LESSON 6
PERFORM MOUTH-TO-MOUTH RESUSCITATION
(TASK 081-833-1042)
TASK:
Identify procedures for opening the airway and performing rescue breathing (mouth-to-mouth or mouth-to-nose resuscitation) on a casualty who is not breathing.
CONDITIONS:
Given multiple-choice questions pertaining to restoring breathing to a casualty.
STANDARD:
Score 70 or more points on a 100-point comprehensive examination.
REFERENCES:
STP
21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.
FM
21-11, First Aid for Soldiers.
NOTE: Some of the task titles and information have changed and are not reflected in FM 21-11 and STP 21-1-SMCT. For up-to-date task information, refer to the Army Training Support Center, Common Core Task internet site at: http://www.atsc.army.mil/dld/comcor/comcore.htm.
|
WARNING
Do not perform mouth-to-mouth resuscitation in a chemical environment.
|
If possible, send someone to get medical help.
| CAUTION: If you come upon a casualty who is in a dangerous area (under hostile fire, near a burning vehicle, etc.), remove the casualty (and yourself) from the danger before beginning mouth-to-mouth resuscitation. |
6-3. POSITION THE CASUALTY FOR MOUTH-TO-MOUTH RESUSCITATION
If the casualty is not lying on his back, position the casualty face up on a firm surface.
| CAUTION: The casualty should be carefully rolled as a unit so that his body does not twist. If a spinal injury is suspected and assistance is available, support the casualty's head and neck while one (or more) helpers gently turn the casualty's trunk and legs. |
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 head. Repeat the procedure with the other arm.
Kneel beside the casualty with your knees near his 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).
Roll the casualty toward you using a steady and even pull. The head and neck should stay in line with the back.
Return the casualty's arms to his sides. Straighten the casualty's legs. Reposition yourself so that you are now kneeling at the level of the casualty's shoulders.
6-4. OPEN THE CASUALTY'S AIRWAY
Many times an unconscious casualty's tongue may be blocking his airway. The muscles of the tongue relax when a person loses consciousness. The tongue may slide to the back of the mouth and cover the opening to the trachea (windpipe). Moving the tongue away from the trachea may result in the casualty resuming breathing on his own. Even if the casualty has not stopped breathing, the procedures for opening the airway will allow him to breathe easier.
The two preferred methods of opening the casualty's airway are the head-tilt/chin-lift method and the jaw thrust method. The jaw thrust method is used if you suspect that the casualty has suffered a neck injury or severe head injury (deformed-look, major wounds, etc.). The jaw thrust keeps movement of the neck to a minimum.
Head-Tilt/Chin-Lift
| CAUTION: Do not use the head-tilt/chin-lift method if a spinal or neck injury is suspected. |
Kneel at the side of the casualty's head.
Place one of your hands on the casualty's forehead and apply firm, backward pressure with your palm. This will cause the casualty's head to tilt back.
Place the fingertips of your other hand under the bony part of the casualty's lower jaw and lift to bring the chin forward. The fingertips should not press deeply into the soft tissues under the chin since the pressure could make breathing difficult. Use your fingertips, not your thumb, to lift the chin.
FIGURE 6-1. HEAD-TILT/CHIN-LIFT
Lift the chin forward until the upper and lower teeth are almost brought together. The mouth should not be closed as this may block the airway. If needed, the thumb may be used to depress the casualty's lower lip slightly to keep his mouth open.
Kneel at the top of the casualty's head (looking toward the casualty's feet).
Rest your elbows on the ground or floor.
FIGURE 6-2. JAW THRUST
Place one hand on each side of the casualty's head and place the tips of the index and middle fingers under the angles of the casualty's lower jaw. Place your thumbs on the jaw just below the level of the teeth.
Raise your fingertips to lift the jaw forward (upward). This action will also cause the casualty's head to tilt backward somewhat.
If the casualty's lips are still closed after the jaw has been moved forward, use your thumbs to retract the lower lip and allow air to enter the casualty's mouth.
Place your ear over the casualty's mouth and nose with your face toward the casualty's chest. Maintain the open airway (head-tilt/chin-lift or jaw thrust) during your check.
Look for the rise and fall of the casualty's chest and abdomen.
Listen for sounds of breathing.
Feel for his breath on the side of your face.
If the casualty is breathing and has good air exchange, keep his airway open and proceed to look for life-threatening injuries (massive bleeding, etc.). If he is not breathing or breathing weakly, start mouth-to-mouth resuscitation. The examination process should not take more than five seconds.
FIGURE 6-3. CHECKING FOR BREATHING WHILE OPEN AIRWAY
(HEAD-TILT/CHIN-LIFT)
6-6. INITIATE MOUTH-TO-MOUTH RESUSCITATION
Maintain Open Airway
Keep the casualty's airway open during the rescue breathing process. Keeping the casualty's lower jaw forward prevents the tongue from blocking the airway.
Close Casualty's Nose
If you are using the head-tilt/chin-lift, use the thumb and index finger of your hand on the casualty's forehead to gently pinch the casualty's nose closed. 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. With the other hand, lift the chin while keeping your fingertips on the bony part of the lower jaw near the chin.
Administer Two Full Breaths
Open your mouth wide and take a deep breath.
Place your mouth over the casualty's mouth. Make sure that your mouth forms a good seal so that air will not escape when you blow air into the casualty's mouth. Maintaining the open airway will keep the casualty's mouth open slightly.
Blow into the casualty's mouth. As you blow, observe the casualty's chest. If air is getting into the casualty's lungs, his chest will rise.
FIGURE 6-4. ADMINISTERING MOUTH-TO-MOUTH RESUSCITATION
(HEAD-TILT/CHIN-LIFT)
After blowing into the casualty's mouth, quickly break the seal and take another deep breath. Seal your mouth over the casualty's mouth again and blow. Administering the two breaths (ventilations) should take about two to three seconds.
Break the seal over the casualty's mouth and release his nose. This will allow the casualty's body to exhale.
FIGURE 6-5. ADMINISTERING MOUTH-TO-NOSE RESUSCITATION
(HEAD-TILT/CHIN-LIFT)
| CAUTION: If you cannot seal off the casualty's nose or if the casualty has injuries to his mouth area that prevent you from administering mouth-to-mouth resuscitation, administer mouth-to-nose resuscitation. Close the casualty's mouth, seal your mouth over the casualty's nose, and blow two breaths into his nostrils. |
Evaluate Effectiveness of the Ventilations
If the casualty begins breathing again on his own, look for injuries. Then evacuate the casualty to a medical treatment facility. Do not leave the casualty alone since his breathing may stop again. The casualty may still require help to keep his airway open.
If air goes in and out of the casualty's lungs but he does not start breathing on his own, check his pulse. (Pulse beats mean that the heart is still pumping blood.)
Continue to maintain the casualty's airway. If the head-tilt/chin-lift method is being used, keep one hand pressing on the casualty's forehead.
Use the index and middle fingers of your free hand to feel for the artery in the groove next to the casualty's Adam's apple (larynx).
FIGURE 6-6. FEELING FOR CAROTID PULSE
Once the artery is located, press on the pulse area gently with your two fingers for five to ten seconds and feel for a pulse. Look for signs of spontaneous breathing (rising and falling of the casualty's chest, etc.) while checking the pulse.
| CAUTION: Do not use your thumb to feel for the casualty's pulse. If you use your thumb, you may feel the pulse in your thumb instead of the casualty's pulse. |
Evaluate the situation and perform needed actions.
If the casualty has no pulse seek medical help immediately. If a casualty is without a pulse (heartbeat) for more than six minutes, he probably cannot be revived.
If the casualty has a pulse but is not breathing on his own, continue mouth-to-mouth resuscitation.
If the casualty resumes breathing on his own, check for bleeding and other injuries. Continue to monitor the casualty's breathing and be prepared to resume mouth-to-mouth resuscitation if needed. (NOTE: If a casualty is breathing on his own, he will also have a pulse.)
If the casualty's chest did not rise and fall, then fresh air is not getting into his lungs. Try to open the casualty's airway more. (If the head-tilt/chin-lift method is being used, lift the chin more. If the jaw thrust method is being used, tilt the head backward slightly.) Then administer two full breaths again. If the casualty's chest still does not rise, a foreign object is probably blocking his airway. Administer finger sweeps (see Perform Finger Sweep) and manual thrusts (see Perform Abdominal Thrusts or Perform Chest Thrusts) as needed in order to unblock his airway. Once the airway is unblocked, administer two full breaths again and reevaluate.
6-7. PERFORM FINGER SWEEP, IF NEEDED
| WARNING | |
| Do not use the finger sweep technique if the casualty is conscious. The finger sweep can trigger the casualty's "gag reflex" and cause him to vomit. | |
Open the casualty's mouth. If the casualty's mouth does not open readily, cross your finger and thumb and push his teeth apart.
Lift the casualty's jaw using the tongue-jaw lift. Grasp the casualty's tongue and lower jaw between your thumb and fingers and lift the jaw. Moving the tongue and jaw makes foreign objects easier to locate.
Look inside the casualty's mouth to see if you can locate the obstruction.
Insert the index finger of your free hand down along the inside of the casualty's cheek to the base of his tongue.
Sweep the throat with a "hooking" motion. Many foreign objects can be dislodged by using a hooking action when moving your finger from the side of the casualty's mouth toward the center. You may need to push the object to the side of the casualty's throat before you can secure the object to be removed.
| CAUTION: Take care to avoid forcing the object deeper into the casualty's airway. |
Pull the object out of the casualty's throat.
Remove the object with your fingers.
Try to ventilate the casualty again (mouth-to-mouth or mouth-to-nose) and check for breathing.
If the casualty is breathing on his own, treat any major injuries and evacuate the casualty.
If the casualty's chest rises and falls but he does not breathe on his own, check the casualty's pulse.
If you are unable to ventilate the casualty (chest does not rise), perform manual thrusts (see Perform Abdominal Thrusts or Perform Chest Thrusts).
FIGURE 6-7. PERFORMING A FINGER SWEEP
6-8. PERFORM ABDOMINAL THRUSTS, IF NEEDED
FIGURE 6-8. ADMINISTERING AN ABDOMINAL THRUST
(CASUALTY IN SUPINE POSITION)
A manual thrust acts like an artificial cough. Each thrust is performed with the intent of dislodging the obstruction without having to perform additional thrusts. The abdominal thrust is usually the preferred method of administering a manual thrust.
| WARNING | |
| If the casualty has an abdominal wound, is noticeably pregnant, or is extremely overweight, use the chest thrust method. | |
Kneel astride the casualty's thighs.
Place the heel of your other hand on top of the heel of the hand on the casualty's abdomen.
Press into the abdomen using a quick forward (inward) and upward thrust. The thrust can be delivered by locking your elbows and shifting your body weight forward.
Release the pressure on the casualty's abdomen (shift your body weight backward).
Quickly evaluate the effectiveness of the thrust.
If the obstruction has been dislodged, perform a finger sweep to remove the obstruction, administer two full breaths, and evaluate their effectiveness.
If the obstruction was not dislodged, administer additional thrusts (up to five). If the obstruction is not expelled, call for help again. Then repeat the procedures for initiating resuscitation, perform a finger sweep, and administer abdominal thrusts again. Continue until the object is expelled and the casualty's airway is open (chest rises during ventilations).
| CAUTION: If the casualty vomits, turn him onto his side and use a quick finger sweep to remove vomitus from his mouth. |
6-9. PERFORM CHEST THRUSTS, IF NEEDED
The chest thrust is used to remove an airway obstruction in an unconscious casualty if the casualty has an abdominal wound, is noticeably pregnant, or is extremely overweight.
Kneel close beside the casualty's chest.
Locate the lower edge of the casualty's rib cage.
FIGURE 6-9. LOCATING COMPRESSION SITE FOR CHEST THRUST
Run the fingers of one hand (usually your dominant hand) along the lower edge of the rib cage until you come to the notch where the rib meets the breastbone at the middle of the casualty's chest.
Place your middle finger on the notch. Then place your index finger next to your middle finger. Your index finger should now be on the lower end of the casualty's breastbone. (NOTE: This step assumes that your index finger is closer to the casualty's head than your middle finger. If not, put your index finger on the notch and your middle finger on the breastbone.) Place the heel of your other hand next to your two fingers and over the casualty's breastbone. Do not form a fist. The heel of your hand is on the compression site.
| CAUTION: Make sure that your heel is on the breastbone and not resting on the ribs. |
Remove your fingers from the notch area and place that hand on top of the hand on the compression site. Either extend or interlace your fingers.
Straighten your arms and lock your elbows. Position your shoulders directly above your hands.
FIGURE 6-10. ADMINISTERING A CHEST THRUST
(CASUALTY IN SUPINE POSITION)
Using the weight of your body, apply enough pressure straight down to depress the casualty's breastbone 1 to 2 inches.
| CAUTION: Do not bend your elbows, rock, or allow your shoulders to sag while delivering the thrust. If the thrust is not delivered properly, it will lose some of its effectiveness and could result in additional injury. |
Release the pressure by shifting the weight of your body from your arms. Do not remove your hands from the compression site. If you remove your hands from the site, repeat the procedures for locating the compression site. Delivering a thrust at the wrong compression site can injure the casualty.
Quickly evaluate the effectiveness of the thrust.
If the obstruction has been dislodged, perform a finger sweep to remove the obstruction, administer two full breaths, and evaluate their effectiveness.
If the obstruction was not dislodged, administer additional chest thrusts (up to five). If the obstruction is not expelled, call for help again. Then repeat the procedures for initiating resuscitation, perform a finger sweep, and administer chest thrusts again. Continue until the object is expelled and the casualty's airway is open (chest rises during ventilations).
6-10. CONTINUE MOUTH-TO-MOUTH RESUSCITATION
Open the casualty's airway.
Take a breath.
Close the casualty's nostrils.
Seal your mouth over the casualty's mouth.
| CAUTION: If the casualty has face injuries that prevent you from administering mouth-to-mouth resuscitation, close his mouth, seal your mouth over his nose, and administer mouth-to-nose resuscitation. |
Blow the breath into the casualty's lungs. Observe the rising of the casualty's chest to ensure that the ventilation is effective.
Break your seal over the casualty's mouth and release his nose. Observe the casualty's chest fall and listen for exhalation.
| CAUTION: If the chest does not rise and fall, reposition his airway (tilt head back more or lift jaw more) and try again until the chest rises and falls. |
After about one minute (12 ventilations), stop ventilating the casualty and check the casualty's carotid pulse. Observe the casualty's chest for spontaneous breathing (breathing on his own without your help) as you feel for the pulse. The procedure should take 3 to 5 seconds.
Evaluate the situation and determine needed action.
If the casualty has no pulse and you are not qualified to administer CPR, seek medical aid for the casualty. If you are qualified to administer CPR, administer CPR and send someone to seek medical help.
If the casualty has a pulse and is breathing on his own, check for other injuries while continuing to monitor the casualty's breathing and pulse.
If the casualty has a pulse but is not breathing on his own, continue to administer mouth-to-mouth (or mouth-to-nose) resuscitation at the rate 10 to 12 ventilations per minute. Check the casualty's pulse after every 12 ventilations to ensure that his heart is still beating. When checking the casualty's pulse, also observe the casualty's chest to see if he is breathing on his own. Continue administering rescue breathing until spontaneous breathing occurs, you are relieved, you must seek medical help, or you are too exhausted to continue.