The document provides instructions for performing respiratory resuscitation through mouth-to-mouth resuscitation and chest compressions, describing the proper positioning of the casualty and operator, hand and arm movements for artificial respiration, and methods for clearing obstructions and improving airflow. Proper timing and rates are emphasized to effectively oxygenate the blood through inflation of the lungs until normal breathing resumes.

1. Northern Christian College
“ The Institution for Better Life”
Laoag City
COLLEGE OF NURSING
“EmErgEncy rEsuscitation”
Reporters: Rhodmark, Karen, Rox Anne, Windy, Rose Anne
BSN IV-A S.Y. 2012-2013

3. RESPIRATORY RESUSCITATION

4. RESPIRATORY RESUSCITATION
PURPOSE:
•Immediately oxygenate the blood in order to
forestall the irreversible changes that 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 though the air has to be
blown past an obstruction in the casualty throat or
wind pipe.

5. •"Delay of one or two seconds may
prove fatal“
•The first aider's equipment is his hands,
his mouth and his lungs.
•The well-trained first aider will be
conditioned to take the immediate action
of inflating the casualty's lungs while
simultaneously positioning his head and
lower jaw to open the air passage.

6. 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.

9. 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.

10. 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.

12. 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 casualty's 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

15. 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.

17. - if casualty is in a state of spasm or convulsion and his
mouth cannot be opened or if he has no teeth.
How to do:
1. work from the side of the casualty with his head
extended
2. open the mouth wide take a deep breath, and seal
your lips widely on the casualty's 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.

18. OBSTRUCTION IN THE AIR PASSAGES
Infant or young child
1. lay the child prone with the head downwards over the
knee
2. give three or four sharp slaps between the shoulders to
dislodge the foreign body or hold the child up by his
legs
3. smack him smartly three or four times between the
shoulders

19. Adult
1. turn the casualty on his side and strike
him three or four sharp blows between
the shoulders
2. check if any debris has come into the
throat by feeling with the fingers

22. TURNING
1. 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 leg
3. go down on the left knee opposite the casualty's head,
placing the right foot on the ground out of the side
4. place the casualty's 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 casualty's hands.

23. POSITION OF THE CASUALTY
1. lay the casualty in the prone position on a flat
surface
2. place the casualty's hand one over the other,
under his forehead.
3. the head must be turn slightly on one side
4. the nose and mouth must be unobstructed.

24. POSITION OF THE OPERATOR
1. place one knee with the inner side in line with
the casualty's cheek six to twelve inches from
the top of his head
2. place the other foot with heal in line with the
casualty's elbow.
3. place the hands on the casualty's 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 casualty's feet.

26. HOW TO DO:
MOVEMENT 1
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.
2. the movement takes seconds counting one,
two. This pressure causes expiration.

27. MOVEMENT 2
1. the operator now rocks back counting "three"
for one second and slides his hand pass the
casualty's 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 operator's
arm should remain straight for the whole
period.

28. 4. counting "six" for one second the operator lowers
the casualty's 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.

30. SUMMARY OF COUNTING AND
TIMING
the 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

31. HOLGER-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 child's head
2. grasp the shoulders with the fingers underneath and the
thumbs on top
3. press with the thumbs on the shoulder-blades for two
seconds (for expiration), the left shoulder for 2 seconds
(for inspiration).

32. If there are chest injuries- do the arm raising-
lowering procedure only at the rate of 12 times a
minute.
If the arms are injured- place them by the side of
the body then do the complete procedure but insert
your hands under the casualty's shoulders and raise
them for inspiration.
both arms and chest- do arms raising and lowering
by inserting your hands under the casualty's
shoulder only.

33. 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

34. 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.

36. - to be used only when it is impossible or inexpedient to turn the
casualty on to his face.
THE CASUALTY'S 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 casualty's head must be
turned as as possible to one side.

37. MOVEMENT 1
1. kneel just above the casualty's 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 and
press them firmly against the front and ribs of his chest.
RHYTHM
movements should be performed 12 times per minute.

40. Turning the casualty
Should the casualty be lying on his back, turn him to prone
posItion as follows:
1. stoop on his side
2. place his arms above his head
3. cross his far leg over his near leg
4. protect his face with one of your hands
5. grasp his clothing at the hip on the opposite side of the
body and quickly and gently turn him over

41. Position of the casualty
1. lay the casualty in prone position
2. place the casualty's hands one over the other,
under his forehead.
3. the head must be turned slightly to one side
4. the nose and mouth must be unobstructed

42. Position of the operator
1. face the casualty's head
2. kneel on both knees at the casualty's side in a position
just below his hip-joint
3. sit back on your heels to allow free sway
4. place your hands on the loins of the casualty's 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

43. ARTIFICIAL RESPIRATION (SCHAFER'S METHOD
POSITION OF CASUALTY AND OPERATOR)
MOVEMENT 1
Without bending your elbow, swing slowly forward by
unbending the knees until the thighs are in an almost upright
position and the shoulders vertically above the hands, so
allowing the weight of your body to be communicated to the
casualty's loins.
The compressing in Movement 1 is to be effected solely by
the weight of the operator's body and not by muscular effort.
The pressure should not exceed 60 litre.

44. MOVEMENT 2
swing slowly back on to your heels thus relaxing
the pressure. This causes the abdominal organs to
fall back and the diaphragm to drop this including
inspiration.
RHYTHM
The two movements, which must be carried out
smoothly and rhythmically should take five
seconds.

45. ARTIFICIAL RESPIRATION (SCHAFER'S METHOD)
MOVEMENT ONE
Changing Operators
It 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.