081-831-1042 Perform Mouth to Mouth Resuscitation

All living things must have oxygen to live. It is through the breathing process that the lungs draw oxygen from the air and put it into the blood for the heart to pump through the body where it is used. Each living cell requires a constant supply of oxygen. Some cells are more dependent on the constant supply of oxygen than others. Cells in the brain and nervous system may die after four to six minutes without oxygen. This lack of oxygen may mean irreversible brain damage because these dead cells can never be re-placed. If you can help someone by performing mouth-to-mouth resuscitation, you may save his or her life.

1. Emergency procedures must be applied to a casualty quickly and correctly. In order for the soldier to apply the correct procedure, the casualty must be in the proper position.

2. Procedures of this step are--

a. Check for responsiveness. Establish whether the casualty is conscious by gently shaking him or her and asking, "Are you O.K.?"

b. Call for help.

c. Position the unconscious casualty face up on a firm surface.

(1) Straighten the casualty's legs. Take the casualty's arm that is nearest to you. Move it so that it is straight and above his or her head. Repeat the procedure with the other arm.

(2) Kneel beside the casualty with your knees near his or her shoulders (leave space to roll the body). Place one hand behind the head and neck for support. With your other hand, grasp the casualty under the far arm (armpit area).

(3) Roll the casualty toward you using a steady and even pull. The head and neck should stay in line with the back.

(4) Return the casualty's arms to his or her side. Straighten the casualty's legs. Reposition yourself so that you are now kneeling at the level of the casualty's shoulders. If a neck injury is suspected and the jaw thrust will be used, kneel at the casualty's head looking toward the feet.

1. The tongue is the single most common cause of an airway obstruction. In most cases, the airway can be cleared by simply extending the neck. This action pulls the tongue away from the air passage in the throat. This procedure is called the head-tilt/chin-lift method.

2. Procedures of this step are the following:

a. Kneel at the level of the casualty's shoulders.

b. Place one hand on the casualty's forehead and apply firm, backward pressure

with the palm to tilt the head back.

c. Place the fingertips of the other hand under the bony part of the lower jaw and lift, bringing the chin forward.

1. After establishing an open airway, it is important to maintain that airway in an open position. Often the act of just opening and maintaining the airway will allow the casualty to breathe properly. Once the rescuer uses the head-tilt/chin-lift method to open the airway, he or she should maintain that head position to keep the airway open. Failure to maintain the open airway will prevent the casualty from receiving an adequate supply of oxygen.

2. The procedures of this step are--

a. Look for the chest to rise and fall.

c. Feel for breath on your cheek.

1. If the chest does not rise and fall and no air is exhaled, the casualty is breathless (not breathing). This is a sign for you to begin mouth-to-mouth resuscitation. In this method of rescue breathing, you inflate the casualty's lungs with air from your lungs.

2. Procedures of this step are--

a. Maintain the airway and gently pinch the nose closed using the hand on the casualty's forehead.

(1) Let the same hand, pinching the nose closed, exert pressure on the casualty's forehead to maintain the backward head tilt and maintain an open airway.

(2) With the other hand, lift the chin while keeping your fingertips on the bony part of the lower jaw near the chin.

b. Take a deep breath and place your mouth, in an airtight seal, around the casualty's mouth.

c. Give two full breaths (one and one-half to two seconds each), taking a breath between them, while watching for the chest to rise and fall and listening and/or feeling for air to escape during exhalation.

1. Improper chin and head positioning is the most common cause of difficulty with ventilation. If the initial attempt to ventilate the casualty is unsuccessful, reposition the casualty's head and repeat rescue breathing.

2. The procedures of this step are as follows:

a. Reposition the casualty's head slightly farther backward.

b. Repeat the steps in "Give breaths to ensure and open airway." 

(1) Maintain the airway and gently pinch the nose closed, using the hand on the casualty's forehead.

(2) Take a deep breath and place your mouth, in an airtight seal, around the casualty's mouth.

(3) Give two full breaths (one and one-half to two seconds each), taking a breath between them, while watching for the chest to rise and fall and listening and/or feeling for air to escape during exhalation.

3. If the chest rises, go to "Check for a pulse."; if it does not rise, continue with "Perform abdominal or chest thrusts.".

1. In order for oxygen from the air to flow to and from the lungs, the upper airway must be unobstructed. If the unconscious casualty has signs of airway obstruction, immediate action is essential.

2. Procedures for the two thrusts are--

a. Abdominal thrusts.

(1) Kneel astride the casualty's thighs.

(2) Place the heel of one hand against the casualty's abdomen, slightly above the navel but well below the tip of the breastbone, with the fingers pointing toward the casualty's head.

(3) Place the other hand on top of the first.

(4) Press into the casualty's abdomen with a quick, forward and upward thrust. You can use your body weight to perform the maneuver. Each thrust should be a separate, distinct movement.

(5) Repeat the sequence of abdominal thrusts as long as necessary to remove the object from the obstructed airway (up to five thrusts).

b. Chest thrusts.

(1) Kneel close to the side of the casualty's body.

(2) Locate the lower edge of the casualty's ribs and run the fingers up along the rib cage to the notch where the ribs meet the breastbone.

(3) Place the middle finger on the notch with the index finger just above it on the lower end of the breastbone.

(4) Place the heel of the other hand on the lower half of the breastbone next to the two fingers.

(5) Remove the fingers from the notch and place that hand on top of the other hand extending or interlacing the fingers.

(6) Straighten and lock the elbows with the shoulders directly above the hands.

(7) Without bending the elbows, rocking, or allowing the shoulders to sag, apply enough pressure to depress the breastbone one and one-half inches to two inches.

(8) Give several (up to five) thrusts with each thrust given slowly, distinctly, and with the intent of relieving the obstruction.

1. If you cannot administer rescue breathing due to an airway obstruction, then remove the airway obstruction using the finger sweep method.

2. Procedures of the finger sweep method include the following:

a. Open the casualty's mouth by grasping both the tongue and lower jaw between your thumb and fingers and lifting (tongue-jaw lift) the jaw open.

b. Insert the index finger of the other hand down along the cheek to the base of the tongue.

c. Use a hooking motion from the side of the mouth toward the center to dislodge the object. Take care not to force the object deeper into the airway.

d. Reopen the airway and repeat the breaths.

1. When a casualty's heart has stopped, he or she is unconscious and limp; the pupils of the eyes are open wide. When evaluating a casualty or when performing the preliminary steps of rescue breathing, feel for a pulse.

2. Checking for a pulse requires the following steps:

a. Use the first two fingers in the groove in the casualty's throat beside the Adam's apple.

b. Without using the thumb, check pulse for 5 to 10 seconds.

3. If a pulse is found but the casualty is not breathing, continue with mouth-to-mouth resuscitation. If no pulse is found, cardiopulmonary resuscitation (CPR) must be performed by qualified personnel. Send for qualified medical personnel.

1. You as a lifesaving agent would continue rescue breathing until the casualty starts to breathe on his or her own, until you are relieved by another person, or until you are too tired to continue.

2. Continuation of lifesaving procedures involves the following:

b. Recheck for pulse and breathing for three to five seconds after every 12 breaths.

c. Continue mouth-to-mouth or mouth-to-nose resuscitation until breathing is restored.

3. In a real emergency situation, the care giver would watch the casualty closely, would maintain an open airway, and would check for other injuries. (See task Evaluate a Casualty, task number 081-831-1000.) Performance of mouth-to-mouth resuscitation requires the following sequence and procedures:

1. Roll the casualty onto his or her back if necessary. Do this carefully so that the body does not twist.

2. Open the airway using the head-tilt/chin-lift method. Quickly remove any foreign material or vomitus in the mouth if necessary.

a. Kneel at the level of the casualty's shoulders.

b. Place one hand on the casualty's forehead and apply firm, backward pressure

with the palm to tilt the head back.

c. Place the fingertips of the other hand under the bony part of the lower jaw and lift, bringing the chin forward.

3. Check for breathing within three to five seconds by placing an ear over the casualty's mouth and looking toward the chest.

a. Look for the chest to rise and fall.

b. Listen for sounds of breathing.

c. Feel for breath on your cheek.

4. Give breaths to ensure an open airway. When mouth-to-mouth resuscitation breathing cannot be performed because the casualty has jaw injuries or spasms, the mouth-to-nose method may be more effective.

c. Give two full breaths (one and one-half to two seconds each), taking a breath

d. If chest rises, go to step 8. If chest does not rise, continue with step 5.

5. Reposition the casualty's head slightly farther backward and repeat the breaths. If chest rises, go to step 8 "Check for a Pulse". If chest does not rise, continue with step 6 "Perform abdominal or chest thrusts".

6. Perform abdominal or chest thrusts. Abdominal thrusts should be used unless the casualty is in the advanced stages of pregnancy, is very obese, or has a significant abdominal wound.

a. Abdominal thrusts.

(1) Kneel astride the casualty's thighs.

(2) Place the heel of one hand against the casualty's abdomen, slightly above the navel but well below the tip of the breastbone, with the fingers pointing toward the casualty's head.

(3) Place the other hand on top of the first.

(4) Press into the abdomen with a quick forward and upward thrust.

(5) Give up to five thrusts with each thrust a separate, distinct movement.

b. Chest thrusts.

(1) Kneel close to the side of the casualty's body.

(2) Locate the lower edge of the casualty's ribs and run the fingers up along the rib cage to the notch where the ribs meet the breastbone.

(3) Place the middle finger on the notch with the index finger just above it on the lower end of the breastbone.

(4) Place the heel of the other hand on the lower half of the breastbone next to the two fingers.

(5) Remove the fingers from the notch and place that hand on top of the other hand extending or interlacing the fingers.

(6) Straighten and lock the elbows with the shoulders directly above the hands.

(7) Without bending the elbows, rocking, or allowing the shoulders to sag, apply enough pressure to depress the breastbone one and one-half to two inches.

(8) Give several thrusts (up to five).

7. Perform a finger sweep and repeat the breaths.

a. Open the mouth by grasping the tongue and lower jaw to lift the jaw open or crossing the fingers and thumb to push the teeth apart.

b. Insert the index finger of the other hand down along the cheek to the base of the tongue.

c. Use a hooking motion from the side of the mouth toward the center to dislodge the object. Take care not to force the object deeper into the airway.

d. Reopen the airway and repeat the breaths.

e. If chest rises, go to step 8 "Check for a pulse". If chest does not rise, repeat steps (6) "Perform abdominal or chest thrusts", and (7) "Perform a finger sweep and repeat breaths until the airway is clear."

8. Check for a pulse for 5 to 10 seconds. Use the first two fingers in the groove in the casualty's throat beside the Adam's apple.

a. If a pulse is found but the casualty is not breathing, continue with mouth-to-mouth resuscitation.

b. If no pulse is found, CPR must be performed by qualified personnel. Send for qualified medical personnel.

a. Recheck for pulse and breathing for three to five seconds after every 12 breaths.

b. Continue mouth-to-mouth or mouth-to-nose resuscitation until breathing is restored.

1. Performance Exercise:

a. Students must perform the specified actions in correct sequence. Prior to per-forming the exercise, students pair off. One student performs the exercise while the other plays the part of the casualty. Students then switch positions. Evaluators rate each student's performance.

b. Have additional personnel (at least one) available to evaluate students on performance of the exercise and to rate each student as "GO" or "NO GO."

d. A copy of the evaluation exercise procedures and solutions can be found in Appendix C.

2. No written exam.

GO NO GO

Perform mouth-to-mouth resuscitation.

NOTE: Evaluator states, "You observe a casualty who is unconscious and is not

breathing. You are not in a chemical environment. Using Resusci-Anne as a

simulated casualty, begin your course of action."

NOTE: Evaluator will indicate different situations (e.g., chest rises, chest does not rise,

clear airway obstruction, etc.).

NOTE: The student must (do the following)--

1. Roll the casualty onto his or her back.

2. Open the airway using the head-tilt/chin-lift method.

3. Check for breathing within three to five seconds by placing an ear over the

casualty's mouth and looking toward his or her chest.

4. Give breaths to ensure an open airway (two full breaths of one and one-half to

two seconds each).

NOTE: Evaluator states, "Airway is still closed."

5. Reposition the casualty's head slightly farther backward and repeat the breaths.

NOTE: Evaluator tells the soldier to use either abdominal or chest thrusts.

6. Perform abdominal or chest thrusts.

NOTE: Evaluator states, "Airway is still obstructed."

7. Perform a finger sweep and repeat the breaths.

8. Check for a pulse using the first two fingers in the groove in the casualty's

throat beside the Adam's apple.

9. Continue mouth-to-mouth resuscitation at the rate of about 10 to 12 breaths

per minute, and recheck for pulse and breathing after every 12 breaths.

NOTE: Instructor will tell the student if spontaneous breathing has been restored.

Perform mouth-to-mouth resuscitation.

NOTE: The student must (do the following)--

1. Roll the casualty onto his or her back.

2. Open the airway using the head-tilt/chin-lift method.

3. Check for breathing within three to five seconds by placing an ear over the casualty's mouth and looking toward his or her chest.

4. Give breaths to ensure an open airway (two full breaths of one and one-half to two seconds each).

5. Reposition the casualty's head slightly farther backward and repeat the breaths.

6. Perform abdominal or chest thrusts.

7. Perform a finger sweep and repeat the breaths.

8. Check for a pulse using the first two fingers in the groove in the casualty's throat beside the Adam's apple.

9. Continue mouth-to-mouth resuscitation at the rate of about 10 to 12 breaths per minute, and recheck for pulse and breathing after every 12 breaths.