Ventilation Techniques Learning Objectives the end otis par, you wil be able to + Decerbe modifications to compressions and breaths with an advanced airway in place + Prove rescue breathing for respiratory arest victims + Describe techniques forgiving breaths without a barrier device for aduts, ciliron, ‘and infants ‘CPR and Breaths With an Advanced Airway ‘This section explains modifications to compressions and breaths after an advances arway's placed during a resuscitation attempt. Advanced airways prevent airway ‘obstruction and can provide & route for more effective oxygenation and ventilation. Example of advanced always include laryngeal mask airway, supragiotc alway device, ‘and endotracheal tube, Table 5 summarizes the compression-to-ventiation ratio with and without an advanced away for adults, children, and infants. ‘Tablo-8. Comparison of Comprossion-to-Ventilation Ratio During CPR With anc Without an Advanced Airway Pee ne ‘No advanced airway in * Compression rato of 100 + Compression rate of 100 place to 120/min | $0 120/mia (eG, mouth-to-mouth, bag-_* 30 compressions to | # 30.compressions to 2 ‘mask device, pockst mask) breaths breaths (1 rescuer) + 15 compressions to 2 breaths @ rescuers)Rescue breathing is giving breaths to an unresponsive victim who has a pulse but is, "ot breathing. You may provide rescue breathing by using a barrier device (eg, pocket ‘mask or bag-mask device. if emergency equipment is not available, the rescuer may provide breaths by using the mauth-to-mauth or mouth-to-mouth-and-nose technique. Table 6 outlines how to provide rescve breathing for adults, children, and infants Give 1 breath every 5 to 6 seconds Give 1 breath every 310 5 seconds {about 10 to 12 breaths per minute). (12 to 20 breaths per minut). * Give each breath in 1 second. * Each breath should result in visible chest rise. * Check the pulse about every 2 minutes Caution When to Start CPR in an Infant or a Child When Providing Rescue Breathing Hf you notice signs of poor perusion in an infant despite adaquate rescue breathing tt is, despite effective oxygenation and ventilation) and the heart rata ie 60/min or less, start CPR (compressions and breaths), Respiratory Arrest ‘Respirator atest occurs when normal breathing stops, preventing essential oxygen ‘supply and carbon dioxide exchange. Lack of oxygen to the bain eventually causes ‘ person to become unresponsive. If not treated immediately, this can result in brain injury, cardia arrest, and death. Respiratory arrest is an emergency that, in certain situations, is potentaly reversible if treated ear. For example, opioid overdose can cause unresponsiveness, respiratory depression, and respratory atest (seo “Part: Opioid-Associated Life-Threatening Emergencies’ Respiratory arrest can be identified when the victim le found to be unresponsive, not breathing or only gasping, but stil has a pulse. BLS providers should be able to quickly ‘entity respiratory atest, activate the emergency response system, and begin rescue ‘breathing. Quick action can prevent the development of cardiac ares. Techniques for Giving Breaths Without a Barrier Device Overview Many cardiac arests happen at home or othor settings where rescue equipment isnot available. This section describes techniques for ghving breathe when you do net have barter device, such as a pocket mask or bag-mask device.-to-Mouth ‘Mouth-to-mouth breathing isa quick, effective technique used to provide oxygen to an jing for Adults _urrosponcive adult or child. Follow these stops to give mouth-to-mouth breathe to adults Children and children: fescue ropes seen Pinch the nose closed with your thumb and index finger (using the hand on ‘the forehead) DDelvr 1 breath over 1 second. Watch for the chest to rise as you ave the brea i cheese on ooo ieedcotin a EE Give a second breath (iow for about 1 second). Watch forthe chest to ris. Figure 38. Nout to:mouth baths Breathing Techniques 1 ‘olowing techniques are used to give breaths in infants (Table 7) ears: + Mouth-o-mouth-and-nose + Mouth-to-mouth The mouth-o-mouth-and-nose technique is preferred for infants. However, if you can't cover the infant's nose and mouth with your mouth, use the mouth-to-mouth technique instead. ‘Table 7. Techniques for Giving Breaths to Infants oo Techniqu Mouth-to-mouth- | © Waintain ahead tit-chin it to keep the airway open. and-nose * Place your mouth over the infant's mouth and nose and ereate fan alright seal (Figure 38), (continued)* Blow into the infants nose and mouth (pausing to inhale between breaths), just enough to make the chest rise with each breath. + Ifthe chest does not rise, repeat the head tit-chin ft to reopen the arway and ty to give a breath that makes the chest ile. ‘may be necessary to move the infant's head through a range of positions to provide effective breaths. When the away is open, | Wve breaths that make the chest rie, Tinea iene I! Se aes ee ae [toeapee ates Sees ie esr pa ara Bice eee ee ee a ae rhage ree sia etn ee ents eo eee Mouth-to-mouth Risk of Gastric Inflation Ifyou give breaths too quickly or with too much fore, al is Bkaly to enter the stomach ; rather than the kings, Ths can cause gastric inflation filing ofthe stomach with ai. + Gastric inflaton frequenty develops during mouth-to-mouth, mouth-lo-mask, or bag- ‘mask ventiation, ft can result in serious complications. Rescuers can reduce the risk of Gastric infation by avoiding giving breath too rapidly, too forcefully, or with too much volume, During high-quality CPR, however, gastric inflation may sll develop even when rescuers give breaths correct, ‘To reduce the risk of gastric ination: * Deliver each breath over 1 second, ‘+ Deliver just enough ai to make the victim's chest rise,Choking Relief for Adults, Children, and Infants ‘This section fscusses choking (foreign-body away obstruction). You wil learn to recognize choking and perform manewers to ralleve choking. Choking rll maneuvers {are the same for adults and children (1 year and older). A diferent technique is used 10 relieve choking for infants (ess than 1 year, [At tho end ofthis part, you wil be able to * Describe the technique for reef of foreign-body airway obstruction for an adult or child + Describe the technique for rele of foreign-body ainvay obstruction for an infant Early recognition of foreign-body away obstruction isthe key to successful outcome. tis important to distinguish this emergency from fainting stroke, heart attack, seizure, ‘rug overdose, or other conditions that may cause sudden respratory distress but require dtferent treatment Foreign badles may cause a range of signs fom miko severe airway obstruction Table 9. 9. Signs of a Foreign-Body Airway Obstruction and Rescuer Actions fairway Good ar exchange | As long as good air exchange continues, encourage the vetim to en + Can cough forcefully ‘continue coughing. «May vmeeze between coughs | * Do not interfere wth the victim's own attempts to relieve the ‘obstruction, but stay withthe victim and monitor the concition. : * iti alway obstruction continues or progresses to signs of severe away obstruction, activate the emergency response system, '* Clutohing the tvoat with the If the vitim i an adult or child, ask him if he is choking. the thumb and fingers, making the victim nods "yes" and cannot talk, severe airway obstruction is ‘universal cnoking sign (Figure 40) present. (An infant can't respond to questions.) * Unable to speak or cry ‘+ Take steps immediately to relieve the obstruction, Poor or no ar exchange ‘= If severe arway obstruction continues and the victim becomes. ‘Weak, ineffective cough orno | _unresponsive, start CPR, ‘cough at all * you are not alone, send someone to activate the emergency «+ High-pitched noise while Inhaing | ‘sponse eystom. Ifyou are alone, provide about 2 minutes of CPR pees atal before leaving to activate the emergency response system. + Increased respiratory dificuty ++ Possible cyanosis (urning bie)[Figure 40. Th urivral choking ign nests the ned rtp when actin is ching Choking Relief in a Responsive Adult or Child Abdominal Thrusts Use abdominal thrusts ¢he Heimiicn manewve to relieve choking Ina responsive adut or child Do not use abcominal thrust to rlieve choking In an infant. {Give each individual thrust with the intention of relieving the obstruction. it may be necessary to repeat the thrust several times to clear the alway, Abdominal Thrusts Folow these steps to perform abdominal thrusts on a responsive adult or child who is With Victim Standing standing o siting or Sitting ‘Stand or knoe! behind the victim and wrap your arms around the victi’s waist (Figure 41), Place the thumb side of your fist against the victim's abdomen, in the midina, slightly above the navel and well below the breastbone, Repeat thrusts untl the object's expelled from the airway ofthe victim becomes unresponsive 72Figure 41. Abdomina thrusts wih me vicim standing. Pregnant and Obese Victims It the victim is pregnant or bese, perform chest thrusts instead of abdominal thrusts (Figure 42) Figure 42. Perm enest rust insta of abdonial ust na pregant or bese choking ii, Relief in an Unresponsive Adult or Child |A choking victim's condtion may worsen, and he may become unresponsive. f you are ‘aware that the victim's condition is caused by a foreign-body airway obstruction, you wil know to look for foreign body in the throat. Gently lower the victim to the ground if you see that he is becoming unresponsive. | ean CPR, starting with chest compressions. Do nt check ora puse (continued)(continued) Each time you open the away to give breaths, open the victim's mouth wide. Look for the object + Ifyou see an object that can be easly removed, remove it with your ‘ingors * Ifyou do not see an object, continue CPR. ‘Sometimes the choking victm may already be unresponsive when you frst encounter im, n this situation you probaly will not know that a forign-body airway obstruction exists, Activate the emergency response system and start high-quality CPR, Giving Effective Breaths When There Is an Airway Obstruction B ‘When a choking victim loses consciousness, the muscles inthe larynx may relax. This could convert a complete/severe airway obstruction to a partial obstruction. In addition, ‘chest compressions may create at least as much force as abdominal thrusts, 50 they may help expel the object. Giving 90 compressions and then removing any object seen in the mouth may allow you to eventualy give effective breaths Actions After Choking You can tol i you have successtuly removed an airway obstruction in an unresponsive Relief Victim if you ‘+ Feel air movement and see the chest rise when you cive breaths + See and remove a foreign body from the victim's mouth ‘Alter you relieve choking in an unresponsive victim, treat him as you would any Lnresponsive victim. Check for responsiveness, check for breathing and pulse, confirm that the emergency response system has been activated, and provide high-quality CPR or rescue breathing as needed {tthe victim is responsive, encourage the victim to seek immediate medical attention. PPotental complications from abdominal thrusts should be evaluated. Choking Relief in Infants Choking Relief in a Ue back slaps and chest thrusts or choking retin an fart. Do not use sbdorina Responsive Infant thrusts. Follow these steps to rete choking na respenv infant ‘kneel or sit wit the infant in your lap, Hold the infant facedown with the head slighty lower than the chest, esting on yur forearm. Support the infants head and jaw with your hand, Take care to ‘avoid compressing the soft tissues ofthe infant's throat. Rest your forearm on {yur lap or thigh to support the infant. se (contvecDeliver up to 5 back saps [Figure 43A) forcefully between the infant's shoulder blades, using the heel of your hand. Delve each slap with sufficient force to attempt to cisiodge the foreign bod. ‘Alter delivering up to 5 back saps, place your free hand on the infant's back, ‘Supporting the back of the infants head with the palm of your hand. The infant willbe adequately cradled between your 2 forearms, withthe paim of one hand supporting the face and jaw while the palm of the other hand supports the back ofthe infant's head. ‘Turn the infant as a unit while carefully supporting the head and neck. Hold the Infant faceup, with your forearm resting on your thigh. Koop the infant's head lower than the tank. Provide up to 5 quick downward chest thrusts Figure 438) inthe mid of the chest, over the lower half ofthe breastbone (the same location as for Chest compressions during CPR). Deliver chest thrusts at arate of about 1 per second, each with te intention of creating enough fores to dislodge the foreign body. [Repeat the sequence of up to 5 back slaps and upto § chest thrusts until the ‘object is removed or the infant becomes unresponsive. a 5 FFigure 43. Reet of choking nan fant. Ay Back saps. B, Cheet rust ‘Choking Relief in an the inant viciin becomes unresponsive, stop giving back slaps and begin CPR, ‘Unresponsive Infant _ stexing with chest compcessions, To eleve choking in an unresponsive infant, perform the following stops: ‘Shout for help. if someone responds, sand that person to activate the ‘emergency response system. Place the Infant on a frm, fat surface ‘Begin CPR (starting with compressions) with 1 extra step: each time you open ‘he alrnay, look forthe object inthe back of the troat. I you see an object. ‘and can easiy remove it, remove it. Note that you do not check fora pulse before boginring CPR. After about 2 minutes of CPR, activate the emergency response system jifno lone has done so), 7516 Blind Finger Sweeps Do not perform a bind finger aweep, because it may push the foreign body back into the airway, causing futher obstruction or injury Life Is Why [At the American Heart Association, we want people to experience more o life's precious ‘moments. What you lean in this course can help build heather, tonger ves for ‘everyone, 1. Which isan example ofa mild freign-bady airway obstruction? ‘4 Gyanosis (turning ue) '. High-piched noise while inhaling Inability to speck or ry {Wheezing between coughs 2. Which victim ofa severe airway obstruction should receive abdominal thrusts? 1 An average-size 27-year-old man 'b.A woman who is obviously pregnant An obese 50-year-old man 4. An average-size S-month-old infant 8. You ave performing abdominal trusts on 2 9-year-old child when he suddenly becomes unresponsive. Alter you shout for nearby help, what fs the most appropriate ‘action to take next? ‘2. Begin high-quality CPR, stating with chest compressions Check fora pulse ©. Continue performing abdominal thrusts 4. Provide 5 back sins folowed by 5 chest trusts ‘Soo Ancwors to Reviow Questions in the Appendix