Emergency First Aid

EMERGENCY FIRST AID: Newborn Respiratory & Choking

Patient: Maggie (Newborn / NICU Grad)
High Risks: Aspiration (choking on milk), Respiratory Distress (Retractions), Apnea (Stopped breathing).

🛑 IMMEDIATE DANGER SIGNS (Call 911)

If you see ANY of these, call 911 immediately:

  1. Blue/Gray Skin: especially around the lips, tongue, or face (Cyanosis).
  2. Stopping Breathing: Pauses longer than 20 seconds, or shorter pauses accompanied by blue skin/limpness.
  3. Unresponsiveness: You cannot wake her, she is limp (like a rag doll), and does not react to pain/stimulation.
  4. Severe Retractions: The skin is sucking in deeply between her ribs or at her neck while she is resting (not eating), and she is grunting (making a rhythmic "ugh, ugh" noise).

SCENARIO A: Choking While Feeding

Context: Maggie is on paced feeding. If milk goes down the wrong pipe or she gets overwhelmed.

Mild GaggingTrue Choking
Signs: Red face, coughing, sputtering, crying. She is making noise.Signs: Silent. Mouth open but no sound. Face turning blue/purple. Cannot cough or cry.
ACTION:
1. Stop Feeding.
2. Sit her upright.
3. Let her cough it out.
4. DO NOT hit her back (this can lodge liquid deeper).		ACTION:
1. Call 911 (put phone on speaker).
2. Start Back Blows immediately.

🚑 Procedure: Infant Choking (Conscious)

Step 1: 5 Back Blows

  1. Hold Maggie face down on your forearm, supporting her jaw with your hand (do not cover her mouth/nose).
  2. Rest your forearm on your thigh for support. Her head must be lower than her chest.
  3. Use the heel of your hand to give 5 firm back blows between her shoulder blades.

Step 2: 5 Chest Thrusts

  1. If the obstruction doesn't clear, turn her over (face up) on your forearm.
  2. Support her head (still lower than her chest).
  3. Place 2 fingers in the center of her chest (just below the nipple line).
  4. Give 5 quick chest thrusts (pushing down about 1.5 inches).

Repeat: Alternate 5 Back Blows and 5 Chest Thrusts until she coughs/cries (airway clear) or becomes unconscious (start CPR).

SCENARIO B: Respiratory Distress (Retractions)

Context: Maggie has a history of "lung fatigue."

The "Working Too Hard" Check:

  • Look at her ribs: Is the skin sucking in between them?
  • Look at her neck: Is the hollow of her throat sinking in with every breath?
  • Listen: Is she "Grunting"? (A rhythmic noise on the exhale).
SeverityAction
Mild (During Feed)Stop Feeding. Burp her. Hold her upright. Wait 5 mins. If it stops, resume slowly.
Moderate (Persists after Feed)Stop Feeding. Undress her to see chest clearly. Check temp. If she is breathing fast (>60 breaths/min) for more than 10 mins, go to ER.
Severe (Blue / Grunting)Call 911. Do not put her in a car seat (the angle can compress the airway further). Keep her flat or slightly elevated until help arrives.

SCENARIO C: Infant CPR (Unresponsive)

Context: If she stops breathing and has no pulse.

  1. Check Responsiveness: Flick the bottom of her feet. Call her name.
  2. Call 911.
  3. Check Pulse: Place fingers on the inside of her upper arm (brachial artery). Check for no more than 10 seconds.
  4. Start Compressions:
    • Place Maggie on a firm, flat surface.
    • Place 2 fingers in the center of the chest (just below nipple line).
    • Push down 1.5 inches deep.
    • Rate: Fast (100-120 beats per minute). "Stayin' Alive" tempo.
    • Ratio: 30 Compressions : 2 Puffs of air (cover her nose and mouth with your mouth).
    • Note: If you are alone, do 2 minutes of CPR before leaving to call 911.

🏥 When to go to the ER (Non-Life Threatening but Urgent)

  • Fever: Rectal temperature > 100.4°F (38°C). Do not give Tylenol before going; they need to see the fever.
  • Dehydration: Fewer than 3 wet diapers in 24 hours (or dry for 10+ hours).
  • Vomiting: Projectile vomiting (shoots across room) or Green/Bright Yellow vomit (bile).