Presentation of Common Bloodborne Pathogens Part 2

Even though there are many blood-borne pathogens, the three that account for the majority of cases include hepatitis B, hepatitis C, and HIV. 

Hepatitis B

The cause of Hepatitis B is the hepatitis B virus; the primary injury is inflammation of the liver- which can be acute or chronic. In the acute phase, the infection will last for up to 6 months before complete recovery. In the chronic phase, the infection is lifelong and is most likely occurs in individuals who are immunocompromised.

The majority of adults with hepatitis B usually have full recovery even if the symptoms are severe. On the other hand, children and younger people are more likely to develop chronic hepatitis B infection. There is a vaccine to prevent hepatitis B but once you have acquired the infection, there is no cure for it.

Symptoms

Signs and symptoms of hepatitis B infection range from mild to severe. The symptoms usually become obvious 4-12 weeks after the initial infection. Rarely one may see the symptoms after about 2 weeks post-infection. Younger people including children may not show any obvious symptoms. The classic signs of hepatitis B infection include:

  • Dark urine
  • Pale stools
  • Vague abdominal pain
  • Joint pain
  • Nausea and vomiting
  • Fever
  • Loss of appetite
  • Fatigue and weakness
  • Yellowing of the eyes and skin
  • Itching

If hepatitis B infection becomes chronic it can lead to permanent liver damage and liver failure. There is also a risk of developing liver cancer.

The reason why hepatitis B is of major concern to healthcare workers is because 1) it is highly infectious. After a single needle stick injury, there is a 5%-30% chance of developing a liver infection. Secondly, because symptoms may not present for many months, many people may not know that they have acquired the infection.

Hepatitis C

Another viral infection that can cause inflammation of the liver is hepatitis C. The hepatitis C virus is generally transmitted via contaminated blood products. There is no cure for hepatitis C and if left untreated can lead to permanent liver damage and liver cancer. The good news is that over the past decade, newer medications have been developed that can cure chronic hepatitis C. However, these medications need to be taken for at least 4-to 6 months and are costly.

Unfortunately close to 50% of people with hepatitis C don’t know if they are infected chiefly because they have no symptoms, which can take many years to appear. For this reason, the USPSTF recommends that all adults above age 18 undergo a screening test for hepatitis C.

Symptoms

Unlike other types of hepatitis, hepatitis C infection tends to remain silent for many years. At the same time, the virus continues to damage the liver and can even be transmitted to others.

Signs and symptoms include:

  • Easy bruising
  • Bleeding easily
  • Very little appetite
  • Fatigue
  • Dark urine
  • Pale colored stools
  • Yellow discoloration of skin and eyes
  • Itchy skin
  • Abdominal distention due to fluid accumulation
  • Weight loss
  • Confusion
  • Numerous spider-like blood vessels on the abdomen

Even though hepatitis C starts as an acute infection, most patients have no symptoms. The acute symptoms if they occur will include fatigue, jaundice, muscle aches, and fever. The acute symptoms usually last 1-3 months after the initial virus exposure.

Some people can clear the hepatitis C virus and the acute infection does not always become chronic. It appears that about 15-25% of the people have the ability to spontaneously clear the virus. Sometimes acute hepatitis C will also respond to available antiviral treatment. To date, there is no vaccine to prevent hepatitis C but there are effective treatments.

HIV and AIDS

Acquired immunodeficiency syndrome (AIDS) is a life-threatening infection caused by the human immunodeficiency virus (HIV). The virus is known to damage the immune system and interferes with the body’s ability to fight disease and infections. HIV is known to infect and kill white blood cells, known as T Cells or CD4 Lymphocytes. These cells are vital for fighting organisms. When the number of CD4 cells drops to less than 200, one is unable to fight infections. At this stage the individual becomes vulnerable to opportunistic infections- organisms that are normally not infective but because the immune system is suppressed now start to thrive.

HIV is predominantly acquired via sexual activity. But it can also spread via blood transfusion, use of illicit IV drug injections, or sharing dirty needles. It is also known to spread from the pregnant mother to the fetus during pregnancy.

Without treatment, the virus slowly weakens the immune system and destroys the ability to fight off infections. There is no cure for HIV but there are medications available that can control and prevent the progression of the disease. Over the past 2 decades, antiviral drugs have significantly decreased the death rate from AIDS.

Symptoms

The symptoms of HIV and AIDs vary on the infection phase:

Primary infection

Most people who acquire HIV will develop a flu-like illness within 10-21 days. This primary acute viral infection my last 2-6 weeks.

Typical signs and symptoms may include

Headache

Fever

Rash

Muscle pain

Swollen glands under the armpit or neck

Sore throat

Painful mouth sores

Cough

Diarrhea

Weight loss

Loss of appetite

Night sweats and chills

The above symptoms are usually mild. However, as the concentration of the virus builds up in the bloodstream, the symptoms will become more obvious.

Latent infection

During this stage of the infection, the virus is still present in the blood circulation but most people do not have any symptoms. Without antiretroviral treatment, the latent stage can last for 2-7 years. Some individuals may develop much more severe disease much earlier.

Symptomatic HIV infection

As the virus continues to multiply in the body and the load increases, soon the patient will start to develop symptoms. The individual may be unable to fight off even the common cold. At this stage the symptoms will include:

Generalize fatigue

Fever

Swollen gland under the armpit and neck

Weight loss

Diarrhea

Thrust (oral infection of the mouth)

Skin rash

Pneumonia

Shingles

Loss of appetite

Progression to AIDS

Today availability of antiretroviral treatment has significantly slowed the death from AIDS. If untreated most patients with HIV develop AIDS in 8-10 years.

Rare Bloodborne pathogens

There are many other blood pathogens but most healthcare workers will rarely encounter them in clinical practice. Some of these include the ebola virus, West Nile virus, zika virus, Lassa fever, Marburg virus, dengue, and so on. For the most part, it is unlikely that a healthcare worker will have exposure to these organisms unless working in an area of an outbreak.

Bloodborne Pathogens Part 1

All individuals who work in a clinical setting, medical laboratory, healthcare institution, or research facility may come in contact with body fluids from another person. This places them at high risk for coming into contact with bloodborne pathogens. But what are bloodborne pathogens?

Blood-borne pathogens are organisms (viruses, bacteria, fungi) that can cause potentially serious and fatal diseases. To be safe from blood-borne pathogens requires being up to date on the information and practicing avoidance.

Today nearly 5.6 million healthcare workers in the US regularly encounter blood-borne pathogens in their daily work. Unfortunately despite the best precautions, a few healthcare workers continue to develop signs and symptoms of an infection every year. The only way to protect yourself is by being proactive and using standard infectious disease protocols.

What Are Bloodborne Pathogens?

By definition, bloodborne pathogens are disease-causing organisms that can be transmitted from one person to another, through blood or other bodily fluids or materials. They include the following:

  • Blood
  • Serum
  • Genital secretions
  • Semen
  • Amniotic fluid
  • Cerebrospinal fluid
  • Saliva
  • Peritoneal, Pleural, and synovial fluid

Unlike blood, the transmission of bloodborne pathogens from other body fluids is not common. In general, urine, saliva, sweat, and fecal material are said to be low-risk materials for transmission. However, most institutions recommend wearing appropriate PPE and taking universal precaution measures. On the other hand, exposure to genital secretions or semen is considered a high risk for transmission of bloodborne pathogens. Of course, the risk also depends on the type of activity (ie vaginal, anal, or oral intercourse).

Examples of Blood borne pathogens

The majority of blood-borne pathogens tend to occur after contact with blood. Classic examples of bloodborne pathogens include the following:

Hepatitis B, C

HIV

Malaria

Zike virus

West Nile virus

Ebola 

Hepatitis B, C, and HIV make up the vast majority of blood-borne pathogens today. 

Once acquired, these blood-borne pathogens can cause both acute and chronic illnesses. These illnesses may present with fever, weakness general malaise, jaundice, weight loss, rash, etc. The condition may flare up now and then. To date, only hepatitis B can be prevented by vaccination, but there is no cure for hepatitis C or HIV.

The OSHA Bloodborne Pathogens Standard

In 1991, OSHA (the Occupational Safety And Health Administration) published the first guidelines on blood-borne pathogens. This guideline recommended employers be proactive and take steps to decrease the employee’s risk of exposure to blood-borne pathogens. The OSHA standard describes which employees are at risk, what the common bloodborne pathogens are, and the steps to lower the risk of transmission. The OSHA bloodborne pathogen standard has the following mandatory steps for employers:

  • Develop an Exposure Control Plan that has to be available to all employees. It also needs a regular update every year
  • Enforce the practice of universal protocol
  • Ensure that physical steps like engineering precautions are in place. This includes availability of sharps disposal bins, self sheathing needles, and needleless procedures where feasible
  • Ensure that employee work practices are safe and done in a manner that minimizes the risk of exposure
  • Have in place proper methods for handling and discarding infected laundry
  • Have in place methods for sanitizing infected surfaces
  • That employees have individual protective equipment like gloves eye protection masks and gowns
  • That free hepatitis B vaccination is available to all employees. Ten days prior to any tasks, the employee needs to receive the hepatitis B vaccine
  • Ensure that all potentially infected individuals have free post-exposure examination according to CDC guidelines
  • Have a reporting mechanism for all documented injuries to potential bloodborne pathogens
  • Regularly educate workers about the risk of bloodborne pathogens, place signage throughout the facility and use proper labels

Revised OSHA Blood Borne Pathogen Standard

In 2001, OSHA revised the bloodborne pathogens standard and included the Needlestick Safety and Prevention Act. In addition, it also made more recommendations for employers which include the following

  • Documenting all sharp injuries within the facility, the type of device, and the seriousness of the injury
  • Maintaining a sharp injury data bank
  • An expanded definition of engineering controls
  • Ensuring that novel needle and sharp technology changes also have exposure control protocol in place

What is CPR: an update

Cardiopulmonary resuscitation (CPR) is a lifesaving procedure that can be used to save lives in emergencies like drowning or heart attack, where the individual’s heartbeat and/or breathing have suddenly stopped. CPR can be performed anywhere when an individual develops cardiac arrest including areas outside the hospital like an airplane, swimming pool, or even a shopping mall. According to the American Heart Association (AHA), when you witness a cardiac arrest, CPR should be quickly started with fast and hard chest compressions. The ‘hands only’ CPR recommendations apply to both first responders and all untrained bystanders.

The AHA states that individuals who are unsure how to perform CPR or are afraid to initiate CPR should be aware that it is better to at least make an attempt- this is better than doing nothing at all; by doing even the most basic CPR- this can help save someone’s life.

Ample data show that CPR can keep oxygen-rich blood from the heart flowing to the brain and other body organs until emergency medical services can restore the heart’s natural rhythm. When the heart stops beating, the brain and other organs no longer receive the oxygen-rich blood. To prevent serious injury to the brain and other organs, it is vital to resume blood flow in a matter of minutes.

AHA recommendations

Untrained individuals: Even if you have not been trained in CPR or worry about giving rescue breaths, then at least perform hands-only CPR. To be effective, the chest compressions should be uninterrupted at a rate of 100-120 a minute until the first responders (paramedics) arrive. It is not absolutely necessary for untrained individuals to offer rescue breathing.

Trained individuals with up-to-date knowledge and skills: for those who have training in CPR and feel confident about their ability, the first task is to check if the person is breathing and has a pulse. If the individual is not breathing or there is no pulse, start chest compression ASAP. The goal is to initiate CPR with 30 chest compressions prior to giving two rescue breaths.

Trained individuals but not up to date with skills: for those individuals who have received CPR training some time ago and do not feel confident with their ability, the AHA recommends starting chest compressions at a rate of 100-120 a minute

The above recommendations only apply to infants, children, and adults who need CPR these recommendations do not apply to newborns- those less than 4 weeks of age.

Call 911

Individuals who are bystanders or those untrained in CPR should assist by calling 911 or the local emergency services as soon as possible before starting CPR. TIn many cases, the dispatcher can guide you on how to perform the procedure effectively until EMS arrives. To save a life, learn how to do CPR by taking an accredited first aid course that includes CPR and how to use an automatic external defibrillator (AED) 

CPR 101

Before you start CPR, you need to do the following:

  1. Check if the area is safe for the individual who has arrested
  2. Check if the individual is responsive or unresponsive?
  3. If the individual appears unresponsive, shake or tap his upper body (shoulder) and ask loudly, ‘are you okay?’
  4. When you discover a person who is not conscious, and if you are with another person who can assist, have him or her call the local emergency number or call 911.
  5. If the individual has developed cardiac arrest in a mall, plaza, or another public place, ask if there is an AED available
  6. While one person is communicating, the other person should start CPR- do not try to do everything on your own, especially when help is available. The key is to start CPR and avoid wasting time.
  7. If you are alone and have access to a phone, call the local emergency number or 911 before starting CPR. Ask for an AED if available
  8. As soon as the AED is available, deliver one shock as instructed by the device and then start CPR

Remember C-A-B

The AHA recommends that people who do CPR remember C-A-B in order to perform the sequence of CPR:

C: Chest compressions

A: Airway should be open

B: Rescue breathing

Compressions

The primary reason for the compressions is to restore blood flow to the brain and other organs. Compression requires the use of both hands. Place both hands over the mid chest and push down hard and fast. This is the most important maneuver in CPR and has to be done right to be effective. The technique of chest compressions is as follows:

  1. The arrested individual has to be on his/her back against a solid/firm surface
  2. Kneel on the right or left next to the individual’s shoulder and neck
  3. Apply the heel of your hand over the center of the individual’s chest should be in between the two nipples
  4. Place your other hand on top of the first hand. Maintain your elbows straight and position your shoulders directly above your hands
  5. Push down with your hands on the chest. Compress the chest for at least 2 inches (5 centimeters) but not more than 2.5 inches. The compressions have to be performed using the entire body and not just the hands
  6. Push hard and fast at a rate of 100-120 compressions a minute. After every compression, permit the chest to recoil back into its original position.
  7. If you have had no CPR training, continue with chest compressions until medical personnel arrive or until you see signs of movement in the individual. If you have training in CPR, go to the mouth area and perform rescue breathing.

The Airway

The goal is to keep it open

For those individuals trained in CPR, once you have performed 30 chest compressions, go to the mouth and open the airway using the chin lift, head-tilt maneuver. To do this, place your palm of the left hand on the individual’s forehead and gently tilt the head back. Then with your right hand, gently raise the chin forward to open the airway

Start breathing for the individual

Rescue breathing can be done either via mouth to mouth or mouth to nose. The latter approach may be necessary if the individual’s mouth has an injury or if you are not able to open it. In the Covid-19 era, current recommendations for rescue breathing involve the use of a bag-mask device that has a high-efficiency particulate air filter.

  1. After you open the airway using the chin lift and head tilt maneuver, pinch the nostrils with your left hand. At the same time cover the individual’s mouth with your mouth. For mouth-to-mouth breathing to be effective, the seal has to be good.
  2. Next, give the first rescue breath that lasts 1-2 seconds and watch the chest to see if it rises. If the chest shows an upward motion, give the second rescue breath
  3. If the chest fails to rise, repeat the chin lift, head tilt maneuver, and give the second rescue breath. Always be careful not to breathe with too much force or provide too many breaths.
  4. One cycle of CPR involves 30 chest compressions followed by 2 rescue breaths.
  5. After every 2 rescue breaths, resume chest compressions

Use AED

As soon as an AED is available, apply the paddles to the chest. The newer generation of AEDs are fully automatic, easy to use and provide voice prompts. Follow the prompts. Initially give one shock and then resume chest compressions for at least 120 seconds before administering a second shock. If you have no idea how to use an AED, the 911 operator or the local emergency services. Many times, these individuals can provide you with instructions. Continue CPR until the emergency medical personnel arrive.

Why do we need AED training?

Sudden death is not a rare event; each year close to 350,000 people suffer a cardiac arrest and without immediate treatment, a significant number die. Sudden death can occur at any time and in any location; the individual may suddenly stop breathing, lose consciousness, and collapse.

EMS ARRIVAL

When you come across a person who is having a cardiac arrest, the first thing to do is to call 911. But depending on where you are, the average time for EMS to arrive at the scene can vary from 5-to 10 minutes; and if it is rush hour the delay can even be more. When a person develops a cardiac arrest, the brain can only survive without blood for no more than 3-4 minutes. For each minute of delay in defibrillation, the odds of survival are significantly reduced by 10%. Even if the individual survives, residual brain damage is common. 

Brain Injury

Even with successful CPR most patients will have various types of neurological deficits which may take months or years to recover. Because the nerves are very sensitive to the lack of oxygen, there is a risk of permanent brain damage. So if there is going to be a delay in EMS arrival the only chance of protecting the brain and other organs is having access to an AED. 

However, even if you get access to an AED it is also important to request the services of emergency medical professionals. But once the victim’s heart rhythm is restored, the odds of survival are markedly improved but immediate care in an intensive care setting is necessary.

AEDs

AEDs have been around for about half a century and studies show that when used promptly, they can restore normal heart rhythm following a cardiac arrest. The latest AEDs are portable, light, rugged, user-friendly, and come with visual and verbal prompts. Because AEDs are effective in restoring heart rhythm after a heart attack, today they can be found in many places. This includes most work and public places including airplanes, railway stations, governmental buildings, and most sports arenas.

The latest AEDs can guide the rescuer on how to perform CPR and where to place the electronic pads on the victim’s body. These high-tech electrical pads can quickly sense the victim’s heart rhythm. And if there is a need will administer a shock to restore the heart rhythm.

Who can use an AED?

Because a cardiac arrest is a life-threatening emergency that requires immediate treatment, virtually anyone can use an AED. Even a child can use these devices in an emergency. More sophisticated AEDs are primarily used by healthcare workers who have good knowledge and training in the treatment of heart attacks. Most lay people usually use the simpler AEDs found in public places. There are at least 6 types of AEDs on the market for public use and they all work similarly. But still, a first-time responder should have some idea how these devices operate and when to use them.

Are there laws regarding the use of AEDS?

Over the past few years, all US states have defibrillator laws that protect the manufacturer. These laws also protect the bystander who provides CPR and uses the AED on a patient who has suffered a cardiac arrest.

What is the current status of AEDs in the US?

Currently, almost all states are working to do the following:

  • Ensure that AEDs are readily available in all public places
  • Encourage the public to learn how to use AEDs
  • Ensure that all AEDs on the market meet the manufacturer’s standard
  • Develop a registry of AED locations in every city
  • Create good samaritan laws to protect citizens from liability
  • Create a list of registered AED users who are certified

Operating an AED

The latest AEDs are so simple to use that even a child can operate the device. As soon as you remove the device from the box turn it on as it will provide verbal prompts on how to proceed.

However, before you use the AED it is important to know the signs of a cardiac arrest. If you come across an individual that has fainted or is unresponsive, before you use an AED you should do the following:

  1. Time is critical and you should move quickly and accomplish the below tasks within 10-15 seconds
  2. First, check if the individual is responsive/ ask the individual in a loud voice if he is okay?
  3. Quickly check the breathing, pulse and if he or she is unresponsive
  4. If there is no pulse and the individual is not breathing, ask someone to call 911
  5. If you are alone, call 911 before you start the resuscitation process
  6. Speak loudly if you see anyone approach you and ask if they find an AED; these devices like fire extinguishers will be found on the walls in glass cases.
  7. Turn the on switch on the AED as it will give you step by step instructions. The prompts will tell you how to check the pulse, breathing and where to place the electrode pads on the victim’s chest
  8. The electrical pads will immediately sense the victim’s heart rhythm and deliver a shock if needed. If the machine plans to deliver a shock, it will tell the user to stand back and press the red button to deliver the shock
  9. Once the defibrillator delivers the shock, you should start CPR. The AED will guide the user through the steps of CPR. 
  10. Continue this process until emergency personnel arrive.

Watch videos

To get some idea how to use an AED, the Red Cross has online videos that can be viewed for free. 

What is an AED?

 

An AED, also known as an automated external defibrillator, is a life-saving medical device that can be used when performing CPR on a cardiac arrest victim. This small advanced electrical device can quickly analyze the victim’s heart rhythm and deliver an electric shock if needed to help restore the heart’s normal rhythm.

The latest AED machines come with specialized electrical pads and a pre-programmed computer link which makes them easy to use. Unlike the first-generation bulky machines, the newer AEDs are compact, portable, and light. The newer AEDs are available in most public places and the work place; they are easy to use when facing a victim with a sudden death emergency. An AED machine can guide the rescuer to provide:

  1. CPR
  2. An electrical shock to the victim to restore the heart rhythm

The history of the AED

AEDs have been around for at least 5 decades. They were first only used in hospitals to restore heart rhythm in patients who arrested from abnormal heart rhythms like ventricular tachycardia or ventricular fibrillation. The first machines were large, cumbersome, and difficult to use. However, by the 80s and 90s, technology had improved significantly which allowed smaller AEDs to be implanted in patients. However, the second generation of AEDs were also quite large and could only be implanted in adults. By the late 90s, the third generation of AEDs were compact, light, and small; and could be implanted in both adults and children with ease.

The modern AED

The modern AED consist of 4 key parts that include the following:

  • The user interface (processor) guides the user on how to attach the pads to the victim and provide CPR. it also delivers an electrical shock when needed and records all the details
  • Long-life battery that operates the processor, provides the electrical shock when needed, and performs self-checks
  • The capacitor is the electrical component that stores and releases the energy from the battery -during the process of shock delivery
  • The wired electrode pads attach to the skin of the victim and can not only detect the heart rhythm but also deliver the shock as needed. 

Who makes AEDs

Several US companies manufacture AEDs and they all have the same basic functionalities. Some of them include the following:

  1. Cardiac Science manufacturers a small compact AED that can manage life-threatening arrhythmias outside the hospital.
  2. Defibtech is another leading manufacturer of AEDs; these AEDs have both vocal and visual prompts to help manage sudden death outside hospitals.
  3. Heartsine has been making AEDs for more than 2 decades. EMS and first responders in many US states use Heartsine AEDs.
  4. Philips Healthcare AEDs have been around for at least 25 years and are ideal for use in children because of the small pads. These AEDs come with all the necessary instructions to help save a life.
  5. Zoll has been making AEDs for many years. It has an excellent reputation with many solid medical products. In most medical institutions, airplanes, train stations, and many public places you are likely to find a Zoll AED.
  6. Physio-Control AED, now run by Stryker, makes AEDs. Both EMS and first responders carry Physio-Control AEDs because of the ease of use.

Why you should have an AED in the workplace

  1. Even though there is no national or federal law that requires workplaces to have an AED, most states have safety laws that mandate AED/CPR tools in the workplace. In general, the AED availability depends on the type of public building and workplace. Some states even require medical oversight and have training requirements when an AED is in the workplace.
  2. It should be part of your 911 emergency activation plan
  3. Having an AED in the workplace will enable you to address or respond to sudden death cases
  4. Heart disease does not discriminate against age, gender, or ethnic background. A heart attack can occur anywhere at any time, and you only have a few precious minutes to save a life
  5. Most modern AEDs are portable. Light and come with visual and audio instructions which guide the use during the resuscitation process. Almost everyone can use an AED safely, provided they have obtained training.
  6. AEDs are a good investment as they help ensure the wellness and health of not only your employees but also your customers

Final Point

An AED should be available in all workplaces and public places. Even if the individual has no training in CPR or the use of an AED, the machine can guide you through the process of saving a life. It is like an insurance policy against sudden death.

Why do we need CPR training?

In-Pulse CPR is an American Heart AHA Training Center (TC)

Introduction

According to the CDC, heart disease is the leading cause of death in the U.S. Each year heart disease claims the lives of more than 600,000 people. And the numbers are gradually increasing each year. According to data released by the American Heart Association, more than 50% of cardiac arrests occur away from a healthcare setting. Tragically, more than 88% of these individuals who suffer cardiac arrest away from a healthcare facility die. The good news is that CPR can save lives if performed promptly.

Chance to Save a life

We live in a hectic fast-paced world. And accidents happen all the time- they may occur anywhere and any time. It is not often that one gets a chance to save a life. But by knowing CPR it can help you save someone; the individual maybe your child, parent, or even a stranger. The most beneficial thing about CPR is that training is not time consuming. It only requires a few hours of dedicated study time. The courses are given by trained professionals who ensure that you learn the basic information. Knowing how to perform CPR can be empowering as it gives you the confidence to deal with an arrest. Once you take a course in CPR, the basic techniques of saving a life will stay with you forever.

Why CPR Matters

Cardiopulmonary resuscitation (CPR) is a life-saving technique that can help maintain blood flow to the brain and other organs during an arrest. Here are some reasons why knowing CPR is critical.

  1. CPR can save a life. When you come across an emergency, the first action is to call 911 but it usually takes EMS a few minutes to arrive. During these precious few minutes, you have the perfect opportunity to save a life. If you have training in CPR, then you can apply the technique to assist the victim until the first responders arrive. By performing CPR ASAP, you can preserve blood flow to the brain and other organs.
  2. Save the life of your loved one. The vast majority of cardiac arrests do not occur in a hospital but in a home. More importantly, many of the victims of sudden cardiac arrest may not have any known risk factors for heart disease. By knowing CPR, you can save the life of a loved one.
  3. Improve your confidence. Studies show that about 30-50% of individuals who suffer a cardiac arrest never receive life saving assistance from bystanders. The reason bystanders may not want to perform CPR is because they may not have the proper training, fear of getting involved, or are not confident about their skills. Anyone can learn how to perform CPR. It is not a complex technique to master and is a technique that people of all ages can easily master. According to the American Heart Association, nearly 2/3rd of Americans who witness a cardiac emergency feel helpless at administering CPR. But by learning the technique once, the key information will be etched in the brain forever. Taking a course can greatly reduce your fears and boost your confidence in the event you have to administer CPR.
  4. Prevent brain death. When the heart stops pumping blood, it only takes 4-6 minutes before the nerves in the brain start to die. Thus it is vital to restore blood flow to the brain as soon as possible. CPR can effectively maintain blood flow to the brain and other vital organs. This increases the chance that the individual may survive and make a complete recovery. Data show that when CPR is initiated within 2 minutes of a cardiac arrest, the chance of survival immediately doubles.
  5. CPR improves your medical knowledge. There is no question that people who take CPR classes are a little smarter than those who do not when it comes to managing a cardiac arrest. By knowing CPR you will have the tools to save a life. Taking classes in CPR not only builds confidence in you but it will equip you with all the knowledge needed to perform a life-saving technique and save a life. The CPR training will allow you to make the appropriate decisions in running cardiac arrest
  6. CPR classes are part of life and learning. Finally learning CPR is not difficult at all and it is a great technique to know just in case you encounter an individual with cardiac arrest. CPR classes should be part of everyone’s education. It is a work-related skill that has benefits that go way beyond the classroom as you may save the life of a loved one.

CPR in Babies

Introduction

There are some subtle differences in performing CPR in babies compared to adults and older children. Babies are not only smaller in size but are also fragile- CPR done inappropriately can cause damage to many internal organs in children less than 1 year of age. But it is important to know how to perform CPR in babies as it can save a life.

Causes of arrest in Babies

When CPR is done properly it can help deliver oxygen to the brain and other organs until trained emergency personnel arrive or the baby recovers.

In general, babies have varied causes for cardiac arrest but the majority of cases are due to an illness or a major injury. Very rare is cardiac arrest in a baby from underlying congenital heart disease.

It is important for everyone that while one can obtain the basics of CPR in babies from reading an online course, there is no substitute for a real hands CPR training course. The basic CPR skills in babies are simple and can be easily learned in several hours.

Offering CPR to a baby

First, check if the baby is responsive to touch or voice. You also need to check if the baby is breathing or only gasping. You need to initiate CPR if the baby is not:

  • Breathing or is gasping
  • Moving or appears lifeless
  • Responding to touch
  • Wake up
  • Alert

Initiating CPR

  1. If you are alone and have a smartphone, initiate CPR while calling 911 but use the speaker to communicate at the same time
  2. Do not leave the baby to make the call.
  3. After 2 mins of CPR (roughly 5 cycles), search for an AED
  4. If you are alone and do not have a smartphone, start CPR for 2 minutes and then call 911 from a landline and see if you can find an AED
  5. If you have someone else with you, ask that person to call 911 stat and get an automated external defibrillator ASAP while you initiate CPR

Chest Compressions

  1. Place the infant on a firm flat surface
  2. Avoid too much time looking for a pulse in a baby
  3. Place two fingers on the middle of the breastbone, just below the nipple line
  4. Perform 30 quick chest compressions. Each time push fast and hard enough to move the baby’s chest about 3-4 cm. Count loud with every chest compression
  5. Try to deliver about 100-120 chest compressions every minute.
  6. In between each compression, allow the baby’s chest to revert back to its original position- this will help ensure blood flowing to the baby’s brain and other organs

Rescue Breathing

  1. First, you need to open the airway: Place the palm of your left hand on the baby’s forehead. Then place two fingers of the right hand, on the chin and gently tilt the head back- this should open the airway.
  2. Place your mouth over the baby’s mouth and nose, forming a tight seal. Give two breaths. Each breath should be enough to cause the baby’s chest to rise. The breath should not be more than 1 second.
  3. The chest should rise. Remove your mouth and watch the chest fall. 
  4. If the baby’s chest does not rise, quickly reposition the forehead and form a tight seal and perform rescue breathing
  5. Give cycles of 30 chest compressions and 2 breaths during the two-minute cycle. 
  6. Continue until EMS arrives or until the baby starts to breathe again.
  7. Two minutes of CPR will permit you to perform 5 cycles of 30 chest compressions with two rescue breaths. 
  8. While 2 minutes of CPR may not sound long, it is quite tiring. Therefore, if you are not alone, you should switch as a performer every 2 minutes.

Recovery position

If the baby starts to breathe on his or her own, there is a chance that it may vomit and this can make breathing difficult. Hence, it is important to place all babies in a recovery position. The chin should be slightly angled from the chest and the face should rest on a flat surface. You have to make sure that nothing is covering or blocking the baby’s nose or mouth. By placing the baby in the recovery position, this will allow for the airway to remain open.

CPR In Children

The protocol for CPR in children is similar to that in adults.

Safety First

  1. Always make sure that the child is away from any impending danger. CPR should always be done in a safe location
  2. The next step is to check the child’s level of consciousness. Do this by tapping the child on the shoulder and asking, “Are you okay?’ Or ‘Can you hear me?’
  3. The third step is to quickly scan the child to see if he or she has any obvious injuries, medical issues, or bleeding

Check for Breathing

  1. Quickly check if the child is breathing on his own. You may have to put your ear next to the child’s nose or mouth and you may feel breath on your cheeks. At the same time, check to see if the child’s chest is moving.
  2. If the child is unconscious but you can see the chest moving, call 911 and wait for EMS to arrive. Children who can breathe do not need CPR

All the above maneuvers should not take more than 10-15 seconds. Time is of the essence and one has to be fast

Call 911

  1. If you are alone with the unresponsive child, call 911 after you have performed 2 mins of CPR.
  2. If there is help available, ask the other person to call 911 and also look for an AED.

Start CPR

If there is no sign of breathing, start CPR ASAP

Chest compressions in a child

  1. First, gently place the child on his/her back against a firm surface
  2. Place the heel of one hand on the center of the chest at the nipple line. If the child is older, then you may want to use two hands to perform CPR- you can do this by placing the other hand on top of the first hand.
  3. In a child, the chest should be compressed by about 2 inches. It is vital not to compress the ribs as they are fragile and susceptible to fracture
  4. Perform 30 chest compressions at a rate of 100 per minute. Let the chest rise completely between each push
  5. After the first 30 compressions, quickly check to see if the child has resumed breathing
  6. If there is no breathing, resume CPR until EMS arrives.

Rescue Breathing

First, check to see if the child has resumed breathing from the CPR

  • To open the child’s airway, lift the chin up with your right hand and at the same time, tilt the head back with the other hand by pushing down on the forehead. 
  • If you suspect that the child has a head or neck injury, do not tilt or manipulate the neck
  • To perform rescue breathing, cover the child’s mouth with yours, pinch the nose and give breaths
  • Give the child two breaths and each time check to see if the chest rises. Each breath should take no more than 1 second.
  • If you do not see the chest rise with the first breath, retilt the head and ensure that you have a proper seal with your mouth before giving the 2nd breath.
  • If the second breath does not cause the chest to rise, there may be an object blocking the child’s airway. Check the mouth quickly to see if there is any food or foreign body.

Continue CPR

If the child has not resumed breathing, continue with CPR and rescue breathing 

  1. Offer two breaths for every 30 chest compressions
  2. If another individual is assisting you, perform 15 compressions followed by 2 breaths.
  3. Continue the cycle of 30 chest compressions and 2 breaths until the child resumes breathing or emergency help arrives.

What If You Are Alone

  • If you are alone with the child and have already performed 2 minutes of CPR or about 4 cycles of compression and rescue breathing) call 911 and look for an AED.

Using an AED

  1. As soon as an AED is available it should be utilized.
  2. For children less than 9 years of age, use a pediatrics automated external defibrillator if available.
  3. If a pediatric AED is not available, you may have to use the standard AED

AED use

  1. Turn on the AED
  2. Today almost all AEDs are automated and provide verbal directions on usage.
  3. Ensure that the child’s chest is dry and attach the pads as shown on the AED machine
  4. You will then be provided with step by step directions on how to use the AED from this point.
  5. Continue chest compressions and follow the AED prompts until the child resume breathing or emergency help arrives.

The only way to be proficient at CPR is to keep updated with the course and assist others when the opportunity arises.

Dad Saves Daughter’s Life with CPR after Seeing It Performed on TV Show

It suddenly happened in the summer of 2021. An unexpected cardiac arrest. This time the victim was a 4-year-old girl.

Fortunately, the girl’s father, Mat Uber, 46, of Carmel, Indiana, saved the little girl’s life after deploying CPR – something he remembered from watching The Office, a sitcom on NBC.

Mr. Uber spoke of the horrifying moment when he realized he had to move fast to rescue his daughter, Vera Posey.

A sudden cardiac arrest (SCA)  during a game of tag was the reason. Having watched CPR on the series, The Office, Uber revived his daughter using what he had remembered. He said Steve Carrell, who played MIchael Scott on the TV show, performed CPR on one of the episodes.

After a few seconds of laughter during the game of chase, Uber’s daughter suddenly slowed down. He said he saw her lying on the ground when he turned around.

Uber added he thought she had hit her head. At that moment, his mind flashbacked to the TV show and CPR. He urged his 16-year-old daughter to call an ambulance.

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In the episode, a CPR teacher visits Dunder Mifflin to educate the staff on how to do chest compressions in tune to the Bee Gees’ 1970s tune Stayin’ Alive.

Uber said, he wondered, “‘What do I know about CPR?’ I don’t have formal training.” He added that the scene from The Office suddenly came to him during that panic-stricken moment. He needed to do something to keep his daughter alive, and do it immediately.

The family later found out that Vera had a life-threatening and rare syndrome that affects the heart’s rhythm called calmodulinopahty.

Paramedics used a defibrillator (AED) to shock Vera’s heart back to a normal while resuming  CPR and resuscitation efforts.

At Riley Hospital for Children in Indianapolis, Uber and his wife discovered that their daughter had gone into cardiac arrest. According to Uber, Vera had no warning signs before the event.

Little Vera received a cardioverter defibrillator (ICD), an implantable device that shocks the heart into working if it stops functioning. Uber hopes that his family’s story will inspire people to get officially certified in CPR and AED.

The father added that Vera is “. . . doing spectacularly [well]. We’re incredibly lucky.”

While CPR, no doubt, saves lives, knowing how to use an automated defibrillator (AED) ensures increased survival rates.

Because it is a medical emergency, sudden cardiac arrest (SCA) must be taken seriously. That is why both CPR and AED training are imperative. When an AED is used, an electric shock is delivered to the heart via the AED. A heart that has stopped beating is brought back into rhythm by applying a jolt of electricity.

Needless to say, both CPR and defibrillation work best when performed as soon as possible following the  onset of an SCA. SCA survivability decreases at an alarming rate with each passing minute.

First responders, such as police officers and paramedics, are familiar with the steps used for defibrillation. If someone is showing signs or symptoms of SCA, call 9-1-1 immediately. The sooner you seek assistance, the sooner they can start receiving life-saving care.

Bystanders can use AEDs and do not need to be emergency personnel. The portable devices often are found at public sites, such as golf courses, airports, cansinos, malls, and hotels.

If an arrhythmia is detected, an AED is programmed to deliver an electric shock. The programming only allows the current to be transmitted to SCA victims. CPR should be given until you can gain access to an AED.

If you or a loved one is at risk for an SCA, you might consider getting advice from a doctor about adding an AED in your home. SCAs can happen without warning. Make sure you are equipped by learning CPR and the AED process.

How CPR Saved One Golfer’s Life

On July 30, 2013, Ralph Harms, 78, was out on the course with his son Joe and friend Doug Green. At the fourth hole, Ralph was excited. He shouted, “Yeah, baby!” after nailing a long putt.

However, three days later Harms awoke in the hospital. He had gone into cardiac arrest and did not recall anything until then.

He compared the event to suddenly switching off a light switch. He did not experience any signs that anything was wrong.

Ralph’s son, Joe, learned CPR from his father about 4 years earlier. At the time, the two men were watching football and saw an ad about getting CPR certified. To maintain his certification, the elderly Harms continued to maintain his endorsement every two years. Ralph remembered showing Joe how to perform chest compressions during a break in the game.


According to Ralph, it was good Joe remembered how to do the compressions, as he would never have been able to tell his tale of survival.

As Doug dialed 9-1-1 on his mobile phone, Joe performed CPR on his Dad. Ralph’s heart stopped three times while emergency personnel were on the way. Joe continued the chest compressions while he waited for help.

For the first three days of his recovery, Ralph was kept in in a drug-induced state of unconsciousness.

The knowledge and use of CPR were both critical to Ralph’s survival. Again, because of CPR, Ralph survived so he could tell people about his experience.

CPR saves lives and does not take a lot of time to learn. Moreover, you can glean this must-have skill easily anytime.

Besides saving lives, learning CPR and AED, in combo, prevents brain death and reduces recovery times. CPR is used when the heart stops beating during a cardiac arrest,

Brain death typically happens four to six minutes after the heart has stopped pumping. When CPR is performed, the brain and other vital organs get the oxygen they need to continue to operate.

Two minutes of cardiopulmonary resuscitation (CPR) increases a person’s chances of survival twofold. The longer a patient goes untreated the greater the physical toll it takes.

While you don’t have to get formal training in CPR, it still is better to have it. In the event of an emergency, phone 9-1-1 immediately.

If a bystander is present, start CPR while he or she calls 9-1-1 and looks for an automatic external defibrillator (AED). This will save you valuable time. Defibrillators (AEDs) are devices that shock the heart and restart it.

Aim to do 100 to 120 pushes each minute in the middle of the chest. The American Heart Association (AHA) recommends that you time the compressions. Hands-only CPR is an alternative to mouth-to-mouth CPR, and does not require breathing into the mouth of the victim.

Continue giving CPR until medical help arrives.

When the heart stops beating abruptly and unexpectedly, it is called a sudden cardiac arrest (SCA). If this occurs, essential organs, such as the brain and heart, are deprived of their blood  and oxygen supply. If SCA isn’t treated within minutes, it frequently results in death.

An understanding of the heart’s mechanisms helps in defining SCA. The heart’s electrical system regulates the heartbeat’s pace and rhythm. Therefore, the heart’s circuitry, when it malfunctions, leads to an arrhythmia or irregular heartbeat.

Arrhythmias come in various forms. As a result, the heart may beat too fast or too slow. In some cases, it may beat erratically. Arrhythmias that prevent the heart from pumping blood to the body trigger an SCA.

It is important to distinguish between an SCA and a heart attack. A heart attack happens when blood flow to a portion of the heart  is disrupted. The heart normally doesn’t stop beating immediately during a heart attack. Even after a heart attack, an SCA may still occur during recovery.

An SCA may also strike healthy individuals with no history of heart disease or another predisposing condition. Therefore, don’t discount the importance of CPR and AED training. With the knowledge you receive, you might very well end up saving the life of someone you love.

Child Respiratory Emergencies

My son was two years old when I returned to work in 2005.  Each day, I strapped him into his car seat to take him to and from his childcare center.  One afternoon, as I drove my son home, I heard a strange sound from the backseat.  I looked in the rearview mirror and my stomach dropped.  His lips were blue, and the strange sound I was hearing were his attempts at gasping for breath.  I took him straight to the emergency room, where the staff treated him using a nebulizer and told me to see his pediatrician right away.  I did, and the hospital’s diagnosis was confirmed – pediatric asthma.

For about three years, I strapped a mask over my son’s face while he sat in my lap and breathed in Albuterol, a bronchodilator that restored his breathing to normal.  The attacks were often sudden – often enough for me to keep the nebulizer in the car and the Albuterol in my purse.  A few times I even rushed into coffee shops or fast-food restaurants and begged them to let me use an outlet to plug in the nebulizer so I could treat my son right away.

Respiratory emergencies are frightening, and, according to Registered Respiratory Therapist Nancy Johnson, respiratory disorders are the second leading cause for parents to take children to the ER.  They are the number one cause for children under the age of four.  Johnson also notes that children under respiratory distress deteriorate quickly and “airway urgencies can quickly progress to airway emergencies.”  She uses the ABCDE Assessment Tool to assess respiratory conditions:

  • Airway (Is it obstructed?)
  • Breathing (Are there signs of distress?)
  • Circulation (Does their color look OK?)
  • Disability (Are they functioning normally?)
  • Exposure (Are there any wounds or notable injuries?)

Approximately half of children with pediatric asthma outgrow it, and my son was in that lucky half.  However, while his asthma was a threat, I received training in child and baby CPR.  Fortunately, I never had to use it, but the knowledge gave me peace of mind.

Does CPR really save lives? Yes, it does.

By Liv Hernandez

Does CPR really save lives? Yes, it does. There is one recent news story that can attest to that. The CDC estimates that administering CPR to a person suffering from cardiac arrest can double their chances for survival. Cardiac arrest can strike an individual at any time or place.

In the case of Steve M., it struck him when he was at his home. He was alone, and very scared when the attack came on. Thankfully his son, Skylar, arrived for a visit a short while later. He was shocked to find Steve lying there unconscious on his bathroom floor. Skylar called the paramedics and was informed that it would be a few minutes before they could arrive.

Skylar jumped into action and began administering CPR to Steve. This ended up saving his father’s life. Steve was conscious again by the time the paramedics arrived. This is just one case that proves how life saving CPR can be. Since Cardiac arrest can strike at any time, you could describe it as a sudden killer. Taking the time to learn and become CPR certified means you can save someone’s life.

You can help them become one less statistic. Death rates for cardiac arrest victims are very high. The majority of these attacks occur in public. This increases the chances of the attack being witnessed by a bystander. If this bystander were to administer CPR they could save the victim’s life.

We all live in this world together, so we should all look out for one another. If you look online you will discover many local institutions that will offer you CPR training. If you were in the same situation as Steve from the story, you would want someone to come to your aid. We all would. Learn CPR and start the change first. Help someone and you just might get the help you need in return. As cardiac arrest numbers rise, more people are joining together to become CPR certified. Join them and help save lives. No one wants to be a statistic.

https://www.heart.org/en/affiliates/cpr-saves-lives-steve-munatones-is-here-to-prove-it

https://www.cdc.gov/heartdisease/cpr.htm

Respiratory emergencies in children

Respiratory emergencies in children are not uncommon and when they occur, they are somewhat more difficult to manage than in adults for several reasons. First, the patient is fragile, secondly, the entire oral cavity and upper airway are small and easily prone to obstruction, and third, without having the right tools and equipment, resuscitation can be difficult. Finally, unlike an adult, the child has a limited respiratory reserve and respiratory distress can quickly lead to cardiopulmonary arrest. To know how to manage respiratory emergencies in children, it is important to know some of the common causes and how they present.

Asthma

Asthma is one of the most common lung disorders that affect adults and children. Each year, children lose close to 14 million school days to asthma. The disorder is characterized by recurrent symptoms that are triggered by many factors that include the following:

  • Environment-air pollution, smoking, allergens, poor air quality
  • Indoor allergens like roaches, pet dander, perfumes dust mites, mold, feathers
  • Having a medical condition like allergic rhinitis, atopic eczema, hay fever
  • Use of certain medications like beta-blockers, aspirin
  • Viral and bacterial infections of the upper respiratory tract
  • Stress

Asthma may occur several times a day or it may occur once a month. In most cases, asthma tends to worsen with exercise or at night.

Presentation

  • Wheezing
  • Chest tightness
  • Shortness of breath
  • Dry cough

Asthma can present with recurrent symptoms that include:

Diagnosis

The diagnosis of asthma is based on the presentation, pattern of symptoms, and response to treatment. Lung function studies (spirometry) can be used to confirm the diagnosis. Once the diagnosis is made the condition is graded depending on the frequency and intensity of the symptoms. The treatment of asthma is with prescription medications.

Status asthmaticus

Acute asthmatic attack (status asthmaticus) is a medical emergency that presents with severe shortness of breath, chest tightness, and wheezing. The individual will have little or no air entry into the lung and some may not even be able to speak. They may use their accessory muscles to breathe and bluish discoloration of the nails and skin is not unusual. An acute asthmatic attack may be triggered by an infection, allergen, or inappropriate or insufficient use of the asthma medication. These patients need immediate treatment in the nearest emergency room. The treatment goals include:

  1. Reversing the airway obstruction immediately with the use of beta-agonists and corticosteroids
  2. Correcting the hypoxemia by administering oxygen
  3. Prevent complications like respiratory arrest and pneumothorax. 

These patients need to be admitted until the acute attack has subsided. Some may even require admission to the ICU because of the need for mechanical ventilation.

The education of the patient is vital in preventing status asthmaticus. Status asthmaticus can usually be prevented if patients are compliant with their medications, avoid triggers and stress factors. 

Croup

Croup also referred to as laryngobronchitis is caused by a viral infection (usually parainfluenza viruses) and mostly affects children between 6 months to 3 years of age. The condition appears to be more common in males than females and tends to occur during the fall season. Besides viruses, croup can also be caused by many bacteria including H. influenzae and Strep pneumonia. The infection leads to a swelling of the larynx, trachea, and large bronchi, which then causes airway obstruction. The classic symptoms of croup include:

  • Stridor
  • Barking cough
  • Hoarse voice
  • Fever
  • A runny nose may also be present

The symptoms usually start at night and last about 24-48 hours.

While many cases of croup are mild, in some children the symptoms can be quite severe and lead to respiratory distress. The diagnosis of croup is made clinically by excluding other causes of airway obstruction. A lateral x-ray may show the classic narrowing of the upper trachea (steeple sign). The Westley score is used to classify the severity of croup and includes five features:

  • Cyanosis
  • Degree of mental alertness
  • Stridor
  • Muscle retractions 
  • Air entry

Most cases of croup are managed conservatively but those with moderate or severe symptoms need epinephrine and steroids. Oxygen is administered if hypoxia is present. Severe cases also need to be hospitalized and monitored. The rare child may even require mechanical ventilation.

Bronchiolitis

Bronchiolitis is a relatively common childhood lung disorder that is associated with wheezing and respiratory distress. In children, it is often mistaken for asthma. Bronchiolitis is caused by the respiratory syncytial virus and affects children less than 2 years of age. The condition is most common during winter. Children at risk for bronchiolitis include those:

  • Who have associated congenital heart disease
  • Were preterm at birth
  • Are immunodeficient
  • Have exposure to tobacco smoke
  • Have a neurological disorder

Typical symptoms include shortness of breath, wheezing, runny nose, fever, and a cough. While most cases are mild, severe cases can present with grunting, nasal flaring, and an irritable child. 

Everyone should take a CPR class. Since there are classes in your home town maybe even this evening, no one has any excuses not to take one. MN PA FL

Diagnosis & Treatment

The diagnosis is usually made from the history and clinical presentation. Most mild cases are treated with supportive treatment. However, severe cases of respiratory distress need hospital admission for oxygen and fluid hydration. Some children may benefit from bronchodilators and nebulized epinephrine. If severe cases are left untreated, death can occur. To prevent spread, parents should be encouraged to wash their hands and avoid smoking.

Pneumonia

Pneumonia, although rare in healthy children, can be very serious. It remains the number one killer of children in many nations. Children who have a weak immune system, are under-nourished, or have a disease like HIV are more prone to pneumonia. It can be caused by viruses and bacteria.

Trigger factors for pneumonia include:

  • Air pollution
  • Smoking exposure
  • Asthma
  • Medical conditions like cystic fibrosis

Typical presentation includes:

  • Fever
  • Wet cough
  • General malaise
  • Shortness of breath
  • Anorexia
  • Congestion
  • Chest discomfort.

In addition, children can also present with lethargy, irritability, and poor feeding. 

Diagnosis & Treatment 

The diagnosis of pneumonia is made from the clinical exam, X-rays, and culture. The treatment usually depends on the type and cause of pneumonia. Bacterial pneumonia is treated with antibiotics but viral pneumonia is managed with supportive care. In most cases, children tend to develop severe pneumonia which compromises their breathing; and without treatment, the bacteria can spread into the systemic circulation. 

Besides oxygen, IV fluids, and antibiotics, some children may require mechanical ventilation. Bacterial pneumonia can be prevented but millions of children do not get the recommended three doses of the childhood vaccine. 

Foreign body aspiration

One very common cause of respiratory distress in children is foreign body aspiration. It is the 6th most common cause of accidental death in this population, with the majority of cases occurring in children aged less than 4. Children tend to put everything in their mouth like coins, buttons, batteries, solid food particles, paper, medications, etc and because the childhood airway is narrow, these objects often get stuck in the upper airway. The symptoms of foreign body aspiration are unfortunately non-specific and may include

  • Fever
  • Wheezing
  • Difficulty breathing
  • Chest discomfort
  • Inability to speak
  • Hypoxia. 

The most common location of the foreign body is in the bronchus followed by the trachea and larynx.

Children with complete airway obstruction can present with respiratory failure and cardiac arrest often requiring a surgical airway or rapid intubation. The diagnosis must be suspected in any child with no prior history of any lung disease like asthma and appropriate workup is vital. 

Besides x-rays, bronchoscopy may be required since not all foreign bodies are radiopaque. Prompt removal of the foreign body is necessary to prevent pneumonia, atelectasis, or pneumothorax. In children with respiratory distress, immediate bronchoscopic removal is recommended. The longer the foreign body remains in the airway, the higher the risk of complications like aspiration, pneumonia, or pneumothorax.

Anaphylaxis

Anaphylaxis is a potentially life-threatening emergency usually due to an allergic reaction. Even though cases of anaphylactic shock are not common, they have been increasing gradually over the past few years, especially in children. An anaphylactic reaction can occur within seconds after exposure to an allergen. 

The symptoms may include:

  • Shortness of breath
  • Wheezing, stridor
  • Hypoxia
  • Extreme respiratory distress
  • Inability speak
  • Swelling of the oral and facial area

If not treated immediately, it can quickly lead to cardiorespiratory arrest.

Diagnosis & Treatment

The diagnosis of anaphylaxis is usually clinical and treatment requires immediate administration of EpiPen (IM epinephrine). These individuals should be transported to the nearest emergency room for further treatment including fluids, steroids, and antihistamines. Individuals with allergies should always carry Epipen on them and wear a bracelet indicating their allergies.

Pneumothorax

Pneumothorax is not as common in children as adults, but when it occurs it can quickly compromise respiratory function. The majority of pneumothorax in children are spontaneous but may occur due to trauma or even asthma. Pneumothorax can be life-threatening if it is large (tension pneumothorax). The classic symptoms include:

  • Chest pain
  • Difficulty breathing
  • Shortness of breath

Diagnosis & Treatment

The diagnosis can be made from the presentation, physical exam, and imaging studies. If the patient is in respiratory distress, immediate treatment requires needle insertion in the chest cavity to evacuate the air. Once stabilized, a chest tube can be placed. 

Know the signs and symptoms of respiratory distress in children

Several common disorders can lead to respiratory distress in children. The key for the responders is to recognize signs of respiratory distress because if left untreated death may follow quickly. Classic signs of respiratory distress in children include:

  • Nasal flaring
  • Labored or rapid breathing
  • Use of accessory muscles
  • Wheezing
  • Grunting
  • Muscle retractions
  • Tripod position
  • Lethargy
  • Irritability
  • Cyanosis

Final point

Pediatric respiratory emergencies can be frightening but if one is alert and decisive, death can be prevented. The key is early detection so that the child can be treated accordingly.

References

  1. Respiratory Management in Pediatrics . http://www.creighton.edu/fileadmin/user/EMS/docs/Respiratory_Management_in_Pediatrics.pdf
  • Respiratory Emergencies in Pediatrics. https://www.slideshare.net/tfalgiani/respiratory-emergencies-in-pediatrics

Learning CPR Pays Off with Beach Save

As part of my health science classes, I was asked to take CPR classes. At that time, I thought that this was a complete waste of my $100. Little did I know that this money would one day save someone’s life. After 8 years, I decided that this was the last time I would renew my CPR certificate because I had never had an opportunity to use the technique on anyone. In 2010, I was visiting the beautiful island of Aruba which is famous for its sandy beaches and pristine blue waters. 

At around noon, I watched a young male wade about 50 meters from the shore and suddenly I noticed that he disappeared under the water. I did see his arms flailing and I realized that he was in trouble. I was never a good swimmer and did not even have a life jacket- the thought of us both drowning did cross my mind but my heart overcame my brain reasoning and I swam to where he was. I quickly noticed that he was unresponsive. I had a major struggle pulling a dead weight and struggled to get him near to the shore, where other people helped me pull the individual out of the water. 

Because he had swallowed water, the first thing I did was place him on his side and pump his stomach. I then started CPR which was another ordeal as I was exhausted from the rescue. Nevertheless, with the help of other people I coordinated the CPR  For the next 12 minutes, there was no sign of life. We all thought he was dead but decided to continue with CPR for another few minutes. We all took turns breathing into his airways and conducting CPR at the same time. 

Finally, just before the ambulance came, we saw some arm movements. The emergency staff transported him to the hospital where he was intubated and resuscitated. I had no idea what his name was, who he was or where he came from. All I could tell was that he was a young  male. For confidentiality reasons, the hospital refused to divulge all details about the individual. In any case, I left my name and number with the nursing staff. Six months later while I was in Toronto, I got a call from a female in Houston; she wanted to thank me for saving her brother. Incredibly he had suffered no adverse effects of the cardiac arrest that lasted about 12 minutes. He was alert and had no neurological or physical deficits. His family wanted to meet me but, alas, I had other things come up. Moral of the story; it is a humbling experience to save a life – it does help to be certified in CPR.

Florida Husband Collapsed

Cardiac arrest happens more than we may think. It is most likely to occur while at home and sadly only about 10 percent of them survive. Cardiac arrest can happen to anyone. You can be young, healthy, old or sickly. Cardiac arrest occurs when the heart stops due to electrical issues and the person stops breathing. When your heart stops pumping blood, your limbs and vital organs, including your brain, do not get the oxygen rich blood that it needs to function.

Learning CPR (cardiopulmonary resuscitation) could be one of the most important things you do for your family and friends. Having an AED (automated external defibrillator) in your home and learning how to use one is also important. The AED is very simple to use and will let you know how to use it and when to use it.

Jennifer and Rich Chap know just how important it is to learn these life saving skills. During the summer of 2012 in Orlando, FL, what started out to be a normal work day for Jennifer ended in her saving her husband’s life. Jennifer was working from home when her cat Buddy started acting strangely as if he was trying to get her attention. She started looking around and found her unresponsive husband collapsed on the kitchen floor gasping for air. He began to take agonal breaths in his wife’s arms. Jennifer sprang to action and called 911 who helped instruct her how to perform CPR until help arrived. When help arrived they took over CPR and used the AED in order to restart Mr. Chap’s heart. Although they were able to get a heartbeat after using the AED, he still wasn’t breathing on his own. The EMT’s had to place an endotracheal tube and use an ambu bag to breathe for him. Since they were unable to feel a pulse at his wrist, they put Rich into therapeutic hypothermia to cool down the body in order to protect the brain. Essentially he was in an induced coma. The doctors were unsure of what his neurological status would be in the future as they were waking him from his coma. Doctors quickly found that answer when Rick’s brother was visiting the hospital and was joking around with Rick. Rick then lifted his arm, turned to his brother, and  used a specific finger to communicate with his brother. Since the incident, Rick is doing well. Jennifer has become an advocate for Sudden Cardiac Arrest awareness and survival

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Disclaimer:
Use of any advise on this site is purely at your own risk.  The information supplied is designed to accompany CPR and first aid training not to replace.  In-Pulse CPR, Inc disclaims any liability for losses you incur as a result of inaccuracy of the information provided on this website.  Information on this site is for education, supplemental to examination by and advice of medical professionals.   Any information regarding first aid treatments is not meant to replace the advice of medical professionals including physicians, paramedics, emergency room attendants, nurses or other licensed medical personnel.