First Aid International

Resuscitation

A person who is having difficulty breathing is in respiratory distress. A person who is not breathing is in respiratory arrest. A person in respiratory arrest needs resuscitation.

When a person is in respiratory arrest, the heart may still be beating. Without resuscitation, the heart will stop beating soon after breathing stops. In some instances the heart may stop beating first, and then breathing stops immediately. This casualty needs cardio-pulmonary resuscitation (CPR), which combines rescue breathing, with external chest compressions (ECC) to circulate the blood. Properly performed CPR can keep a casualty’s vital organs supplied with oxygen-rich blood until ambulance personnel arrive to provide advanced care.

The First Aid Process known as DRABCD

D - DANGER

Ensure the area is safe for yourself as the first aider, the casualties and any bystanders. If it is unsafe and you cannot secure the area without putting yourself at risk, call for for assistance by phoning emergency services. If the area is safe, proceed with;

R - RESPONSE

Gently touch the casualty to try and establish some sort of response. If the casualty responds, ask their name and if they have any injuries, pain etc. Check their vital signs and get an ambulance for the casualty if that is what is required. If the casualty does not respond the casualty is unconscious. Immediately roll the casualty into the lateral position keeping their head, neck and spine in alignment in case of spinal injury. Once in the lateral position proceed with;

A - AIRWAY

Position the casualty’s chin at an angle downward, open the mouth and check for material which may cause an obstruction. Scoop the material out of the mouth using your fingers. Once the airway is clear, continue with;

B - BREATHING

Open the casualty’s breathing passage by putting the head in backward tilt. Bend over the casualty placing your hand on the rib cage and your ear over the mouth and nose. LOOK, LISTEN AND FEEL FOR BREATHING. If the casualty is breathing normally, ensure a safe lateral position and continue to observe the breathing. If the casualty is not breathing normally roll onto their back, give head tilt to open airway & use pistol grip to support give rescue breaths and reassess. If still not breathing normally, commence CPR.

C - COMPRESSIONS

Placing base of palm on the lower half of the sternum, compress chest a 1/3 of depth at a rate of 100 compressions per minute. Ratio of compressions breaths 30:2, 5 cycles / 2 min.

D - DEFIBRILLATION

Casualties requiring CPR also require advanced medical care ASAP. Defibrillation is the next step in the chain of survival. So send for help immediately or use defib if equipped and trained to do so.

For chest compressions to be effective there are some important points to keep in mind:

the casualty should be lying flat on a firm surface

kneel beside the casualty directly opposite their shoulder

position your hands into the middle of the lower half of the sternum

Only the heel on one hand should have contact with the chest, fingers parallel with the ribs and up off the rib cage. The other hand supports the first hand which is in contact with the chest depress the sternum 1/3 of the casualtys depth of chest, keeping compressions very smooth and rhythmical

compress the chest 15 times, then provide 2 effective breaths

repeat this sequence 4 times in a minute

at the end of the first minute check the pulse and breathing

if no change continue as above for two (2) minute blocks.

Do Not Stop Resuscitaiton Unless One of the Following Occurs

The casualty starts to breathe on their own

The casualty’s pulse is not present. Commence CPR

Someone else arrives on the scene and can take over

The ambulance arrives and takes over

You are physically exhausted and unable to continue.

Child (1-8 years)

Head tilt will vary according to the development of the child.

Gently breath air into the child using just enough pressure to make the chest rise

If the breath does not go in, check that the airway is open. More head tilt may be needed to open the airway

Use pistol grip to support jaw

Compressions ½ of chest, however half of sternum, 1 hand

Follow same procedures for resuscitation on adults. (ie: 2 rescue breaths, 30:2 5 cycles in 2 minutes)

Infants (<1 year)

The head on an infant is unstable and must be supported continuously. Because the infant’s tongue is proportionally larger it is more likely to block the airway, so be sure the airway is open when you give resuscitation.

Steady the infant’s head continuously because it is unstable

Do not tilt back the head, but support the jaw

Avoid putting any pressure on the soft tissues under the infant’s chin because this could obstruct the airway

For rescue breaths, cover both the infant’s mouth and nose with your mouth

Compressions 1/3 chest, lower half of sternum 2 fingers.

Follow same procedures for resuscitation on adults. (ie: 2 rescue breaths, 30:2 5 cycles in 2 minutes)

Mouth to Nose Resuscitation

Reasons for use:

rescuer’s choice

jaw clenched tight

when resuscitating in deep water

major mouth/jaw injuries

Technique:

close the casualty’s mouth with the hand that is supporting the jaw

apply head tilt and seal the lips with the thumb

blow into the casualty’s nose

turn your head to the side, look, listen and feel.

Providing resuscitation for a casualty with a possible head, neck or back injury

If you suspect a casualty has sustained a head, neck or back injury, you should try to minimise movement of the head and neck and spine as much as possible. If your casualty is not breathing resuscitation must still be performed and, if possible, you should use jaw thrust and not head tilt and jaw support.

Providing resuscitation via the Mouth to Mask Technique

The mouth-to-mask avoids mouth-to-mouth contact between the first aider and the casualty. Whenever available, this method should be used as it is more hygienic. Resuscitation should not be delayed whilst waiting for the mask to arrive.

Method:

Position yourself at the head of the casualty. Ensure a firm seal over both mouth and nose.

Maintain head tilt, jaw thrust and breathe into the mask. Remove your mouth from the mask, move your head to the side keeping your eyes on the chest to check for inflation and also allow the casualty to exhale.

Can also be delivered from beside casualty. Place mask over mouth & nose & hold in place using pistol grip.

Mouth to Stoma Method of resuscitation

You may at some stage encounter a casualty who has had an operation to remove all or part of the upper end of the windpipe. After such an operation, the person must breathe through an opening called a stoma in the front of the neck.

You may not see the stoma immediately. You will probably notice the opening in the neck as you tilt the head back to open the airway. If you see a tube in the stoma, always keep it in place to keep a hole open for breathing and resuscitation. If you see a valve closing the tube, you must remove the valve before giving breaths to allow the air to enter.

When providing air through the stoma you must ensure:

your mouth is sealed around the stoma

the stoma or tube is not blocked

closure over the mouth and nose to prevent air escaping.

Distension of the stomach

This may occur when air enters the stomach instead of the lungs. This is usually due to too much air being blown into the lungs causing over-inflation or the head is not positioned properly using enough head tilt. If the stomach does become distended DO NOT APPLY PRESSURE TO THE STOMACH as this may cause regurgitation.

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