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.

CPR Ratio

Priorities of First Aid (The Primary Survey)

Life threatening problems are identified and dealt with FIRST. This is done in a strict order of priorities in order to ensure that the most important steps are undertaken in a logical order which will ensure nothing is missed. This is done using a systematic approach called DRABCD.

D - DANGER

Eliminate/Minimize the dangers before you approach. Ensure the safety of yourself, any bystanders and the casualty. If it is too dangerous to approach, keep at a safe distance and call the emergency services. Only move the casualty/casualties if absolutely necessary. Use bystanders to assist you where possible i.e controlling traffic, phoning for help ASAP. Use barrier devices where possible ie use a face shield and gloves.

R - RESPONSE

If you have more than one casualty always treat the unconscious ones first. If someone is screaming and shouting and one is on their back quiet, the quiet one has the priority. If they are screaming and shouting, they are breathing.

Use the touch and talk approach. NEVER SHAKE an unconscious casualty. The best way to see if the casualty responds is to use the 'COWS' method:

  • Can you hear me?
  • Open your eyes?
  • What's your name
  • Squeeze my hands

If the casualty responds, ask their name and carry out the 'History, Signs & Symptoms' assessment principle. If an ambulance is required, call '000' now. If you are in any doubt, call the ambulance out. If the casualty is unconscious, not responding to tallk and touch, call '000' now and move onto the airway.

A - AIRWAY

The Australian Resuscitation Council (ARC) guidelines state 'The casualty should not be routinely rolled onto the side to assess airway and breathing. Assessing the airway of the casualty without turning onto the side (i.e leaving them on their back or in the position in which they have been found) has the advantages of simplified teaching, taking less time to perform and avoids movement.

The exceptions to this would be in submersion injuries or where the airway is obstructed with fluid (vomit or blood). In this instance the casualty should be promptly rolled onto the side to clear the airway.

  • Keeping the head in the position you found it, look in the mouth. If any solid or liquid is found, place the casualty onto their side and clear the airway.
  • If nothing is found in the mouth, leave the casualty on their back and open the airway using the head tilt/chin lift techniques. Place one hand on the casualty's forehead and two fingers under the chin. Tilt the head back and lift chin up opening the airway.

B - BREATHING

Check the casualty's breathing by placing your ear and cheek by their mouth and nose whilst looking at their chest:

  • Look for movement of their chest and upper abdomen.
  • Listen for normal breathing
  • Feel for breath on the side of you cheek

Normal breathing is between 12 -24 breaths per minute. Assess their breathing for no longer than 10 seconds before deciding whether breathing is normal or not. You are assessing for more than the occasional gasp of air.

If the casualty is breathing normally, place them onto their side if not already done. Call '000' and assess their airway and breathing every minute. If the casualty is not breathing, not breathing normally or there is any doubt to whether they are breathing normally, call '000' and then carry out 2 rescue breaths.

Ensuring the head is tilted back and the chin lifted up, seal their mouth with yours and blow in for approx. 1 second. Look out the corner of your eye for normal rise of the chest. Take your mouth off theirs and watch the chest fall, take another normal breath and breathe into the casualty again. Check quickly for normal breathing. If the casualty has begun to breathe normally, place them onto their side and assess their airway and breathing until medical aid arrives. If the casualty has not started breathing normally after 2 rescue breaths, carry out chest compressions immediately.

C - COMPRESSIONS

Place the heel of one hand on the centre of the chest (lower half of the sternum) with your other hand on top. Interlock fingers and pull your fingers off the rib cage. Press down on the chest to a depth of 1/3. Compress the chest 30 times at a rate of 100 compressions per minute. Once you have carried out 30 chest compressions, carry out 2 rescue breaths. Continue at a ratio of 30:2 until either:

  • Professional arrives to relieve you.
  • The casualty begins to breathe normally
  • It becomes too dangerous to continue
  • You become too exhausted to continue
  • Another competent first aider takes over from you
  • The casualty begins to vomit
  • A doctor pronounces death

D - DEFIBRILLATION

Attach an Automatic External Defibrillator (AED) if available and follow the voice prompts if trained.

REMEMBER, ANY RESUSCITATION IS BETTER THAN NO RESUSCITATION AT ALL. IF YOU ARE UNWILLING OR UNABLE TO CARRY OUT RESCUE BREATHS, THEN CARRY OUT CHEST COMPRESSION ALONE BASIC LIFE SUPPORT. IF YOU DON'T DO ANYTHING THEY WILL STAY DEAD.

Child (1-8 years)

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

  1. Gently breathe air into the child using just enough pressure to make the chest rise.
  2. If the breath does not go in, check the airway is open. More head tilt may be needed to open the airway
  3. Use pistol grip to support jaw
  4. Compressions 1/3 of chest using 1 hand
  5. Follow same procedure for resuscitation on adults. (i.e 2 rescue breaths, 30:2, 5 cycles in 2 minutes)

Mouth to Nose Resuscitation

Reasons for use:

  1. Rescuer's choice
  2. Jaw clenched tight
  3. When resuscitating in deep water
  4. Major mouth/jaw injuries

Technique:

  1. Close the casualty's mouth with the hand that is supporting the jaw
  2. Apply the head tile and seal the lips with the thumb
  3. Blow into the casualty's nose
  4. Turn your head to the side, look, listen, feel.
  5. Providing resusctiation 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, 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:

  1. Position yourself at the head of the casualty. Ensure a firm seal over both mouth and nose.
  2. Maintain head tilt, jaw thrust and breathe into the mask. Remove you 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.
  3. 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 valvle 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:

  1. Your mouth is sealed areound the stoma
  2. The stoma or tube is not blocked
  3. Closure over the mouth and nose to prevent air escaping.
  4. 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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