Emergency resuscitation: Part 1 (1963)

the air is free but at times it's worth a king's ransom air is essential to life without it we done air is what we need nothing else will do we breathe in air naturally stop the natural process and again we die in England and Wales alone nearly 6,000 people die every year for lack of air in accidents such as these it's known that many of these need not have died if the rest of us have known what to do for them so let us now see what should be done wherever a person is found not obviously breathing or in a situation where he can't breathe then resuscitation by the exhaled air method must be started immediately now what is this method let's first look at the process of breathing inside the chest are the lungs two very complicated structures which can be filled with air rather like balloons normally when we breathe muscles expand the chest and cause a suction which draws air into the lungs a little oxygen is taken from the air into the blood and distributed throughout the body and a little carbon dioxide leaves the blood and passes into the lungs then the muscles relaxed allowing the chest to contract again and expel the air which now contains a little less oxygen and rather more carbon dioxide than it did this is the normal process of breathing suppose however that for some reason the chest muscles aren't working so that air is not being drawn in well it doesn't matter to the body if instead air is blown into the lungs from outside so long as it gets there once we stop blowing air in the chest will fall and push it out again blow air in let it come out again in again out again and our casualty is getting his oxygen now how do we do it first we must keep a clear air passage to the lungs with a conscious person the air passages are kept open naturally if he becomes unconscious the tongue muscles go limp and allow the tongue to fall back blocking the air passage the question is how can we open it up again here we can take a tip from a sword swallower obviously he can't afford to have his tongue in the way of the sword as it goes down to avoid this the head is thrown back with the chin well forward making a straight line from the lips through the mouth down the throat and in this case into the stomach so when the blade is passed down the tongue is well out of the way this gives us our clue to opening a blocked passage if we arch the neck and put the head well back as the sword swallower does the air passage will be opened even in an unconscious person whose tongue muscles are slick the air passage is further opened by holding the jaw forward the key to the whole procedure is this full extension of the head and now we can think about how to get the air in one of these two men is going to pretend to be unconscious and not breathing the method of resuscitation will be demonstrated by the other as our casualty is not a genuine one we're in no hurry but in a real emergency there must be no delay every second counts nothing absolutely nothing should interfere with the main object of getting air into the lungs with one hand on the neck and the other on the forehead the rescuer puts the casualty into the sword-swallowing position there's often causes the mouth to fall open and it's then necessary to support the jaw to keep the air passage fully open no he's going to breathe air into the lungs but you say surely we breathe out carbon dioxide which is harmful to see what really happens let's first consider normal fresh air very nearly four-fifths of it is nitrogen and one-fifth oxygen with a trace of carbon dioxide now take exhaled air there's the same amount of nitrogen and only a little less oxygen and although there's certainly more carbon dioxide than before this doesn't matter there is still plenty of unused oxygen in the exhaled air so there's no worry on that score so now our rescuer is going to blow air into the casualties lungs if as might happen there is any obstruction of the mouth or throat dentures perhaps or weed or debris or any other object it must be quickly removed then the rescuer closes the nose to prevent the air escaping when he blows notice that he's still holding the head back with his wrists it's no good blowing if the tongue is allowed to close the air passage next he'll take a deep breath and with his mouth opened widely he will seal his lips around the mouth of the casualty and exhale forcibly he may be able to see the chest rise out of the corner of his eye but he'll be able to tell that his breath has gone in anyway after each inflation he watches the chest deflate and listens for the air coming out you're not likely to damage the lungs by blowing too hot except with young children turning the head not only allows the rescuer to watch the chest but also helps him to avoid the casualties exhaled air for the same reason he withdraws will clear to take a new breath the timing of the actions is dictated by the emptying of the casualties lungs when they are empty take a deep breath and fill them again it'll be about 10 times a minute with adults and more often with children the rescuer continues this process until the casualty starts to breathe normally for himself or until qualified medical opinion is available if there is no chance of a doctor being available keep trying for an hour there are several variations of this basic method which we should consider for example it's quite easy to close off the nose with the cheek this leaves the hands-free to keep the head extended also it's perfectly satisfactory to breathe into the nose instead of the month in fact some people prefer this method the best rule is if either method fails try the other with the mouth to nose method the casualties lips must be closed during inflation by the hand which holds the jaw and during expiration it may be necessary to open the mouth slightly to allow free escape of air again with a little practice it may be possible to free one hand by using the cheek in this case to close off the moon now suppose resuscitation is attempted but the rescuer has difficulty in inflating the lungs the first thing to do is to check the extension of the head as the most likely trouble is an air passage still partly obstructed if when she tries again there is no improvement she should try pulling the jaw forward as it may have sagged back taking the tongue with it the exhaled air method is quite suitable for children only in this case the rescuer should enclose both nose and mouth and must only blow gently with infants only light puffs should be used the rule is use no greater force than is needed to expand the chest by the amount it would expand in normal deep breathing incidentally there's no reason why this method shouldn't be taught to school children they are quite capable of resuscitating adults in some countries Norway for example the method is taught in all schools men women and children all should be prepared to save the life of a fellow human being in this way in time if the method is successful the casualty will be seen to start breathing again for himself probably rather feebly at first the rescuer now times her breathing to his returning respiration when she is satisfied that normal breathing has returned she should turn him on his side as breathing returns there's a risk of him being sick and if he was still on his back he could choke the best position is like this the upper knees slightly bent and the lower arm pulled out behind him the rescuer should stay with him even after breathing returns in case further resuscitation becomes necessary in the real-life situation such as the girl accidentally guessed even when normal respiration has returned and the patient has been turned onto her side the emergency is not over shock or other complications may follow so an ambulance should become in these circumstances observation in hospital may be expected for at least 24 hours complications are unlikely to arise beyond that time and now let's summer when faced with a person who is not breathing rule one is don't delay start resuscitation immediately seconds cont rule to open the air passage by extending the head and holding the jaw forward roll three get air into the lungs by breathing into them this is a simple easily learnt and effective method of resuscitation within the capabilities of everyone no one knows when the chance to save a life might come make sure that you are ready if it comes to you