EMERGENCY RESUSCITATION ARTIFICIAL RESPIRATION (TYPES AND TECHNIQUES)A. RESPIRATORY RESUSCITATION PURPOSE: Immediately oxygenate the blood in order to forestall the irreversible changesthat take place in the brain when there is deprivation of oxygen. The first aider must realize that the vital need is to inflate the lungs even thoughthe air has to be blown past an obstruction in the casualty throat or wind pipe. "Delay of one or two seconds may prove fatal" The first aiders equipment is his hands, his mouth and his lungs. The well-trained first aider will be conditioned to take the immediate action ofinflating the casualtys lungs while simultaneously positioning his head and lower jaw toopen the air passage. a) Conscious person in upright position, slowing open air passages. b) In the unconscious casualty lying on his back, the tongue may fall backwards and block the air passages. c) If the neck is extended, the head pressed backwards and the lower jaw pushed upwards, the tongue moves forward thus opening the air passages.
METHODS:1. MOUTH-TO-MOUTH METHOD -method of choice ADVANTAGES: It can be more easily and effectively applied than other methods and used in some situations where they cannot. It gives the greatest ventilation of the lungs and oxygenation of the blood. The degree of inflation of the lungs can be assessed by watching the movement of the chest. It is less tiring, does not require strength and can be applied by a child.How to do: 1. The first aider must take up a convenient position such as lying, kneeling or standing and work from the side. 2. With the casualty on his back, hold his head in both hands, one hand pressing the haed backwards and the other pushing the lower jaw upwards and forwards. 3. Open the mouth wide, take a deep breath.In the case of: INFANT OR YOUNG CHILD 1. seal your lips round his mouth and nose 2. blow gently until you see his chest rise then stop and remove your mouth 3. repeat this procedure at the rate of twenty times per minute ADULT 1. seal your lips round the casualtys mouth while obstructing his nostrils with your
cheek, it may be necessary to pinch the nostrils with the fingers 2. blow into his lungs and watch for the chest to rise, then remove your mouth 3. inflation should be at the rate of ten per minute METHODS OF IMPROVING THE AIR PASSAGE While continuing mouth-to-mouth inflation of the lungs, in the case of: a. an infant or young child -place one hand under his neck and raise gently with the other hand extend the head backwards. b. an adult -grasp the back of the head between the hands.2. MOUTH-TO-NOSE METHOD - if casualty is in a state of spasm or convulsion and his mouth cannot be opened or if he has no teeth. a. work from the side of the casualty with his head extended b. open the mouth wide take a deep breath, and seal your lips widely on the casualtys face around the nose. Make sure your lips do not obstruct his nostrils. c. close the mouth by placing the you thumb on his lower lip.OBSTRUCTION IN THE AIR PASSAGES INFANT OR YOUNG CHILD i. lay the child prone with the head downwards over the knee ii. give three or four sharp slaps between the shoulders to dislodge the foreign body or hold the child up by his legs iii. smack him smartly three or four times between the shoulders
ADULT i. turn the casualty on his side and strike him three or four sharp blows between the shoulders ii. check if any debris has come into the throat by feeling with the fingers3. HOLGER-NIELSEN METHODTURNING • if the casualty is lying on his back turn him to the prone position (face downwards) as follows. • cross his far leg over the near leg • go down on the left knee opposite the casualtys head, placing the right foot on the ground out of the side • place the casualtys arms carefully above his head, and keep them thereduring the turn. • grasp his right upper arm and turn him over, preotecting his face with the other hand. • adjust the position of the casualtys hands.POSITION OF THE CASUALTY • lay the casualty in the prone position on a flat surface • place the casualtys hand one over the other, under his forehead. • the head must be turn slightly on one side • the nose and mouth must be unobstructed.
POSITION OF THE OPERATOR • place one knee with the inner side in line with the casualtys cheek six to twelve inches from the top his head • place the other foot with heal in line with the casualtys elbow. • place the hands on the casualtys back with the heel of the hands on the lower part of the shoulder blades, the thumbs alongside the spine and the fingers pointing the casualtys feet.MOVEMENT 1 • keeping the arms straight-rock gently forward until the arms are vertical or almost vertical depending on the build of the casualty or the operator, using no force. • the movement takes seconds counting one, two. This pressure causes expiration.MOVEMENT 2 • the operator now rocks back counting "three" for one second and slides his hand pass the casualtys shoulders until they can grip his upper arms near the elbows. • the operator raises and pulls the arms until tension is felt for a period of two seconds counting "four, five". ( take care not to raise the chest from the ground) • this movement causes inspiration, the operators arm should remain straight for the whole period. • counting "six" for one second the operator lowers the casualtys arm to the ground and replaced his handsin the original position. • the whole operation occupying 6 seconds that is ten times a minute, should be rhythmic in character and be continued until breathing recommences.
• when the casualty begins to show signs of breathing the operator should continue movement 2 only, raising and lowering the arms alternatively counting 1,2 (2 seconds) for inspiration and 3,4 (2 seconds) for expiration.SUMMARY OF COUNTING AND TIMINGthe counting and timing are as follows: • one-two (2 seconds) back pressure • three- (1 second) sliding hands to arms • four- five (2 seconds) raising arms • six (1 second) sliding hands to backHOLGER-NIELSEN METHOD OF ARTIFICIAL RESPIRATION METHOD(CHILDREN)For children below 5 years of age:1. the arms should be laid by the side and a support placed under the childs head2. grasp the shoulders with the fingers underneath and the thumbs on top3. press with the thumbs on the shoulder-blades for two seconds (for expiration), the leftshoulder for 2 seconds (for inspiration).If there are chest injuries- do the arm raising-lowering procedure only at the rate of 12 timesa minute.If the arms are injured- place them by the side of the body then do the complete procedurebut insert your hands under the casualtys shoulders and raise them for inspiration.both arms and chest- do arms raising and lowering by inserting your hands under the
casualtys shoulder only. PRESSURE FOR ARTIFICIAL RESPIRATION BY THE HOLGER NIELSEN METHOD 24-30 liter for an adult 12-14 liter for half grown children and slender women 2-4 liter for infants Simultaneous Resuscitation of two casualties by one operator until assistance is obtained. 1. Place the casualties side by side, with the adjacent arms extended above the head. 2. Bend the outside arms, and place the foreheads on the backs of the hands, with the heads turned outwards. 3. Kneel astride the two outstretched arms and close to the heads. 4. Perform the method as if the two bodies were one by pressing with one hand between the shoulder-blade of each casualty for expiration and by lifting the outer arms for inspiration.4. SILVESTERS METHOD OF ARTIFICIAL RESPIRATION - to be used only when it is impossible or inexpedient to turn the casualty on to his face. THE CASUALTYS POSITION i. place the casualty on his back on a flat surface ii. raise and support his shoulders on a cushion or folded article of clotting in such a waythat his head hangs backwards. In order to prevent the tongue falling back and obstructing the wind pipe, an assistant must grasp the tongue firmly with handkerchief, draw it forward as far as possible and hold it there. If no assistant is
available, the casualtys head must be turned as as possible to one side. MOVEMENT 1 - kneel just above the casualtys head, place his forearms on hischest as near each other as possible and grasp them firmly below the elbows. - draw his arms upwards, outwards and towards you with a sweeping movement, pressing his elbows towards the ground. MOVEMENT 2 - bring the flexed arms slowly back along the same route and press them firmly against the front and ribs of his chest. RHYTHM movements should be performed 12 times per minute.5. SCHAFERS METHOD OF ARTIFICIAL RESPIRATION Turning the casualty Should the casualty be lying on his back, turn him to prone posution as follows: i. stoop on his side ii. place his arms above his head iii. cross his far leg over hisnear leg iv. protect his face with one of your hands v. grasp his clothing at the hip on the opposite side of the body and quickly and gently turn him over
Position of the casualty i. lay the casualty in prone position ii. place the casualtys hands one over the other, under his forehead. iii. the head must be turned slightly to one side iv. the nose and mouth must be unobstructedPosition of the operator i. face the casualtys head ii. kneel on both knees at the casualtys side in a position just below his hip-joint iii. sit back on your heels to allow free sway iv. place your hands on the loins of the casualtys one on each side of the backbone with wrists almost touching with thumbs as for forward as possible without strain, and the fingers close together at the side of loins and bent over the flanks in the natural hollows just above the brin of the pelvis but clear of it, the tips of the fingers pointing to the ground. v. keep your elbows quite straightARTIFICIAL RESPIRATION (SCHAFERS METHOD POSITION OF CASUALTY ANDOPERATOR)MOVEMENT 1Without bending your elbow, swing slowly forward by untending the knees until the thighsare in an almost upright position and the shoulders vertically above the hands, so allowingthe weight of your body to be communicated to the casualtys loins.
The compressing in Movement 1 is to be effected solely by the weight of the operators bodyand not by muscular effort. The pressure should not exceed 60 litre.MOVEMENT 2swing slowly back on to your heels thus relaxing the pressure. This causes the abdominalorgans to fall back and the diaphragm to drop this including inspiration.RHYTHMThe two movements, which must be carried out smoothly and rhythmically should take fiveseconds.ARTIFICIAL RESPIRATION (SCHAFERS METHOD) MOVEMENT ONEChanging OperatorsIt may frequently be found necessary to change operators as follows: 1. the relief takes up a position at the opposite side of the patient to the operator, places his hands over those of the operator without exercising any pressure and gradually falls into the rhythm of his movements. 2. After working this together for few seconds the operator arrives at the "off" position. 3. He should carefully remove his hand while at the same time the hands of the relief occupy the vacated position.
B. EXTERNAL CARDIAC RESUSCITATION - this is an immediate method of restarting the circulation - is not without its dangers and a first aider should only use this technique if he is surethat the heart is not functioning.If two first aiders are present:- one to undertake respiratory respiration- one to carry out external cardiac resuscitationMETHODa. INFANT OR YOUNG CHILD- with two fingers on the lower half of the sternum applyquickly six to eight sharp but not violent presses at the rate of one per second between eachinflation.b. ADULT- having located the lower half of the sternum,place the ball of the hand on it withthe second hand covering the first. After each inflation of the lungs apply six to eight sharppresses at the rate of one per second.IN ELECTRIC SHOCKAn electric shock acts on the breathing centre in the brain and causes the respiration orbreathing to stop. However, the heart may continue to function for some time even thoughthe breathing has stopped.TREATMENT • Remove the patient from the electric current by using a piece of wood or a stick to
pull him away. • Apply artificial respiration immediately using the mouth to mouth method. as long as the pulse is felt, artificial respiration should be maintained.IN DROWNINGDrowning results in the inhalation of water into the lungs.If a person who had drowned is brought to you proceed as follows: i. turn the patient face down with the head turned to one side and the arms stretched out. If a slope exists, the head must be placed downwards. ii. place your hands round the patients abdomen and raise the body to encourage the water to run out of the lungs. iii. clear the mouth of weeds or any other material obstructing air entry, and of false teeth, if any. iv. loosen the clothing round the neck and waist. v. apply artificial respiration . do not stop until the breathing has been re-established for at least a quarter of an hour. vi. if assistance is available remove wet clothing and treat for shock.RESUSCITATIONIf a casualty is not breathing and if the heart is not beating: it is vital that you take overventilation and circulation so that the flow of oxygen to the brain is maintained.Remember the ABC Rule • First, ensure an open AIRWAY
• Second, BREATHE for the casualty by inflating the lungs and oxygenating the blood Artificial ventilation • Third, CIRCULATE the blood by compressing the chest ( external chest compression)Resuscitation should be attempted even if you are in doubt about whether a casualty iscapable of being revived. You should always continue until spontaneous breathing and pulse restored; anotherqualified person takes over; a doctor assumes responsibilities for the casualty; you areexhausted and unable to continue.- opening the airway-checking the breathing-clearing the airway1.) OPENING THE AIRWAYIf a casualty is unconscious, the airway may be narrowed or blocked making breathing noisyor impossible. This occurs for several reasons:- the head may tilt forward narrowing the air passage- muscular control in the throat will be lost, which may allow the tongue to sag back andblock the air passage and because the reflexes are impaired, saliva or vomit may lie in theback of the throat blocking the airway.If the casualty still does not breathe, begin artificial ventilation immediately.1. kneel beside the casualty2. lift the casualtys chin forwards with the index and middle fingers of the hand while
pressing the forehead backwards with the heel of your other hand. The jaw will lift thetongue forward, clear of the airway.Checking Breathing1. continue holding the casualtys airway open and place you ear above her mouth and nose2. look along her chest and abdomen. If she is breathing, you will hear and feel any breath onthe side of your face and see movement along the chest and abdomen.Clearing the Airway1. turn the casualtys head to the side, keeping it well back.2. hook your first two fingers and sweep round inside the mouth. But do not spend timesearching for hidden obstructions and make surethat you do not push anyobject further downthe throat.3. check breathing again2.) BREATHINGArtificial ventilation- the technique of breathing for a casualty.a.) Mouth-To-mouth ventilation -most efficient method of artificial ventilation in all cases where a casualty is notbreathing. -you blow air from your lungs into the casualtys mouth or nose to fill the casualtyslungs. - enables you to watch the casualtys chest for movement, indicating that the lungs arebeing filled or that the casualty is breathing again naturally and to observe changes in the
casualtys colour. - can be used by first aiders of any age and in most circumstances. - Easiest to carry out if the casualty is lying on his/her backMETHODS:1. Remove any obvious obstructions over face or constrictions around neck. Open airway andremove any debris seen in the mouth and throat.2. Open your mouth wide, take a deep breath, pinch the casualtys nostrils together with yourfingers and seal your lips around his mouth. Blow into the casualtys lungs, looking along hischest, until you can see his chest rise to maximum expansion.3. remove your mouth well away from the casualtys and breath out any excess air whilewatching his chest fall. Take a deep breath, repeat inflation.4. after two inflations check the pulse to make sure the heart is beating.b.) mouth-to-nose ventilation- close the casualtys mouth with your thumb and seal your lips about his nose. Proceed as formouth-to-mouth.c.) artificial ventilationIn this technique, the nose is pinched so that air blown into the casualtys mouth cannotescape through the nasal passage but is forced into the lungs.CIRCULATIONIt is pointless continuing artificial ventilation if the casualtys heart is not beating, because theoxygenated blood will not be circulating.EXTERNAL CHEST COMPRESSION
Contractions can be simulated in a non-beating heart by compressing the chest. By pressing down on the lower half of the breast bone you increase the pressure inside the chest thus driving blood out of the heart and into the arteries. When you release the pressure, the chest returns to its normal position and blood flow back along the veins and refills the heart as it expands. External chest ventilation is always preceded and accompanied by artificial ventilation. To be effective, it must be carried out with the casualty lying on a firm surface. CHECKING FOR CIRCULATION The only reliable way of establishing a lack of circulation is to check the pulse at the neck (carotid pulse). This pulse can be felt by placing your finger tips gently on the voice box and sliding them down into the hollow between the voice box and the adjoining muscle.METHOD OF EXTERNAL CHEST COMPRESSIONIf mouth-to-mouth ventilation by itself is unsuccessful and the casualty’s heart stops, or hasstopped beating, you must perform External Chest Compression in conjunction with mouth-to-mouth ventilation. This is because without the heart to circulate the blood, oxygenated bloodcannot reach the casualty’s brain. To be used if hearts from stops from functioning becauseoxygenated blood cannot reach the casualty’s brain.STEPS 1. Lay the casualty on his back on a firm surface. Kneel alongside him facing his chest and
in line with his heart. Find the junction if his rib margins at the bottom of his breast bone. Place the heel of one hand along the line of the breast bone, two finger breaths above this point, keeping your fingers off the ribs. 2. Cover the left hand with the heel of your other hand (right hand) interlock your fingers. Your shoulders should be directly over the casualty’s breast bone and your arms straight. 3. Keeping your arms straight, press down vertically on the lower half of his breast bone to move it 4-5 cm (1 ½ -2 inch) for the average adult. Release pressure Complete 15 compressions at the rate of 80 compressions per minute. Compressions should be regular and smooth, not Jerky and Jabbing (to find the correct speed, count one and two and three, and so on). 4. Move back to the casualty’s head, re-open by airway and give two breaths of mouth-to- mouth ventilation. 5. Continue with 15 compressions followed by two full ventilators, repeating the circulation check after the first minute. Thereafter, check pulse after every three minutes. 6. As soon as the pulse returns, stop compressions immediately. Continue mouth-to-mouth ventilation until natural breathing is restored, assisting it when necessary, and adjusting it to the casualty’s rate. Place the casualty in the Recovery Position (Refer the Topic on Recovery Position).CHECKING FOR RESPONSEWhen resuscitation is successful, the carotid pulse will return. Look at the casualty’s face andlips. The colour will improve as blood containing oxygen begins to circulate. When the casualtyis not breathing, the normal colour turns to blue (cyanosis).
RESUSCITATION WITH TWO FIRST AIDERS 1. One should take charge and maintain the open airway, 2. perform mouth-to-mouth ventilation and check circulation; 3. the other should perform External Chest Compression.STEPS 1. One first aider takes up a position at the casualty’s head, the other kneels alongside the casualty, level with the middle of her chest. 2. The first aider at the head immediately opens the airway, gives the first two inflations and checks for circulation (Refer Topic on Checking for Circulation). If it is absent, the other first aider should begin chest compression. 3. Resuscitation then continues with the first aider at the head keeping the airway open and giving a single inflation on the upstroke of every fifth compression by her partner. The compressions are continued at a rate of 80 per minute until the circulation returns and the pulse is felt (To find the correct speed count one and two and three and so on). Pulse check must be carried out after the first minute and then every three minutes.Note: these needs to be a short pause after every five compressions, allowing time for the lungsto inflate.RESUSCITATION FOR CHILDRENFor children and infants place your hand just below the centre of the breast bone for ExternalChest Compression giving five compressions to one inflation per cycle.
ARTIFICAL VENTILATION FOR CHILDREN STEPSFor ChildrenOpen the child’s airway. Seal your lips around his mouth and nose and breath gently into thelungs at a rate of 20 breaths per minute. Check for circulation after giving the first two inflationsFor Babies (or) Children under Two 1. Open the airway being careful not to tilt the head back too far. 2. Seal your lips around the baby’s mouth and nose and puff gently into the lungs at a rate of 20 breaths per minute. 3. Check for circulation after giving the first two inflations.EXTERNAL CHEST COMPRESSION—STEPSFor Children Use light pressure with one hand only. Press at a rate of 100 compressions perminute to a depth of 2.5-3.5 (1-1 ½ inch) with five compressions to one ventilation.For Babies (or) Children under TwoMake sure the baby is on a firm surface. Support his head and neck by sliding one hand under hisback. Using two fingers only, press at a rate of 100 times per minute to a depth of 1.5-2.5 cm (1½-1 inch).THE RECOVERY POSITIONPosition ensures that an open airway is maintained because the tongue cannot fall to the back ofthe throat: the head and neck will remain in an extended position so that the air passage iswidened; and vomit (or) other fluid will drain freely from the casualty’s mouth.
Recovery position, it must be used immediately id a casualty’s breathing becomes difficult ornoisy and is not relieved by opening the airway; (or) if a casualty has to be left unattended (anunusual event).STEPS 1. Kneel upright alongside the casualty facing his chest. Turn his head towards you and felt it back keeping the Jaw forward in the Open Airway Position. 2. Place the casualty’s arm nearest to you by his side. Lift his buttock and place his hand well underneath with the fingers straight. Holding his far legs under the knee (or) ankle bring it towards you and cross it over his near leg. Bring his other forearm over the front of his chest. 3. Protect and support the casualty’s head with one hand, with the other hand, grasp his clothing at the hip on his side against your thighs. 4. Still supporting his body against your knees readjusts his head to ensure that the airway is open. 5. Bend his uppermost arm at a right angle to support the upper body. 6. Bend his uppermost knee at a right angle to bring the thigh well forward to support the lower body.For heavy Casualty You may have to use both hands to turn a heavy casualty. Grasp the clothing at theshoulders and hips and pull him so that his body is against your thighs.If bystanders are present, one may support his head while you do turning. Alternatively, get themto help by kneeling beside you and by pulling at his hips while you pull his should and support
his head. It may be necessary for them to face you and push the casualty towards you as you pull. 7. Carefully pull the other arm out from under the casualty, working from the shoulder down. Leave it lying parallel to him to prevent him rolling on to his back and to avoid interference with his circulation. 8. Check that the final position is stable and that the casualty cannot roll forwards or backwards. Ensure that no more than half his chest is in contact with the ground and that his head remains tilted and his jaw forward to maintain an open airway position.