Expired Air Respiration

Expired air respiration (EAR) is superior to manual methods and widely used in the community. The nose of the patient should be pinched and two gentle breaths given by the rescuer, observing for rise and fall of the chest. It is obvious that maintenance of a clear airway helps to avoid gastric inflation but EAR always poses the risk of aspiration. Owing to this risk, the original American guidelines that recommended four additive breaths, were changed (Standards and Guidelines for CPR and ECC 1986), and it has now been suggested that, in order to keep inflation pressures low, smaller volumes of around 500 ml should be used. A two second inflation time with 3 seconds allowed for exhalation is recommended. In addition, it has been suggested that the application of cricoid pressure might be added to the guidelines.

Disadvantages of EAR include:

• Low inspired oxygen concentration

• Aesthetic considerations

• Risk of cross infection Circulation

The presence of a spontaneous circulation must be sought before initiating CPR. The carotid artery should be palpated for up to 10 seconds. If evidence of circulation is absent, help should be summoned and chest compressions started with the patient on a firm flat surface. The hand position should be over the sternum, two finger breadths up from the xiphisternum, in the midline. The fingers of the upper hand should be interlocked with the hand below and pressure exerted through the heel of the lower hand. Chest compression using direct downward pressure with the arms straight, should be applied to a depth of 4-5 cm at a rate of 100/min (Handley 1997). Even following these guidelines accurately, the artificial circulation produced is poor and chest compressions should be stopped only briefly for essential interventions, or for palpation of the pulse if the clinical condition improves. It is recommended that ventilation and compressions continue in a ratio of 2:15 for single rescuer CPR (Holmberg et al. 1992) and 1:5 for two operators.



Expired Air Resuscitation

Advanced Life Support

Advanced life support (ALS) continues with the provision of BLS techniques but involves the use of extra equipment, which will be dealt with subsequently in the sequence ABC. ALS is specifically directed towards restoring a spontaneous circulation. As ventricular fibrillation is the most common rhythm of cardiac arrest, and since it offers the best opportunity for successful resuscitation if defibrillation occurs early (within 90 seconds) then there must be no delay in delivering up to three DC shocks.

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