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Fig. 16. Artificial mouth-to-mouth respiration

For a "mouth-to-mouth" respiration one makes a deep inhalation, tightly envelops a victim's lips with his lips, using a handkerchief or a gauze as a pad and squeezing the victim's nose with fingers or a cheek, and performs an energetic exhalation. In mouth-to-nose respiration one closes a victim's mouth, and in a mouth-to-mouth and nose respiration (in children) a rescuer envelops both a child's mouth and nose simultaneously with his mouth. Effectiveness of APV is judged by the victim's chest excursion. Absence of signs of expiration (descent of the chest), a "gurgling" sound during inspiration and a gradual increase of the epigastrium in volume give evidence of pumping the air into the stomach that is very dangerous because of the development of regurgitation of gastric content and its getting into respiratory tracts with asphyxia and aspiration pneumonitis.

Victim's expiration is passive. In persons with a rigid chest the expiration is reinforced by pressing on the thorax on both sides or the upper third of the breast bone.

At first, 4-5 preliminary inflations of the lungs are made, then they are continued with a frequency of 12-15 times per minute in adults, 24 — in children of senior age and 30 — in newborns.

Typical errors made in carrying out of APV in the course of resuscitation (L.V. Usenko et al., 2001) are given below:

— a free patency of respiratory tracts is not provided;

— an air-tightness in inflation of air is not provided;

— underestimation (late beginning) or overestimation (beginning of CPCR with intubation) of APV significance;

— absence of control over the chest excursions;

— absence of control over an air penetration into the stomach;

— attempts of medicamentous stimulation of respiration.

C. CARDIAC MASSAGE

APV is combined with performing a closed-chest cardiac massage to supply oxygen to tissues, first of all, to the brain.

Technique of carrying out a closed-chest cardiac massage: A person rendering aid arranges himself on the left or on the right from the victim, places his thenar or hypothenar of the palm upon the lower third of the breast bone (for 2 transverse fingers above the manubrium sterni), a hand is located perpendicular to the breast bone, the 2-nd hand is laid from above at the angle of 90 degrees and rhythmical presses are made on the breast bone not at the expense of manual strength, but at the expense of body mass so that the excursion of the breast bone is 4-5 cm, in so doing the arms must not be bended in elbows. A method of "crossed fingers" is also applied in which the fingers of one hand are passed between the fingers of the other and envelop the palm (Fig. 17).

While pressing on the breast bone, heart cavities are squeezed between the bodies of vertebrae and the breast bone that contributes to an ejection of blood from the ventricles, as well as from the great vessels and the lungs as a result of elevated intrathoracic pressure. A blood return to the heart is passive.

In children a closed-chest cardiac massage is performed with one hand and in newborns — with the help of two fingers (Fig. 18).

Fig. 18. A closed-chest cardiac massage in a newborn: a) method of "two fingers"; b) method of "thumbs".

A frequency of massage movements in adults is 60-70, in children — 80-100 per minute.

If a resuscitation is carried out by one-person, then 4-5 preliminary inflations
of the lungs are performed in the beginning, and later — for every 15 massage
movements — 2 inspirations (Fig. 19).

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