respiratory resuscitation and external cardiac resuscitation

1. EMERGENCY RESUSCITATION
ARTIFICIAL RESPIRATION (TYPES AND TECHNIQUES)
A. RESPIRATORY RESUSCITATION
PURPOSE:
 Immediately oxygenate the blood in order to forestall the irreversible changes
that take place in the brain when there is deprivation of oxygen.
 The first aider must realize that the vital need is to inflate the lungs even though
the air has to be blown past an obstruction in the casualty throat or wind pipe.
 "Delay of one or two seconds may prove fatal"
 The first aider's equipment is his hands, his mouth and his lungs.
 The well-trained first aider will be conditioned to take the immediate action of
inflating the casualty's lungs while simultaneously positioning his head and lower jaw to
open the air passage.
a) Conscious person in upright position, slowing open air passages.
b) In the unconscious casualty lying on his back, the tongue may fall backwards
and block the air passages.
c) If the neck is extended, the head pressed backwards and the lower jaw pushed
upwards, the tongue moves forward thus opening the air passages.

2. METHODS:
1. MOUTH-TO-MOUTH METHOD -method of choice
ADVANTAGES:
 It can be more easily and effectively applied than other methods and used in
some situations where they cannot.
 It gives the greatest ventilation of the lungs and oxygenation of the blood.
 The degree of inflation of the lungs can be assessed by watching the movement of the
chest.
 It is less tiring, does not require strength and can be applied by a child.
How to do:
1. The first aider must take up a convenient position such as lying, kneeling or standing and
work from the side.
2. With the casualty on his back, hold his head in both hands, one hand pressing the haed
backwards and the other pushing the lower jaw upwards and forwards.
3. Open the mouth wide, take a deep breath.
In the case of:
INFANT OR YOUNG CHILD
1. seal your lips round his mouth and nose
2. blow gently until you see his chest rise then stop and remove your mouth
3. repeat this procedure at the rate of twenty times per minute
ADULT
1. seal your lips round the casualty's mouth while obstructing his nostrils with your

3. cheek, it may be necessary to pinch the nostrils with the fingers
2. blow into his lungs and watch for the chest to rise, then remove your mouth
3. inflation should be at the rate of ten per minute
METHODS OF IMPROVING THE AIR PASSAGE
While continuing mouth-to-mouth inflation of the lungs, in the case of:
a. an infant or young child -place one hand under his neck and raise gently
with the other hand extend the head backwards.
b. an adult -grasp the back of the head between the hands.
2. MOUTH-TO-NOSE METHOD - if casualty is in a state of spasm or convulsion and his
mouth cannot be opened or if he has no teeth.
a. work from the side of the casualty with his head extended
b. open the mouth wide take a deep breath, and seal your lips widely on the casualty's
face around the nose. Make sure your lips do not obstruct his nostrils.
c. close the mouth by placing the you thumb on his lower lip.
OBSTRUCTION IN THE AIR PASSAGES
INFANT OR YOUNG CHILD
i. lay the child prone with the head downwards over the knee
ii. give three or four sharp slaps between the shoulders to dislodge the foreign body
or hold the child up by his legs
iii. smack him smartly three or four times between the shoulders

4. ADULT
i. turn the casualty on his side and strike him three or four sharp blows between the
shoulders
ii. check if any debris has come into the throat by feeling with the fingers
3. HOLGER-NIELSEN METHOD
TURNING
• if the casualty is lying on his back turn him to the prone position (face downwards) as
follows.
• cross his far leg over the near leg
• go down on the left knee opposite the casualty's head, placing the right foot on the ground
out of the side
• place the casualty's arms carefully above his head, and keep them thereduring the turn.
• grasp his right upper arm and turn him over, preotecting his face with the other hand.
• adjust the position of the casualty's hands.
POSITION OF THE CASUALTY
• lay the casualty in the prone position on a flat surface
• place the casualty's hand one over the other, under his forehead.
• the head must be turn slightly on one side
• the nose and mouth must be unobstructed.

5. POSITION OF THE OPERATOR
• place one knee with the inner side in line with the casualty's cheek six to twelve
inches from the top his head
• place the other foot with heal in line with the casualty's elbow.
• place the hands on the casualty's back with the heel of the hands on the lower part of
the shoulder blades, the thumbs alongside the spine and the fingers pointing the
casualty's feet.
MOVEMENT 1
• keeping the arms straight-rock gently forward until the arms are vertical or almost
vertical depending on the build of the casualty or the operator, using no force.
• the movement takes seconds counting one, two. This pressure causes expiration.
MOVEMENT 2
• the operator now rocks back counting "three" for one second and slides his hand pass
the casualty's shoulders until they can grip his upper arms near the elbows.
• the operator raises and pulls the arms until tension is felt for a period of two seconds
counting "four, five". ( take care not to raise the chest from the ground)
• this movement causes inspiration, the operator's arm should remain straight for the
whole period.
• counting "six" for one second the operator lowers the casualty's arm to the ground and
replaced his handsin the original position.
• the whole operation occupying 6 seconds that is ten times a minute, should be
rhythmic in character and be continued until breathing recommences.

6. • when the casualty begins to show signs of breathing the operator should continue
movement 2 only, raising and lowering the arms alternatively counting 1,2 (2
seconds) for inspiration and 3,4 (2 seconds) for expiration.
SUMMARY OF COUNTING AND TIMING
the counting and timing are as follows:
• one-two (2 seconds) back pressure
• three- (1 second) sliding hands to arms
• four- five (2 seconds) raising arms
• six (1 second) sliding hands to back
HOLGER-NIELSEN METHOD OF ARTIFICIAL RESPIRATION METHOD
(CHILDREN)
For children below 5 years of age:
1. the arms should be laid by the side and a support placed under the child's head
2. grasp the shoulders with the fingers underneath and the thumbs on top
3. press with the thumbs on the shoulder-blades for two seconds (for expiration), the left
shoulder for 2 seconds (for inspiration).
If there are chest injuries- do the arm raising-lowering procedure only at the rate of 12 times
a minute.
If the arms are injured- place them by the side of the body then do the complete procedure
but insert your hands under the casualty's shoulders and raise them for inspiration.
both arms and chest- do arms raising and lowering by inserting your hands under the

7. casualty's shoulder only.
PRESSURE FOR ARTIFICIAL RESPIRATION BY THE HOLGER NIELSEN METHOD
24-30 liter for an adult
12-14 liter for half grown children and slender women
2-4 liter for infants
Simultaneous Resuscitation of two casualties by one operator until assistance is obtained.
1. Place the casualties side by side, with the adjacent arms extended above the head.
2. Bend the outside arms, and place the foreheads on the backs of the hands, with the heads
turned outwards.
3. Kneel astride the two outstretched arms and close to the heads.
4. Perform the method as if the two bodies were one by pressing with one hand between the
shoulder-blade of each casualty for expiration and by lifting the outer arms for inspiration.
4. SILVESTERS' METHOD OF ARTIFICIAL RESPIRATION
- to be used only when it is impossible or inexpedient to turn the casualty on to his face.
THE CASUALTY'S POSITION
i. place the casualty on his back on a flat surface
ii. raise and support his shoulders on a cushion or folded article of clotting in such a
waythat his head hangs backwards. In order to prevent the tongue falling back and
obstructing the wind pipe, an assistant must grasp the tongue firmly with
handkerchief, draw it forward as far as possible and hold it there. If no assistant is

8. available, the casualty's head must be turned as as possible to one side.
MOVEMENT 1
- kneel just above the casualty's head, place his forearms on hischest as near each other as
possible and grasp them firmly below the elbows.
- draw his arms upwards, outwards and towards you with a sweeping movement, pressing his
elbows towards the ground.
MOVEMENT 2
- bring the flexed arms slowly back along the same route and press them firmly against the
front and ribs of his chest.
RHYTHM
movements should be performed 12 times per minute.
5. SCHAFER'S METHOD OF ARTIFICIAL RESPIRATION
Turning the casualty
Should the casualty be lying on his back, turn him to prone posution as follows:
i. stoop on his side
ii. place his arms above his head
iii. cross his far leg over hisnear leg
iv. protect his face with one of your hands
v. grasp his clothing at the hip on the opposite side of the body and quickly and gently
turn him over

9. Position of the casualty
i. lay the casualty in prone position
ii. place the casualty's hands one over the other, under his forehead.
iii. the head must be turned slightly to one side
iv. the nose and mouth must be unobstructed
Position of the operator
i. face the casualty's head
ii. kneel on both knees at the casualty's side in a position just below his hip-joint
iii. sit back on your heels to allow free sway
iv. place your hands on the loins of the casualty's one on each side of the backbone with
wrists almost touching with thumbs as for forward as possible without strain, and the
fingers close together at the side of loins and bent over the flanks in the natural
hollows just above the brin of the pelvis but clear of it, the tips of the fingers pointing
to the ground.
v. keep your elbows quite straight
ARTIFICIAL RESPIRATION (SCHAFER'S METHOD POSITION OF CASUALTY AND
OPERATOR)
MOVEMENT 1
Without bending your elbow, swing slowly forward by untending the knees until the thighs
are in an almost upright position and the shoulders vertically above the hands, so allowing
the weight of your body to be communicated to the casualty's loins.

10. The compressing in Movement 1 is to be effected solely by the weight of the operator's body
and not by muscular effort. The pressure should not exceed 60 litre.
MOVEMENT 2
swing slowly back on to your heels thus relaxing the pressure. This causes the abdominal
organs to fall back and the diaphragm to drop this including inspiration.
RHYTHM
The two movements, which must be carried out smoothly and rhythmically should take five
seconds.
ARTIFICIAL RESPIRATION (SCHAFER'S METHOD) MOVEMENT ONE
Changing Operators
It may frequently be found necessary to change operators as follows:
1. the relief takes up a position at the opposite side of the patient to the operator, places
his hands over those of the operator without exercising any pressure and gradually
falls into the rhythm of his movements.
2. After working this together for few seconds the operator arrives at the "off" position.
3. He should carefully remove his hand while at the same time the hands of the relief
occupy the vacated position.

11. B. EXTERNAL CARDIAC RESUSCITATION
- this is an immediate method of restarting the circulation
- is not without its dangers and a first aider should only use this technique if he is sure
that the heart is not functioning.
If two first aiders are present:
- one to undertake respiratory respiration
- one to carry out external cardiac resuscitation
METHOD
a. INFANT OR YOUNG CHILD- with two fingers on the lower half of the sternum apply
quickly six to eight sharp but not violent presses at the rate of one per second between each
inflation.
b. ADULT- having located the lower half of the sternum,place the ball of the hand on it with
the second hand covering the first. After each inflation of the lungs apply six to eight sharp
presses at the rate of one per second.
IN ELECTRIC SHOCK
An electric shock acts on the breathing centre in the brain and causes the respiration or
breathing to stop. However, the heart may continue to function for some time even though
the breathing has stopped.
TREATMENT
• Remove the patient from the electric current by using a piece of wood or a stick to

12. pull him away.
• Apply artificial respiration immediately using the mouth to mouth method. as long as
the pulse is felt, artificial respiration should be maintained.
IN DROWNING
Drowning results in the inhalation of water into the lungs.
If a person who had drowned is brought to you proceed as follows:
i. turn the patient face down with the head turned to one side and the arms stretched out.
If a slope exists, the head must be placed downwards.
ii. place your hands round the patients abdomen and raise the body to encourage the
water to run out of the lungs.
iii. clear the mouth of weeds or any other material obstructing air entry, and of false
teeth, if any.
iv. loosen the clothing round the neck and waist.
v. apply artificial respiration . do not stop until the breathing has been re-established for
at least a quarter of an hour.
vi. if assistance is available remove wet clothing and treat for shock.
RESUSCITATION
If a casualty is not breathing and if the heart is not beating: it is vital that you take over
ventilation and circulation so that the flow of oxygen to the brain is maintained.
Remember the ABC Rule
• First, ensure an open AIRWAY

13. • Second, BREATHE for the casualty by inflating the lungs and oxygenating the blood
Artificial ventilation
• Third, CIRCULATE the blood by compressing the chest ( external chest
compression)
Resuscitation should be attempted even if you are in doubt about whether a casualty is
capable of being revived.
You should always continue until spontaneous breathing and pulse restored; another
qualified person takes over; a doctor assumes responsibilities for the casualty; you are
exhausted and unable to continue.
- opening the airway
-checking the breathing
-clearing the airway
1.) OPENING THE AIRWAY
If a casualty is unconscious, the airway may be narrowed or blocked making breathing noisy
or impossible. This occurs for several reasons:
- the head may tilt forward narrowing the air passage
- muscular control in the throat will be lost, which may allow the tongue to sag back and
block the air passage and because the reflexes are impaired, saliva or vomit may lie in the
back of the throat blocking the airway.
If the casualty still does not breathe, begin artificial ventilation immediately.
1. kneel beside the casualty
2. lift the casualty's chin forwards with the index and middle fingers of the hand while

14. pressing the forehead backwards with the heel of your other hand. The jaw will lift the
tongue forward, clear of the airway.
Checking Breathing
1. continue holding the casualty's airway open and place you ear above her mouth and nose
2. look along her chest and abdomen. If she is breathing, you will hear and feel any breath on
the side of your face and see movement along the chest and abdomen.
Clearing the Airway
1. turn the casualty's head to the side, keeping it well back.
2. hook your first two fingers and sweep round inside the mouth. But do not spend time
searching for hidden obstructions and make surethat you do not push anyobject further down
the throat.
3. check breathing again
2.) BREATHING
Artificial ventilation- the technique of breathing for a casualty.
a.) Mouth-To-mouth ventilation
-most efficient method of artificial ventilation in all cases where a casualty is not
breathing.
-you blow air from your lungs into the casualty's mouth or nose to fill the casualty's
lungs.
- enables you to watch the casualty's chest for movement, indicating that the lungs are
being filled or that the casualty is breathing again naturally and to observe changes in the

15. casualty's colour.
- can be used by first aiders of any age and in most circumstances.
- Easiest to carry out if the casualty is lying on his/her back
METHODS:
1. Remove any obvious obstructions over face or constrictions around neck. Open airway and
remove any debris seen in the mouth and throat.
2. Open your mouth wide, take a deep breath, pinch the casualty's nostrils together with your
fingers and seal your lips around his mouth. Blow into the casualty's lungs, looking along his
chest, until you can see his chest rise to maximum expansion.
3. remove your mouth well away from the casualty's and breath out any excess air while
watching his chest fall. Take a deep breath, repeat inflation.
4. after two inflations check the pulse to make sure the heart is beating.
b.) mouth-to-nose ventilation
- close the casualty's mouth with your thumb and seal your lips about his nose. Proceed as for
mouth-to-mouth.
c.) artificial ventilation
In this technique, the nose is pinched so that air blown into the casualty's mouth cannot
escape through the nasal passage but is forced into the lungs.
CIRCULATION
It is pointless continuing artificial ventilation if the casualty's heart is not beating, because the
oxygenated blood will not be circulating.
EXTERNAL CHEST COMPRESSION

16. Contractions can be simulated in a non-beating heart by compressing the chest. By pressing
down on the lower half of the breast bone you increase the pressure inside the chest thus
driving blood out of the heart and into the arteries. When you release the pressure, the chest
returns to its normal position and blood flow back along the veins and refills the heart as it
expands.
External chest ventilation is always preceded and accompanied by artificial ventilation. To be
effective, it must be carried out with the casualty lying on a firm surface.
CHECKING FOR CIRCULATION
The only reliable way of establishing a lack of circulation is to check the pulse at the neck
(carotid pulse). This pulse can be felt by placing your finger tips gently on the voice box and
sliding them down into the hollow between the voice box and the adjoining muscle.
METHOD OF EXTERNAL CHEST COMPRESSION
If mouth-to-mouth ventilation by itself is unsuccessful and the casualty’s heart stops, or has
stopped beating, you must perform External Chest Compression in conjunction with mouth-to-
mouth ventilation. This is because without the heart to circulate the blood, oxygenated blood
cannot reach the casualty’s brain. To be used if hearts from stops from functioning because
oxygenated blood cannot reach the casualty’s brain.
STEPS
1. Lay the casualty on his back on a firm surface. Kneel alongside him facing his chest and

17. in line with his heart. Find the junction if his rib margins at the bottom of his breast bone.
Place the heel of one hand along the line of the breast bone, two finger breaths above this
point, keeping your fingers off the ribs.
2. Cover the left hand with the heel of your other hand (right hand) interlock your fingers.
Your shoulders should be directly over the casualty’s breast bone and your arms straight.
3. Keeping your arms straight, press down vertically on the lower half of his breast bone to
move it 4-5 cm (1 ½ -2 inch) for the average adult. Release pressure Complete 15
compressions at the rate of 80 compressions per minute. Compressions should be regular
and smooth, not Jerky and Jabbing (to find the correct speed, count one and two and
three, and so on).
4. Move back to the casualty’s head, re-open by airway and give two breaths of mouth-to-
mouth ventilation.
5. Continue with 15 compressions followed by two full ventilators, repeating the circulation
check after the first minute. Thereafter, check pulse after every three minutes.
6. As soon as the pulse returns, stop compressions immediately. Continue mouth-to-mouth
ventilation until natural breathing is restored, assisting it when necessary, and adjusting it
to the casualty’s rate. Place the casualty in the Recovery Position (Refer the Topic on
Recovery Position).
CHECKING FOR RESPONSE
When resuscitation is successful, the carotid pulse will return. Look at the casualty’s face and
lips. The colour will improve as blood containing oxygen begins to circulate. When the casualty
is not breathing, the normal colour turns to blue (cyanosis).

18. RESUSCITATION WITH TWO FIRST AIDERS
1. One should take charge and maintain the open airway,
2. perform mouth-to-mouth ventilation and check circulation;
3. the other should perform External Chest Compression.
STEPS
1. One first aider takes up a position at the casualty’s head, the other kneels alongside the
casualty, level with the middle of her chest.
2. The first aider at the head immediately opens the airway, gives the first two inflations and
checks for circulation (Refer Topic on Checking for Circulation). If it is absent, the other
first aider should begin chest compression.
3. Resuscitation then continues with the first aider at the head keeping the airway open and
giving a single inflation on the upstroke of every fifth compression by her partner. The
compressions are continued at a rate of 80 per minute until the circulation returns and the
pulse is felt (To find the correct speed count one and two and three and so on).
Pulse check must be carried out after the first minute and then every three minutes.
Note: these needs to be a short pause after every five compressions, allowing time for the lungs
to inflate.
RESUSCITATION FOR CHILDREN
For children and infants place your hand just below the centre of the breast bone for External
Chest Compression giving five compressions to one inflation per cycle.

19. ARTIFICAL VENTILATION FOR CHILDREN STEPS
For Children
Open the child’s airway. Seal your lips around his mouth and nose and breath gently into the
lungs at a rate of 20 breaths per minute. Check for circulation after giving the first two inflations
For Babies (or) Children under Two
1. Open the airway being careful not to tilt the head back too far.
2. Seal your lips around the baby’s mouth and nose and puff gently into the lungs at a rate of
20 breaths per minute.
3. Check for circulation after giving the first two inflations.
EXTERNAL CHEST COMPRESSION—STEPS
For Children Use light pressure with one hand only. Press at a rate of 100 compressions per
minute to a depth of 2.5-3.5 (1-1 ½ inch) with five compressions to one ventilation.
For Babies (or) Children under Two
Make sure the baby is on a firm surface. Support his head and neck by sliding one hand under his
back. Using two fingers only, press at a rate of 100 times per minute to a depth of 1.5-2.5 cm (1
½-1 inch).
THE RECOVERY POSITION
Position ensures that an open airway is maintained because the tongue cannot fall to the back of
the throat: the head and neck will remain in an extended position so that the air passage is
widened; and vomit (or) other fluid will drain freely from the casualty’s mouth.

20. Recovery position, it must be used immediately id a casualty’s breathing becomes difficult or
noisy and is not relieved by opening the airway; (or) if a casualty has to be left unattended (an
unusual event).
STEPS
1. Kneel upright alongside the casualty facing his chest. Turn his head towards you and felt
it back keeping the Jaw forward in the Open Airway Position.
2. Place the casualty’s arm nearest to you by his side. Lift his buttock and place his hand
well underneath with the fingers straight. Holding his far legs under the knee (or) ankle
bring it towards you and cross it over his near leg. Bring his other forearm over the front
of his chest.
3. Protect and support the casualty’s head with one hand, with the other hand, grasp his
clothing at the hip on his side against your thighs.
4. Still supporting his body against your knees readjusts his head to ensure that the airway is
open.
5. Bend his uppermost arm at a right angle to support the upper body.
6. Bend his uppermost knee at a right angle to bring the thigh well forward to support the
lower body.
For heavy Casualty
You may have to use both hands to turn a heavy casualty. Grasp the clothing at the
shoulders and hips and pull him so that his body is against your thighs.
If bystanders are present, one may support his head while you do turning. Alternatively, get them
to help by kneeling beside you and by pulling at his hips while you pull his should and support

21. his head. It may be necessary for them to face you and push the casualty towards you as you pull.
7. Carefully pull the other arm out from under the casualty, working from the shoulder
down. Leave it lying parallel to him to prevent him rolling on to his back and to avoid
interference with his circulation.
8. Check that the final position is stable and that the casualty cannot roll forwards or
backwards. Ensure that no more than half his chest is in contact with the ground and that
his head remains tilted and his jaw forward to maintain an open airway position.