Basic Life Support: Artificial Ventilation Slide Presentation prepared by Randall Benner, M.Ed., NREMT-P

Learning Objectives Describe the signs of respiratory distress. Explain the proper victim assessment for breathing problems. Describe how to open an airway of a victim who does not have spinal injury. Describe how to open an airway of a victim who you suspect does have spinal injury. Describe the process for assessing breathing rate and depth. © 2012 Pearson Education, Inc.

Learning Objectives Explain how to restore breathing through artificial ventilation. Adapt ventilation support procedures to infants and children. Identify an obstructed airway. Use the technique for dislodging foreign objects that are obstructing the airway of a conscious person. © 2012 Pearson Education, Inc.

1. What is your first immediate action to protect yourself? 2. How will you determine his level of responsiveness? 3. What assessment should be conducted first? 4. How would you manage the airway?

Respiratory Distress The most common type of breathing problem is respiratory distress. Definition: An abnormal condition where breathing is labored, noisy, irregular, or unusually fast or slow, or a combination of these Causes: injury, asthma, hyperventilation, and anaphylactic shock © 2012 Pearson Education, Inc.

Respiratory Distress: Signs and Symptoms Abnormal breathing patterns (difficulty catching the breath, gasping for air, or slow or rapid breathing) Unusual breathing noises (wheezing, snoring, crowing, or gurgling) Dizziness Chest pain Tingling in hands or feet Clammy skin Abnormal skin color © 2012 Pearson Education, Inc.

Respiratory Distress: Signs and Symptoms © 2012 Pearson Education, Inc.

Respiratory arrest is a true medical emergency. Total cessation of breathing or respiratory effort Causes: electric shock, drowning, suffocation, toxic gas inhalation, head and chest injuries, heart problems, stroke, drug overdose, and allergic reactions

Basic Life Support When oxygen is cut off to the lungs gradually the heart will stop beating, causing cardiac arrest. The body’s cells have a residual oxygen supply that keeps them alive for a short time even after breathing and heartbeat stop. Every second that passes without a fresh supply of oxygen brings the patient one step closer to death. Basic Life Support (BLS) is a combination of first aid procedures necessary to sustain life in an emergency situation. First steps are to Open the airway Provide rescue breathing © 2012 Pearson Education, Inc.

Victim Assessment Four basic steps Determine the level of victim responsiveness. Activate the EMS system. Observe for signs of life and determine rate and depth of breathing. Position the victim and open the airway. © 2012 Pearson Education, Inc.

Activating the EMS System Call first: If you are alone and are treating an unresponsive victim who you believe may have a cardiac-related condition, activate EMS. If you have an Automated External Defibrillator, retrieve this before returning to the patient. Care first: If you are alone and treating an unresponsive victim who you believe to be suffering from a respiratory problem such as choking or drowning, perform five cycles of CPR (about 2 minutes). Then active EMS.

Victim Assessment Positioning the Victim and Opening the Airway: If you do not suspect cervical spinal injury, use the Head-tilt/Chin-lift maneuver. If you do suspect cervical spinal injury, use the Jaw-thrust maneuver. Assess the victim’s rate and depth of breathing; if adequate, place them in the recovery (modified HAINES) position. If not, prepare to perform chest compressions and rescue breathing. © 2012 Pearson Education, Inc.

If you see liquids (such as vomitus) in the mouth, wrap your index and middle fingers in cloth and sweep the liquid out. If you can see solid foreign objects (such as broken teeth), quickly hook them out with your index finger.

(H.A.IN.E.S. is an acronym for High Arm IN Endangered Spine)

Head-tilt/Chin-lift Maneuver © 2012 Pearson Education, Inc.

Jaw-thrust Maneuver © 2012 Pearson Education, Inc.

Types of Rescue Breathing Mouth-to-mouth ventilation Mouth-to-barrier ventilation Mouth-to-nose ventilation Mouth-to-stoma ventilation (a stoma is a small surgical opening in the neck) © 2012 Pearson Education, Inc.

Mouth-to-Mouth Ventilation Mouth-to-mouth ventilation is the simplest, quickest, and most effective way to perform rescue breathing.

If you don’t see the chest rise and fall on the first attempt, reposition the airway and try again. (The most common cause of difficulty with ventilation is improper positioning of the head and chin.) If the second try also fails, assume the airway is blocked by a foreign object.

Rescue Breathing: Special Issues Breaths that are given too rapidly or excessively will cause air to enter the stomach instead of the lungs. This can cause vomiting and passing of stomach contents into the lungs. Gastric distention: occurs most often in children and victims with obstructed airways who have been breathed into too forcefully. Infants and children require you to adapt procedures to their anatomy and capacity. © 2012 Pearson Education, Inc.

Measures to prevent gastric distension Blow only hard enough to make the chest rise. Deliver steady breaths over 1 second with a volume of air that makes the chest rise. Make sure the airway is open.

Mouth-to-Mouth Ventilation and Disease Transmission Compressions alone are acceptable for CPR until EMS arrives. You are statistically more likely to perform ventilations or CPR on a family member or friend than on a stranger. Your concerns about disease transmission can be easily addressed by carrying a small (keychain- or pocket-sized) barrier device.

Mouth-to-Barrier Ventilation 1. The face shield: covers the victim’s mouth; in some face shields, a short airway extends into the victim’s mouth to hold down the tongue. You breathe through the face shield to deliver ventilations; because the face shield covers only the mouth, you must still pinch the victim’s nose closed.

2. The face mask covers the victim’s nose and mouth, creating an airtight seal; you deliver ventilations through a one-way valve so that the victim’s exhaled breath does not enter your mouth.

To use a barrier device: 1. Extend the victim’s neck and lift the chin. 2. Place the barrier device over the victim’s mouth, or mouth and nose (depending on the type of device). 3. Create an airtight seal. 4. If using a face shield, pinch the nostrils closed. 5. Deliver breaths smoothly and evenly over one second with enough force to make the chest rise.

Mouth-to-Nose Ventilation You can’t open the victim’s mouth The victim’s mouth is so large that you can’t seal it off with your mouth The victim has no teeth, which interferes with the formation of a good seal The victim has mouth injuries

Mouth-to-Stoma Ventilation A stoma is a small, permanent surgical opening in the neck through which the surgical patient breathes.

Rescue Breathing: Special Issues Infants and children Infants and children should receive one minute of first aid care before activating the EMS system, when First Aider is acting alone. If the victim is an infant or small child, seal both their mouth and nose with your mouth, deliver breaths more often, and use less force. © 2012 Pearson Education, Inc.

Ventilating an Infant © 2012 Pearson Education, Inc.

Obstructed Airways Emergencies Airway obstructions can be partial or complete. If partial, the victim will be able to cough/breathe. Watch for these signs of partial obstruction Weak cough High-pitched wheezing Increased strain while breathing Clutching at the throat Slight cyanosis (blueness) © 2012 Pearson Education, Inc.

Obstructed Airways Emergencies Signs of complete airway obstruction are Inability to speak, groan, cough, or cry out Absence of breath sounds Labored use of muscles used in breathing Progressive restlessness, anxiety, and confusion Unresponsiveness If you suspect complete obstruction, attempt for about two minutes to clear the airway, then activate EMS. Be prepared to give first aid. © 2012 Pearson Education, Inc.

Obstructed Airways Emergencies There are two main techniques used for conscious adult or older-child victims Back blows (never to be used on infants or young children) Abdominal thrusts (also called the Heimlich maneuver) © 2012 Pearson Education, Inc.

Abdominal Thrusts © 2012 Pearson Education, Inc.

Obstructed Airways Emergencies There are numerous and varying techniques for the following circumstances Victims who are, or become, unconscious Victims who are pregnant or obese Victims who are infants All of these circumstances require specialized treatments. Review text pages 61 through 64, and Figures 4.12 through 4.25, for details. © 2012 Pearson Education, Inc.

Summary Basic life support (BLS) describes the first aid procedures necessary to sustain life in an emergency. Victim assessment is the crucial first step of BLS. If you do not suspect spine injury, open airways using the head-tilt, chin-life maneuver. © 2012 Pearson Education, Inc.

Summary If you suspect spine injury, open airways using the jaw-thrust maneuver. A victim with occasional gasping and ineffective breathing should be considered as having no breathing at all. For adult victims, activate the EMS system immediately, before beginning any rescue procedures, if you are acting alone. © 2012 Pearson Education, Inc.

Summary Infants and children should receive one minute of first aid care before activating the EMS system, when acting alone. If the victim is an infant or small child, seal both their mouth and nose with your mouth, deliver breaths more often, and use less force. Perform the Heimlich maneuver only if there is complete obstruction of the airway and the victim cannot speak, cough, groan, or cry out. © 2012 Pearson Education, Inc.