Artificial respiration including manual and instrumental methods.

1. ARTIFICIAL RESPIRATION
Dhruvi A. Prajapati
Assistant Professor
Dept. of Chemistry & QA
Babaria Institute of Pharmacy
BITS Edu campus - Vadodara

2. Introduction
• Artificial respiration, any measure that causes air to flow in
and out of person’s lungs when natural breathing is
inadequate or ceases, as in respiratory paralysis, drowning,
electric shock, choking, gas or smoke inhalation or poisoning.
• Also can be defined as act of breathing (inhaling oxygen &
exhaling carbon dioxide) during which lungs are provided with
air.
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3. Introduction
• Artificial respiration can be bought by an artificial lung ( in
respiratory paralysis particularly), a pulmotor or any other
mechanical respirator.
• But in the absence of any professional help, the rescusers in
emergency situations carry out the artificial respiration by
mouth to mouth or mouth to nose method.
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4. Artificial respiration includes resuscitation by the following two
actions:
1. It establishes and maintains an open air passage from the
upper respiratory tract to the lungs, and
2. It exchanges oxygen and carbon dioxide in the terminal air
sacs of lungs while the heart is still active.
Objective
• To maintain pulmonary ventilation by adjusting partial
pressure of oxygen in artery.
• Initiate and facilitate pumping of heart maintain circulation.
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5. Resuscitation methods
Resuscitation methods
Manual methods
1. Mouth to mouth respiration
2. Prone Pressure method
3. Arm lift chest pressure method
4. Arm lift back pressure method
5. Tilting or Eve’s rocking method
Instrumental methods
1. Drinker’s method
2. Bragg Paul’s method
3. Continuous insufflation
method
4. Tank respirator
5. Resuscitator
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7. i) Mouth-to mouth respiration method
Also known as the
rescue breathing method/
expired air method/
intermittent positive pressure breathing method/
direct method.
Best method of artificial respiration
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8. Steps:
1. The rescuer should tilt back the subject’s head with hands.
2. Then the rescuer should observe the subject and listen to the air being
exhaled form his/her mouth by bending ear to the subject’s mouth.
3. The rescuer should also check the subject’s chest to see the rise & fall.
4. The rescuer should check for any kind of obstruction in the subject’s
airway.
5. Now the rescuer should close the subject’s nose with a pinch, take a
deep breath, seal his/her lips over subject’s mouth & breath into it
several times. But rescuer should take a pause after each breath.
6. While breathing in, the rescuer should feel the subject’s brathing &
continuous with the process steadily by taking a pause to take a breath.
7. The rescuer should observe the rise and fall of the subject’s chest and
make sure that the breaths are effectively passing through the subject.
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9. • Mouth to mouth-
1 2 3
4 5 6
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10. Advantages:
• The subject is given exhaled air containing carbon dioxide,
which stimulates the respiratory centre.
• Good ventilation is obtained.
• It is the best method of artificial respiration for new borns.
Disadvantages:
• Since the subject is laid in supine position, if the water from
abdomen is not drained it regurgitate back into the lungs
leading to respiratory infections.
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11. ii) Prone pressure method
(Schafer’s method)
• In this method of artificial respiration, the subject is laid with
his/her face downward and the rescuer applies pressure
rhythmically with hands to the lower part of the thorax.
• Steps:
1. The subject shouls be laid on the abdomen with one arm stretched
overhead and other arm bent at the elbow so that the face rests on
the hand or the forearm and the nose and mouth are free for
breathing.
2. The rescuer should kneel across the subject’s hips with his/her knees
just below the subject’s hip bones. The palms of the hands should be
on the subject’s back with the fingers on the ribs, the little finger
touching the lowest rib.
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12. 3. With the arms held straight, the rescuer should slowly lean forward so
that his/her bodyweight is bearable by the subject. By this process, the
lower part of the chest and the abdomen are compressed, air is forced
out of the lungs, the diaphragm is kept in natural motion, other organs
are massaged and the blood circulation is accelerated.
4. Now the rescuer should immediately lean back to remove the pressure,
thus returning to the position. By this process, the pressure is removed,
the chest wall expands, the diaphragm descends and fresh air enters the
lungs.
5. After 2 seconds, the rescuer should again lean forward. This process of
compression and release of the chest wall should be repeated 12-15
times a minute, with a complete respiration in 4-5 seconds. The rescuer
should follow his/her own breathing rate, in case a watch is not available.
The proper rate is determined by counting leaning forward with each
expirtion and then backward with each respiration.
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14. Advantages:
• Any muscular exertion is not required for this process.
• Gas exchange between the outer environment and the inside of the
lungs occur efficiently.
• The process is simple and does not demand any complex
manipulations.
• The air passages do not get blocked by the falling back of the tongue
into the pharynx.
• In downed subjects, the water and mucus are expelled rapidly through
the mouth and nostrils.
• The internal organs are not injured.
• The process is non-exhaustive, thus can be continued for a long time.
• This method can also be used in case of injured thorax or back.
Disadvantages:
• Inspiration is passive and expiration is active, which is un-physiological.
• This method cannot be applied if the abdomen is injured.
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15. iii) Arm Lift Chest Pressure method
(Sylvester’s method)
• In this method of artificial respiration, the subject is laid on
his/her back and the rescuer presses his/her arms over the
subject’s chest to force out air from the lungs and draw fresh
air inside by pulling them above the head.
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16. Steps:
1. The subject should be placed in supine position.
2. The rescuer should stand or kneel at the head end and hold both the
arms of the subject.
3. The rescuer should raise the subject’s hands above the head, then fold
them back on the chest and compress the chest wall.
4. Such movements alternately increase and decrease the thoracic cavity,
thus drawing in and forcing out air from the lungs.
5. This method is commonly performed in operation theatres or in accident
cases.
6. The subject’s tongue should be kept pulled out and the mucus coming out
from the mouth should be wiped out timely.
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18. Advantages:
• Both inspiration and expiration is active, thus good ventilation
is obtained.
Disadvantages:
• This method is not preferred for drowned subjects as they are
laid in supine position, thus water cannot be drained out from
the lungs effectively
• This is an exhausting method.
• This method cannot be applied if there is a fracture in the rib
or thorax.
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19. iv) Arm Lift Back Pressure method
(Holger-Nielsen method)
• In this method of artificial respiration, the rescuer kneels at
the subject’s head’ compresses the chest by applying pressure
on the back, and then pulls up the elbows to expand the lungs.
Steps:
1. The subject’s arms should be folded and his/her face should be
turned sideways and placed on hands.
2. The rescuer should kneel about 6 inches from the subject’s head and
place the heels of his/her hands on the upper edge of the subject’s
shoulder blades with the fingers spread out obliquely
3. The rescuer should slowly rock forward on staright elbows until
his/her arms are almost vertical, exerting steady pressure on the
subject’s chest.
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20. 4. Then the rescuer should slowly rock backward, sliding his/her hands to
the subject’s arms just above the elbow.
5. The rescuer should continue to rock backward by grasping the subject’s
arms and raising the arms until tension is felt and then drawing them
slightly towards himself/herself.
6. Finally, the rescuer should lower the arms, completing the cycle.
7. This movement is carried out atlease 10 times per minute so that the
whole cycle takes about 6 seconds.
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22. Advantages:
• This method can be used in drowned subjects as water is
drained out from the lungs effectively.
• This method can also be used if the abdomen is injured.
Disadvantages:
• This method cannot be applies if the chest wall is injured.
• This method cannot be applied if there is a fracture in the
arms.
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23. v) Tilting or Eve’s Rocking method
• In this method of artificial respiration, the subject is tied on a
stretcher and his/her head & feet are alternately tilted by 45°
angle.
• This movement is carried out for 8-9 times per minute, 7
seconds for each movement.
• When the head is tilted, the weight of abdominal viscera
pressed against the diaphragm so that air is forced out of the
lungs.
• When the feet are tilted, diaphragm descends & air is drawn
into the lungs.
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26. i) Drinker’s method
• In this method of artificial respiration, the subject is placed in
an airtight chamber with the head outside.
• The pressure within the chamber is lowered and elevated
alternately using mechanically driven pumps.
• In case of lower pressure, the chest swells up and air is drawn
into the lungs; while in case of high pressure, the chest
compresses down and air is forced out of the lungs.
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28. • This method maintains artificial ventilation for desired time
length.
• It is very useful when artificial respiration is required for
prolonged duration (such as in morphine poisoning, in
paralysis of respiratory muscles, etc.)
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29. ii) Brag Paul’s method
• In this method of artificial respiration, the subject’s chest wall
is wrapped with a rubber bag.
• Pressure within the bag is elevated and lowered alternately
using pumps.
• This alternately compresses and relaxes the chest wall, thus
carrying out respiration.
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31. iii) Continuous Insufflation method
• In this method of artificial respiration, a thin flexible tube is
inserted in the subject’s trachea till its bifurcation and a
constant stram of oxygen is pressed through it into the lungs
to keep them slightly distened.
• Thus, respiration is maintained without any movement of the
subject.
• This method is applied to subjects who are to undergo
operation requiring opening of the thorax.
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32. iv) Tank respirator
• In this method of artificial respiration, the subject’s body is
placed within a tank with head protruded through a flexible,
airtight collar.
• A motor driven leather diaphragm placed opposite to the
subject’s head, moves back and forth to rise & lower the
pressure within the tank.
• Inward movement of diaphragm develops positive pressure
around the body and causes expiration; while outward
movement of diaphragm develops negative pressure and
causes inspiration.
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34. v) Resuscitator
• In this method of artificial respiration, air is forced through the
mask (fitted over the subject’s face) into the lungs during the
positive pressure cycle.
• Then it either let the air flow out of the lungs during the
remainder of the cycle or pulls out the air by negative
pressure.
• Resuscitator has a safety valve to prevent the positive
pressure form rising up to +14 mmHg and the negative
pressure from falling below -9 mmHg.
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