I have been teaching CPR for more than 20 years and have seen it evolve from an uncertain approach to a victim in cardiac arrest to recognizing cardiac arrest and performing the necessary steps to save the victim regardless of age. Years ago much of the emphasis was on opening the airway and delivering breaths. As we learned more about what happens to the heart in arrest we began to concentrate on delivering more effective compressions and realizing that delivering an effective shock to the heart to stop it so it could try and correct the abnormal rhythm was an essential part of saving a victim whose heart was in an abnormal non-productive rhythm.
Day by day, year by year the art of delivering effective CPR became more and more important to the victim’s survival. Today it is not unusual to expect that “Good” CPR and early defibrillation will save approximately 30% of the victims, and result in minimum rehabilitation after the event. This is true more for adults than it is for infants. Due to the special circumstances related to Infant victims, the survival rate depends on recognizing these differences and acting accordingly.
When you encounter an infant who is not breathing, the color will not be pink like you always expect them to be. It will be most likely bluish or cyanotic. Another thing we must remember is that infants are belly breathers. If you want to find out if they are breathing, lay your fingers lightly on their belly. If you don’t feel the “flutter” then you know the baby is not breathing effectively, immediately call for help, if no one comes, then proceed with CPR by checking the pulse.
How Do You Take The Pulse Of An Infant?
Taking an infant’s pulse presents a very special challenge. When you check an infant’s pulse you should visualize taking the baby’s hand closest to you and placing the thumb in the baby’s ear. Of course you don’t actually have to place the thumb in the ear. This action opens up the area on the inside of the baby’s arm and plainly presents the brachial artery location between the elbow and the shoulder (see Fig.1). While holding the baby’s arm up by the hand, place your middle finger and ring finger on the brachial artery and hold them there for 10 seconds (see Fig. 3). If the infant’s heart beat is 60 beats per minute or less start compressions. Remember to use the middle and ring finger. I tell my students to make the OK sign and then take the pulse. Why the OK sign? Isn’t there a pulse in your thumb? Use your middle and ring finger to take a pulse and keep your thumb tucked. That way you’re OK and so is the victim.
Fig 1. Picture shows holding the infant’s hand a short distance away from their ear exposing the underarm.
Now here is the 64 thousand dollar question. If the baby’s heart beat is 60 beats per minute, how many beats should you feel in 10 seconds? Believe it or not most people say 6 when asked. We tend to multiply in our heads 6 times 10 to get 60.
Fig 2. This picture shows holding the arm up exposing the under arm area:
Actually, it is one beat per second. So if you take the pulse for 10 seconds, which I recommend all the time, then you should feel at least 10 beats. This can be critical when treating an infant. If you don’t, then start compressions. If you do, then check and see if you need to do rescue breathing. Remember when delivering breaths to an infant it is like blowing the tops off of dandelions, very soft and gentle. When you see the baby’s chest rise, STOP delivering the breath, and unless the baby is in cardiac distress, the breaths should be delivered at a rate of one breath every 5 seconds.
See the attached pictures:
Fig 3. This picture shows the middle and ring finger taking the pulse at the brachial artery:
Fig 4.This picture shows holding the hand exposing the under arm area:
The written material will explain taking it at the brachial artery. It is very important that the video shows the proper attitude and actions when taking a pulse, especially with infants. I would go back to the old school. Show the student exactly where to press to palpate the brachial artery. Take the baby’s thumb and put it next to it’s ear. This action opens up the area on the inside of the baby’s arm and plainly presents the brachial location between the elbow and the shoulder. The present host mentions taking the pulse and that it should be at least 60 beats per minute, but they don’t explain how many beats you should feel if you are taking the pulse for 10 seconds. The student should know that 60 beats per minute is one beat per second, so if you are taking the pulse for 10 seconds you should feel 10 beats. The host should also explain that it applies to the child as well only it is taken at the carotid on the child.