You arrive on the scene: Check the scene for safety
1. Check for consciousness. Gently tap the shoulder and shout.
2. Call 911.
3. Check for Breathing and a Pulse:
If the child is lying on his stomach, turn him over onto his back. Put your ear close to the child's trach. Watch the chest for movement. Look, listen and feel for breathing. Check for a pulse by sliding your two fingers into the groove on the side of the child's neck as you look for signs of life and breathing for 10 seconds.
a. Suction the trach tube. If the trach has an inner cannula, remove it and suction the length of the trach tube.
b. Change the trach if it is plugged or dislodged.
c. Give two breaths to the trach, using a resuscitation bag.
Breaths Go In: Pulse But No Breathing
Begin Rescue Breathing:
a. Place the resuscitation bag on the trach and give one breath every three seconds (count 1-1000, 2-1000, breath, etc.).
b. Recheck for signs of life every two minutes or every 40 breathes.
No Pulse, No Breathing
a. Position the heel of one hand on the center of the child's chest (use two hands to compress the chest if the child is large).
b. With elbows locked and straight, compress the chest 2 inches in depth 30 times. Give two breaths using the resuscitation bag (continue with 30 compressions / two breaths, 30 compressions / two breaths).
Continue CPR until another rescuer takes over, you see signs of life or help arrives. If you witness a sudden collapse, call 911. No pulse, no breathing, begin CPR.