is expelled, the infant starts breathing, or advanced help arrives. Reassess periodically.