infant BLS

[a0011010011]

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.

True BUT I can provide resonable answers to the instructor WHY I did what I did..............

 

[akflightmedic]

Yes that video proves everything. 2 kids playing with a dummy, 3rd kid watching and a bird along for the ride completely verifies you are in EMT school and not a troll.

Nice work!

 

[JPINFV]

True BUT I can provide resonable answers to the instructor WHY I did what I did..............

I hate to be Debbie Downer, but, so what? Do you think that you should pass if you screwed the pooch during a practical? Remediate? Sure. Pass? Not if you're doing it wrong.

 

[a0011010011]

I hate to be Debbie Downer, but, so what? Do you think that you should pass if you screwed the pooch during a practical? Remediate? Sure. Pass? Not if you're doing it wrong.

No, it was not final exams, so I am safe on that, but I prefure to understand the logic of the exam, fix myself understand, try to explain why i did what I did and why I did it.
It still does not make sense to me, I guess I could have asked about the quality of breaths the infint was giving.
but the symtoms of blue after a few venilations still gets me. I thought residual, from lack of O2, I was getting a raised chest on the ventilations.

So why would the baby be blue ? lack of O2. yes, because of the rising chest why would their be blockage of the airway ?

what else is preventing 100 % oxidation ? (no chest compresions)


So what i got from this thread as a final note, the instructor screwed up on his exam theory. it was more of a ad- hoc type of exam. I should have checked with him about the QUALITY of breaths. (I still dont get how I have viable breaths to a partial obstruction) It is VERY possible that he was screwing with me, Shake me up a little to make me think. thanks for the help anyway, I was just trying to see where I screwed up. Oh yes and I forget to mention out of a class of 25 , we all failed.............

 

[a0011010011]

Yes that video proves everything. 2 kids playing with a dummy, 3rd kid watching and a bird along for the ride completely verifies you are in EMT school and not a troll.

Nice work!

Did you at least like the bird ?

 

[medichopeful]

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.

You're right. I was hoping to learn something interesting from the responding comments and everything, but unfortunately there just wasn't enough to even work with. It did let me go over infant CPR again, which isn't something we went over much. But other than that, it wasn't very useful.

 

[MusicMedic]

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.

What really got me on this scenario, is why would u flip the Infant patient on its stomach to clear the airway? and twice? i dunno about where your from but generally we use a Suction device to clear the airway. Or the recovery position if they dont have any spinal injury, but then again you wouldn't use the recovery position on an Infant!

Thats my biggest gripe with this scenario among other things.

 

[juxtin1987]

Before I post this i want to add a disclaimer for experienced EMT's/Medics This answer is simpy textbook/registry based so please don't flame me for it =P.

1. 60 bpm in an infant with cyanosis justifies chest compressions regardless of FBAO or not. (Remember that lack of oxygen in the lungs is not the definitive means for cyanosis or hypoxia, hypoperfusion can occur by poor circulation as well)

2. Positive Pressure ventilations with a bvm is contraindicated at this point because you have yet to establish a patent airway.

3. Respiratory Failure = Heart Failure in children and infants so keep that in mind when testing for your CPR/Cardiac Management test, it was not a test on Airway management and AMBU/BVM Application.

4. EMT for dummies tells us ABC's in that order for a reason, A= Patent airway prior to B = breathing, it doesn't matter if the patient is breathing at 3/min or 60/min if there isn't an unobstructed patent airway with adequate tidal volume then assisted ventilations reminds me of a cat chasing its own tail.

 

[reaper]

Before I post this i want to add a disclaimer for experienced EMT's/Medics This answer is simpy textbook/registry based so please don't flame me for it =P.

1. 60 bpm in an infant with cyanosis justifies chest compressions regardless of FBAO or not. (Remember that lack of oxygen in the lungs is not the definitive means for cyanosis or hypoxia, hypoperfusion can occur by poor circulation as well)

2. Positive Pressure ventilations with a bvm is contraindicated at this point because you have yet to establish a patent airway.

3. Respiratory Failure = Heart Failure in children and infants so keep that in mind when testing for your CPR/Cardiac Management test, it was not a test on Airway management and AMBU/BVM Application.

4. EMT for dummies tells us ABC's in that order for a reason, A= Patent airway prior to B = breathing, it doesn't matter if the patient is breathing at 3/min or 60/min if there isn't an unobstructed patent airway with adequate tidal volume then assisted ventilations reminds me of a cat chasing its own tail.

The first one to suggest compressions! +1

This is a troll. Read his other posts outside this thread. They are well written and articulate. This one is bogus!

 

[lightsandsirens5]

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

Add to that the fact that with a CO emergency, in all probability, there would not be any "gas smell" "prevolent" in the area. (Unless they are in the garage, or runnnig a charcoal grill in the living room.)

 

[firemedic1563]

Thank god someone suggested CPR. Glad I read all the posts to find it.

So why would the baby be blue ?

Maybe because his heart is pumping ineffectively. Suggestions:

First, attempt to suction if you are reasonably certain it is not a FBAO, rather an aspiration. Ensure the airway is open, suctioned, perform CPR, ventilate using BVM (Ambu). Cut and dry CPR for BLS.

 

[juxtin1987]

Thank god someone suggested CPR. Glad I read all the posts to find it.

So why would the baby be blue ?

Maybe because his heart is pumping ineffectively. Suggestions:

First, attempt to suction if you are reasonably certain it is not a FBAO, rather an aspiration. Ensure the airway is open, suctioned, perform CPR, ventilate using BVM (Ambu). Cut and dry CPR for BLS.

I think it's hallarious how much ABC's are drilled into us during class, but when you stop to think about it and break it down, there really isn't a more true statement when it comes to managing a patient with difficulty breathing, cyanosis etc. Take each letter for what it is then correct it...

A. Is their away patent, if not make it patent for them
B. Is their breathing adequate, if not make it adequate for them
C. Is their circulation adequate, if not make it adequate for them

ask yourself these 3 questions on every patient you encounter and your tests will be a breeze.

Other than that the only other things i've found useful in assessment are the obvious DCAP-BTLS and AEIOU-TIPS. Lock these down and you'll surpass the expectations of any BLS course instructor.