Assess Breathing and Initiate Ventilation

Once the airway has been opened, assessment of respiratory effort and air movement should occur. The care provider should look for chest expansions and listen and feel for airflow. The simple act of opening the airway may be adequate for the return of spontaneous respirations. However, if the victim remains without adequate respiratory effort, then further intervention is required. Two slow breaths of 1 2 to 2 s each should be given. At this point, a foreign body obstruction, as indicated by lack of chest rise or airflow on ventilation, may be noted, which would require efforts to relieve the obstruction ( Fig 8-2). Agonal respirations in an individual who has just suffered a cardiac arrest are not considered adequate. Intermittent positive-pressure ventilation, if possible with oxygen-enriched air, should be initiated.

FIG. 8-2. Determine breathlessness.

VENTILATION TECHNIQUES There are a number of techniques for ventilating an individual, including mouth to mouth, mouth to nose, mouth to stoma, mouth to

mask. Rescue breaths of an inspiratory time of 1 2 to 2 s each should be given at a rate of 10 to 12 per minute, with a volume adequate to make the chest rise—800 to 1200 mL in most adults. Too large a volume or too rapid an inspiratory flow rate will likely cause gastric distention, which can lead to regurgitation and aspiration. Expired air has an F,o2 of 16 to 17 percent. Supplemental oxygen should be delivered as soon as possible.

Mouth to Mouth With the airway open, the patient's nose should be gently pinched shut with the rescuer's thumb and index finger ( Fig.,8:3). This prevents air escape. After a deep breath, the rescuer places his or her lips around the patient's mouth, forming an airtight seal. The rescuer slowly exhales. Release the seal and allow adequate time for passive exhalation by the victim, and then repeat the procedure.

FIG. 8-3. Mouth-to-mouth rescue breathing.

Mouth to Nose At times, as with severe maxillofacial trauma, mouth-to-nose ventilation may be more effective. With the airway open, the rescuer lifts the patient's jaw, closing the mouth. After a deep breath, the rescuer places his or her lips around the patient's nose, forming an airtight seal. The rescuer slowly exhales.

Mouth to Stoma or Tracheostomy After laryngectomy or tracheotomy, the stoma or tracheostomy becomes the patient's airway. As with the previous techniques, a seal is made around the stoma or tracheostomy tube, and the rescuer slowly exhales.

Mouth to Mask Placement of the mask properly and securely on a victim's face is important when using a mask for ventilation, either with a bag or via mouth to mask. The mask should be placed over the bridge of the patient's nose and around the mouth. The rescuer places the thumb on the part of the mask that is sitting on the patient's nose and places the index finger of the same hand on the part of the mask sitting on the patient's chin ( Fig 8.-4). The three other fingers of the same hand are then placed along the bony margin of the jaw. The mask can then be firmly sealed to the patient's face. Two hands may be used for this technique if a second rescuer is available. Ventilations are then performed through the mask; some masks also allow for supplemental oxygenation.

FIG. 8-2. Determine breathlessness.

FIG. 8-3. Mouth-to-mouth rescue breathing.

FIG. 8-4. Mouth-to-mask rescue breathing with proper mask placement.

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