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. The sooner the shock is delivered the better for the victim’s survival. 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. Incorporating the 2015 guidelines into infant CPR is very important as of April 2016. 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. When you flick the infant’s foot and get no response you should yell for help. An important thing to remember is that infants are belly breathers. If you want to find out if they are breathing,look at the chest and belly while simultaneously taking the infant’s pulse by taking the infant’s hand and holding its thumb by its ear. This bares the area of the under arm between the elbow and the shoulder so you can easily access its brachial artery. Lightly press two fingers (middle and ring finger) on the area where the brachial is prominent on the inside of their arm. Make sure you make the OK sign with the thumb and pointer while taking the pulse. 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 and placing the baby’s thumb in the baby’s ear. Of course you don’t actually have to place the thumb in the ear. This action places the infant’s arm in a right angle up position and opens up the area on the inside of the baby’s arm plainly presenting the brachial location between the elbow and the shoulder. While holding the baby’s arm up by the hand (see Figure 1), place your middle finger and ring finger on the brachial artery and hold them there for 10 seconds.If the infant’s heart beat is 60 beats per minute or less with no breathing, start compressions. Remember that 60 beats per minute is equivalent to 1 beat per second. Therefore, you have to feel at least 10 beats in 10 seconds.

Figure 1 shows holding the infant’s arm in an upright position away from their ear exposing the underarm. The rescuer places 2 fingers on the brachial artery. 60 beats per minute is one beat per second. So if you take the pulse for 10 seconds, which I recommend, then you should feel at least 10 beats. If you don’t, then start compressions. If you feel more than 10 beats, then check the infant’s breathing and see if you need to deliver rescue breaths. 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. Rescue breaths should be delivered at a rate of ONE breath every 3-5 seconds. Remember to use the middle and ring finger to take a pulse. I tell my students to make the OK sign and then take the pulse. Why the OK sign, you ask? Isn’t there a pulse in your thumb? What is the last thing you want next to a clinically dead person? Need I say more?So use your middle and ring finger to take a pulse and keep your thumb pressed against your forefinger. That way you’re OK and so is the victim. If you don’t feel 10 beats in 10 seconds, start compressions See Figure 2

Figure 2 shows the middle and ring finger taking the pulse at the brachial artery: To deliver CPR to an infant, place your two fingers just below the nipple line and press down one-third the depth of the chest orat least 1 and ½ inches with the pads of your fingers. Deliver compressions at a rate of 100 to 120 per minute, preferably faster.Deliver 5 cycles or 2 minutes of 30 compressions and 2 breaths. Use the pads of your fingers instead of having your fingers vertical to minimize the possibility of injuring the baby’s soft skin. Deliver the breaths by placing your mouth over the infant’s nose and mouth and blowing softly.Delivering breaths to an infant is like blowing the dust off a dandelion. Blow very softly and stop immediately when you see chest rise. After 2 minutes of CPR, if you are alone and no one has come to assist you, take the baby with you and call 911. Better yet, if you have a cell phone on you, put it on speaker and dial 911 while you continue CPR.

Figure 3 shows placing the pads of two fingers just below the infant’s nipple line. Using the pads of your fingers instead of having your fingers vertical minimizes the possibility of injuring the baby’s soft skin. TO TEACH THIS SUBJECT EFFECTIVELYTHE WRITTEN MATERIAL MUST ACCURATELY EXPLAIN EVERY ACTION OF THE VIDEO DEMONSTRATION The written material should explain what it means to take the pulse 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 his ear. This action puts the infant’s arm in an upright right angle which is the preferred position to take the pulse correctly. Furthermore it 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 narrator should describe taking the pulse in the proper location and state that it should be at least 60 beats per minuteor greater. If it is greater you don’t perform CPR on an infant or child (the difference with the child is the pulse is taken at the carotid), and they should stress that if you take the pulse for 10 seconds how you apply the theory to reality. 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. If you don’t, then start CPR. The narrator should also explain that it applies to the child as well. For a child the pulse is taken at the carotid artery with the OK sign.

Figure 4 plainly shows taking the pulse while making the OK sign with the forefinger and thumb.