On normal inspiration, a person
breathes in approximately 21% oxygen. The body uses between 4 —
4.5% of this amount for its normal functions. Therefore, on
expiration a person breathes out approximately 16% oxygen. To
breathe into another person as a means of supplementing their
oxygen supply is not only feasible, but in cases of a
non-breathing casualty, essential. Immediate supplementary
breathing is necessary, as the brain suffers irreversible tissue
damage if deprived of oxygen for longer than about three
minutes. Rapid and effective
resuscitation saves lives!
EXPIRED
AIR RESUSCITATION (EAR) is the method by which a
rescuer breathes for a casualty who is in respiratory arrest.
The common term is 'mouth-to-mouth resuscitation'. It is
a most effective method for sustaining life, as a rescuer
breathes out sufficient oxygen to supply a casualty with the
necessary requirement. There are five methods for delivering
EAR:
MOUTH-TO-MOUTH
where the rescuer seals the casualty's mouth with his or her
mouth and breathes into the airway through the mouth.
MOUTH-TO-NOSE
is used where the casualty has sustained facial injuries that
preclude using the mouth. The rescuer closes the casualty's
mouth, seals the nose with his or her mouth, breathes gently,
then releases the casualty's jaw to allow exhalation.
MOUTH-TO-NOSE-AND-MOUTH
is the preferred method when resuscitating a child, as the
rescuer's mouth can cover and seal the child's nose and mouth.
MOUTH-TO-STOMA
is used for resuscitating a casualty fitted with a stoma from a
pipe-like device fitted into the throat with an opening in the
neck. These devices are often encountered because the casualty
is in a high-risk group, usually because of previous respiratory
and/or cardiac problems. The rescuer breathes through the stoma
directly into the airway — a most effective method.
MOUTH-TO-MASK
is the most desirable method to be employed by the rescuer as a
means of avoiding possible cross-infection. Masks come in
various configurations, but their use is similar — the mask is
fitted firmly over the casualty's nose and mouth, and the
rescuer delivers breaths through the valve or aperture, thus
avoiding direct contact with the casualty's mouth.
EAR
is necessary for casualties in complete respiratory arrest.
Certain conditions cause the loss of respiratory effort, and the
first aid provider should be aware of the potential for
resuscitation. Choking, heroin overdose, near drowning, certain
bites and stings, as well as respiratory conditions such as
asthma and emphysema can cause respiratory arrest necessitating
rapid and effective EAR to sustain life.
Breaths need to be effective, which
is evidenced by the rise and fall of the chest with each breath
from the rescuer. Make up to five attempts to achieve the
initial two effective breaths.
When considering which
resuscitation technique to use, the age of the casualty must be
taken into account. The classifications are:
-
Infant - Newborn to 1 year
-
Young Child - 1 to 8 years
-
Older Child - 9 to 14 years
-
Adult - 15 years and older
Additional consideration must be
given to the physical size of the child. Often a young child
may be as well developed as an older child.
INDICATIONS FOR EAR:
PROCEDURE FOR EAR:
-
check for
DANGER
-
call
help
-
roll casualty away from you
-
check airway
-
open airway
-
look, listen and feel for
breathing
-
if breathing effectively, remain
in stable side position
-
if not breathing, roll onto back
-
ensure airway is open (head tilt
or jaw lift)
-
give two effective breaths - jaw
support (pistol grip). Make up to five attempts to achieve
two effective breaths
-
assess the rise and fall of the
chest (if suspected obstruction — reassess airway)
-
check pulse
-
IF PULSE
PRESENT, commence EAR
for adults and older children by giving one effective
breath every 4 seconds (15 breaths per minute)
-
for younger children and infants,
give one effective breath every three (3) seconds (20 breaths
per minute)
-
reassess pulse about every one
minute
-
constantly reassess airway, be
alert for vomitus
