Warning

Never shake a choking infant. Do not use your fingers to feel blindly down an infant's throat. Only try to remove the obstruction if you can see it clearly.

Ilf the infant has a strong cough, let him or Iter continue. If the object is not dislodged or the child becomes too weak or tired to cough or stops breathing, go to Step 2. If you have a helper, ask him or her to call an ambulance.

Give up to 5 back slaps

2 Lay the infant face downwards on your forearm or lap, with the head lower than the trunk. Support the chin and shoulders with your hand. Give up to 5 back slaps between the infant's shoulders, then check the mouth.

Give up to 5 back slaps

3 If back slaps are not effective, lay tlje infant face upwards along your forearm or on your lap, keeping the head lower than the trunk. Place 2 fingers on the breastbone a finger's width below the nipples and give 5 sharp chest thrusts, one every 3 seconds.

4 Call an ambulance if a helper has not already done so. Continue with cycles of 5 back slaps followed by 5 chest thrusts.

5 If at any time the infant loses consciousness, open his or her mouth, and place your finger on the tongue to allow you a clear view of the back of the mouth. Remove any obvious obstruction.

6 Tilt the head back to open the airway and give 2 breaths of artificial respiration (p.293). If the air does not reach the lungs, reposition the head and try again.

7 If the breaths still do not reach the lungs, repeat Steps 2-6 until medical help arrives or the infant starts breathing unaided again. If the infant does start breathing, hold him or her in the recovery position (p.292) and monitor the breathing and pulse (see ABC of resuscitation, p.290) until medical help arrives.

Cardiopulmonary resuscitation (CPR)

CPR is a life-saving technique in which artificial respiration (p.293) is combined with chest compressions. It is performed on an unconscious victim who is not breathing and has no pulse, to keep the blood circulating and ensure that oxygen is supplied to the tissues. Chest compressions force blood out of the heart and around the body, ensuring that the oxygen supplied by artificial respiration reaches the brain and other vital organs. Do not stop giving CPR until the victim's heart

Adults

Two fingers used to lift victim's chin

ICall an ambulance. Lay the victim face upwards on a hard surface. Open the airway by placing one hand on the forehead to tilt the head back and lifting the chin with two fingers of the other. Look at the chest for signs of breathing and feel for breath on your cheek.

Two fingers used to lift victim's chin

Shoulders _

above centre of victim's chest

Elboivs locked

Shoulders _

above centre of victim's chest

Elboivs locked

Middle finger on end of the breastbone

4 Kneel to one side of the victim. Using the hand farthest from the victim's head, slide your fingers along the lowest rib to where it meets the breastbone. Place your middle finger on this point and your index finger just above it.

7 Kneel upright with your shoulders directly above the victim and your elbows locked straight. Press downwards, depressing the breastbone 4-5 cm (lVi-2 in), then release the pressure without moving your hands. Compress the chest in this way 15 times at a rate of about 15 compressions in 10 seconds, maintaining an even rhythm. Then give 2 breaths of artificial respiration.

starts beating or medical help arrives. If you are too tired to continue, try to find another trained person to take over from you until medical help arrives. When giving chest compressions to children slightly less pressure is used in order to avoid injury and they are also given at a slightly different rate. Breaths of artificial respiration are also given at a different rate in children and it is important not to blow too hard, especially when treating an infant.

2 If the victim is not breathing, pineh tlje nostrils shut wit!) one hand, and keep the chin tilted with the other. Seal your mouth over the victim's mouth, and give 2 breaths of artificial respiration (p.293). Pause to take a breath yourself between giving breaths.

3 Check the pulse at the neck for up to 10 seconds and look for other signs of recovery, such as return of skin colour or breathing. If there is a pulse, continue artificial respiration. If you cannot find a pulse and there are no signs of recovery, begin CPR (see Step 4).

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