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Pillole di Primo Soccorso

PILLOLE DI PRIMO SOCCORSO/7

Disostruzione delle vie aeree – pediatrico.

Nell’ultima chiacchierata abbiamo parlato delle manovre di disostruzione delle vie aeree per gli adulti. Oggi, invece, parliamo delle manovre di disostruzione in età pediatrica. Il termine pediatrico, secondo le Linee Guida ERC (European Resuscitation Council) comprende i bambini appena nati fino a quattro settimane di vita, i cosiddetti neonati; i lattanti, i bambini fino a un anno di età; il termine “bambino” è riferito specificatamente ai bambini da un anno fino alla pubertà. A partire dalla pubertà i bambini vengono chiamati adolescenti. Per questi ultimi vanno applicate le linee guida per gli adulti. È importante distinguere i lattanti dai “bambini” più grandi poiché ci sono importanti differenze rispetto alle tecniche di intervento da utilizzare. Quando un corpo estraneo entra nelle vie aeree, il bambino reagisce immediatamente tossendo, nel tentativo di espellerlo. La tosse spontanea è più efficace e più sicura di qualsiasi manovra il soccorritore possa eseguire. Se la tosse è assente o inefficace e l’oggetto ostruisce completamente le vie aeree, il bambino diverrà rapidamente asfittico. Pertanto, gli interventi per risolvere l’ostruzione da corpo estraneo sono necessari solo quando la tosse diviene inefficace e in questo caso vanno iniziati rapidamente e con decisione. La maggior parte degli episodi di soffocamento nei lattanti e nei bambini avviene durante il gioco o il pasto, quando un tutore è solitamente presente; si tratta quindi di eventi spesso testimoniati, nei quali l’intervento inizia quando il bambino è ancora cosciente. L’ostruzione delle vie aeree da corpo estraneo è caratterizzata dall’insorgenza improvvisa di distress respiratorio, associato a tosse, stridore o impossibilità a emettere suoni. Assunzione di cibo o gioco con piccoli oggetti possono determinare indizi sull’insorgenza dei sintomi che possono allertare il soccorritore. Se un bambino riesce a respirare e tossire, anche se con difficoltà bisogna incoraggiare i suoi sforzi; non bisogna intervenire in questo frangente poiché un intervento potrebbe spostare il corpo estraneo e peggiorare il problema causando un’ostruzione completa delle vie aeree. Se il bambino tossisce in modo efficace, non è necessaria alcuna manovra. Incoraggiare il bambino a tossire e controllarlo continuamente. Se la tosse è o sta diventando inefficace, chiamare immediatamente aiuto e valutare il livello di coscienza del bambino. Se il bambino è cosciente ma la tosse è assente o inefficace, effettuare i colpi interscapolari. Se i colpi interscapolari non risolvono l’ostruzione da corpo estraneo, effettuare compressioni toraciche nei lattanti o compressioni addominali nei bambini. Queste manovre creano una “tosse artificiale” che aumenta la pressione intratoracica e determina la dislocazione del corpo estraneo.

Colpi interscapolari nei lattanti: Posiziona il lattante in posizione prona con la testa più declive rispetto al tronco, per consentire alla forza di gravità di favorire l’espulsione del corpo estraneo. Il soccorritore seduto o inginocchiato deve sostenere il bimbo sulle proprie cosce in sicurezza. Sostieni la testa del lattante, ponendo il pollice di una mano all’angolo della mandibola, e uno o due dita della stessa mano sull’angolo mandibolare controlaterale. La testa viene mantenuta in posizione neutra. Tutto il corpo del lattante è adagiato sull’avambraccio del soccorritore e il tutto sulla sua coscia. Non comprimere i tessuti molli sotto-mandibolari poiché questo peggiora l’ostruzione delle vie aeree. Effettua fino a cinque colpi interscapolari con la parte inferiore del palmo di una mano sul dorso della vittima tra le scapole. L’obiettivo è quello di eliminare l’ostruzione a ogni colpo, che arrivare ad effettuarli tutti e cinque.

Colpi interscapolari nel bambino oltre un anno d’età: posizionarsi in ginocchio con una gamba rialzata; su quest’ultima, posizionare il bambino con il capo in posizione declive; con una mano, mantenendo il mento, sostenere la testa del bambino; effettuare cinque colpi interscapolari. Se i colpi interscapolari non riescono a dislocare il corpo estraneo e il bimbo è ancora cosciente, utilizzare le compressioni toraciche per i lattanti e quelle addominali per i bambini. Non utilizzare le compressioni addominali (manovra di Heimlich) nei lattanti.

Compressioni toraciche nel lattante: Posiziona il lattante in posizione supina con il capo declive. Ciò si ottiene, in modo sicuro, ponendo il proprio braccio libero lungo la schiena del bambino e circondando l’occipite con la mano. Sostieni il lattante sul proprio braccio appoggiato sulla coscia. Identifica il punto di repere per le compressioni toraciche (sulla metà inferiore dello sterno, approssimativamente un dito sopra il processo xifoideo). Esegui cinque compressioni toraciche; queste sono simili a quelle che si eseguono per il massaggio cardiaco, ma sono più brusche e applicate a un ritmo più lento.

Compressioni addominali nei bambini: Posizionati in ginocchio dietro il bambino; poni le tue braccia sotto le sue braccia e circonda il tronco. Chiudi una mano a pugno e posizionala tra l’ombelico e il processo xifoideo della vittima. Afferra il pugno con l’altra mano e comprimi verso l’interno e verso l’alto. Ripeti fino a cinque volte. Dopo l’esecuzione delle compressioni toraciche o addominali, rivalutare il bambino. Se il corpo estraneo non è stato espulso e il bambino è ancora cosciente, proseguire con la sequenza dei colpi interscapolari e delle compressioni toraciche (nei lattanti) o addominali (nei bambini). Chiamare o far chiamare aiuto se ancora non è disponibile. Non lasciare il bambino in questa fase. Se il corpo estraneo è espulso con successo, far controllare sempre le condizioni cliniche del bambino. Nel malcapitato caso che l’ostruzione non si risolva e l’infortunato perda conoscenza, bisognerà adagiarlo a terra supino e attuare la procedura di BLS-Basic Life Support, supporto vitale di base pediatrico, di cui parleremo al prossimo appuntamento.

Intanto, come sempre, Vi invito a frequentare i nostri Corsi di Primo Soccorso e Manovre Salvavita per imparare le tecniche e le procedure corrette. Alla prossima.

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