RESPIRATORY RESUSCITATIONPURPOSE:•Immediately oxygenate the blood in order toforestall the irreversible changes that take place inthe brain when there is deprivation of oxygen.•The first aider must realize that the vital need is toinflate the lungs even though the air has to beblown past an obstruction in the casualty throat orwind pipe.
•"Delay of one or two seconds mayprove fatal“•The first aiders equipment is his hands,his mouth and his lungs.•The well-trained first aider will beconditioned to take the immediate actionof inflating the casualtys lungs whilesimultaneously positioning his head andlower jaw to open 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.
MOUTH-TO-MOUTH METHOD-method of choiceADVANTAGES: 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 head 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 CHILD1. seal your lips round his mouth and nose2. blow gently until you see his chest rise then stop and remove your mouth3. repeat this procedure at the rate of twenty times per minuteADULT1. seal your lips round the casualtys mouth while obstructing his nostrils with your cheek, it may be necessary to pinch the nostrils with the fingers2. blow into his lungs and watch for the chest to rise, then remove your mouth3. inflation should be at the rate of ten per minute
METHODS OF IMPROVING THE AIRPASSAGEWhile continuing mouth-to-mouth inflation of thelungs, 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.
- if casualty is in a state of spasm or convulsion and hismouth cannot be opened or if he has no teeth. How to do:1. work from the side of the casualty with his head extended2. 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.3. close the mouth by placing your thumb on his lower lip.
OBSTRUCTION IN THE AIR PASSAGESInfant or young child1. lay the child prone with the head downwards over the knee2. give three or four sharp slaps between the shoulders to dislodge the foreign body or hold the child up by his legs3. smack him smartly three or four times between the shoulders
Adult1. turn the casualty on his side and strike him three or four sharp blows between the shoulders2. check if any debris has come into the throat by feeling with the fingers
TURNING1. if the casualty is lying on his back turn him to the prone position (face downwards) as follows.2. cross his far leg over the near leg3. go down on the left knee opposite the casualtys head, placing the right foot on the ground out of the side4. place the casualtys arms carefully above his head, and keep them there during the turn.5. grasp his right upper arm and turn him over, protecting his face with the other hand.6. adjust the position of the casualtys hands.
POSITION OF THE CASUALTY1. lay the casualty in the prone position on a flat surface2. place the casualtys hand one over the other, under his forehead.3. the head must be turn slightly on one side4. the nose and mouth must be unobstructed.
POSITION OF THE OPERATOR1. place one knee with the inner side in line with the casualtys cheek six to twelve inches from the top of his head2. place the other foot with heal in line with the casualtys elbow.3. 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.
HOW TO DO:MOVEMENT 11. 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.2. the movement takes seconds counting one, two. This pressure causes expiration.
MOVEMENT 21. 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.2. 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)3. this movement causes inspiration, the operators arm should remain straight for the whole period.
4. counting "six" for one second the operator lowers the casualtys arm to the ground and replaced his hands in the original position.5. the whole operation occupying 6 seconds that is ten times a minute, should be rhythmic in character and be continued until breathing recommences.6. 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 ANDTIMINGthe 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 back
HOLGER-NIELSEN METHOD OF ARTIFICIALRESPIRATION 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 left shoulder for 2 seconds (for inspiration).
If there are chest injuries- do the arm raising-lowering procedure only at the rate of 12 times aminute.If the arms are injured- place them by the side ofthe body then do the complete procedure but insertyour hands under the casualtys shoulders and raisethem for inspiration.both arms and chest- do arms raising and loweringby inserting your hands under the casualtysshoulder only.
PRESSURE FOR ARTIFICIAL RESPIRATIONBY THE HOLGER NIELSEN METHOD24-30 liter for an adult12-14 liter for half grown children and slender women2-4 liter for infants
Simultaneous Resuscitation of two casualties by oneoperator 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.
- to be used only when it is impossible or inexpedient to turn thecasualty on to his face. THE CASUALTYS POSITION 1. place the casualty on his back on a flat surface 2. raise and support his shoulders on a cushion or folded article of clotting in such a way that 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 11. kneel just above the casualtys head, place his forearms on his chest as near each other as possible and grasp them firmly below the elbows.2. 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 andpress them firmly against the front and ribs of his chest.RHYTHM movements should be performed 12 times per minute.
Turning the casualtyShould the casualty be lying on his back, turn him to proneposItion as follows:1. stoop on his side2. place his arms above his head3. cross his far leg over his near leg4. protect his face with one of your hands5. grasp his clothing at the hip on the opposite side of the body and quickly and gently turn him over
Position of the casualty1. lay the casualty in prone position2. place the casualtys hands one over the other, under his forehead.3. the head must be turned slightly to one side4. the nose and mouth must be unobstructed
Position of the operator1. face the casualtys head2. kneel on both knees at the casualtys side in a position just below his hip-joint3. sit back on your heels to allow free sway4. 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.5. keep your elbows quite straight
ARTIFICIAL RESPIRATION (SCHAFERS METHODPOSITION OF CASUALTY AND OPERATOR)MOVEMENT 1Without bending your elbow, swing slowly forward byunbending the knees until the thighs are in an almost uprightposition and the shoulders vertically above the hands, soallowing the weight of your body to be communicated to thecasualtys loins.The compressing in Movement 1 is to be effected solely bythe weight of the operators body and not by muscular effort.The pressure should not exceed 60 litre.
MOVEMENT 2swing slowly back on to your heels thus relaxingthe pressure. This causes the abdominal organs tofall back and the diaphragm to drop this includinginspiration.RHYTHMThe two movements, which must be carried outsmoothly and rhythmically should take fiveseconds.
ARTIFICIAL RESPIRATION (SCHAFERS METHOD)MOVEMENT ONEChanging OperatorsIt may frequently be found necessary to change operators asfollows: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.