The Health bulletin [serial] - University of North Carolina at Chapel Hill

May, 1951 The Health Bulletin 13water. Heart attacks sometime resultfrom such sudden changes, which puttoo great a strain of adjustment on thecirculatory system.9. Children's skins are more tenderthan those of adults. Naps and planneddiversions in the shade or indoors areexcellent for youngsters who tend toplay too long in the hot sun.* * * *FIND 'TUSH-PULL"TECHNIQUE MOST EFFECTIVEIN RESUSCITATIONAn artificial respiration techniqueusing a "push and pull" maneuver isthe most effective of the manual methods,according to a report to the Cotmcilon Physical Medicine and Rehabilitationof the American Medical Association.The report also pointed outcertain advantages of mechanical resuscitatorsbut added that mechanicaldevices should be considered as adjunctsto and not substitutes for manualmethods.Drs. Archer S. Gordon, David C.Painer and A. C. Ivy of the Universityof Illinois College of Medicine, Chicago,made a study of various methods ofartificial respiration, both manual andmechanical. The study made by theChicago doctors was to determine themost effective methods of artificial respiration,a procediure which saves manylives.For their study they used 109 personswho had died less than a hour beforethe tests were performed, and nine livesubjects who were taught to "voluntarilysuspend their respiration."For most of the tests, the doctorsused a recently deceased person because,they said, such a subject is morecomparable to a person requiring artificialrespiration, except perhaps thedeeply anesthetized person where thereIs a temporary cessation of breathing.The effectiveness of artificial respirationdepends on several things but thisstudy was concerned mainly with theamount of air that could be broughtInto the lungs by various manvial andmechanical means.The doctors measured the minutevolume of air exchange with manualmethods by having the body inspireand exspire into a carefully balancedgraphically recording instrument calleda spirometer.With the mechanical methods, theyused a very sensitive and accurate flowmeter to record the volume of air exchange.A record could be made of theamoimt of air exchanged in the lungswith each respiratory movement.According to the report a comparisonof the findings shows that the resultsof the living subjects and recently deceasedones were "essentially in agreement"except that the volimie of airexchange in the living men was fourtimes greater. The doctors explained:"Either the volunteers unconsciouslyaided the artificial maneuvers or thereis less resistence in the conscious personto respiratory exchange. We areinclined to place much more weight onthe results from the corpses and toconsider them applicable in resuscitation(restoration of consciousness) ofnear-dead asphyctic (suffocated) subjects."The report continued:"Our results reaflBrm the fact thatno one method of artificial respirationcan be offered as completely satisfactory.However, there can be no doubtregarding the observation that thosemanual methods which utilize both a'push and pull' maneuver are superior."The mechanical resuscitators employedin this study are not more effectivethan a properly porformed 'pushand pull' manual method. . . . Exceptfor the armamentarium (equipment) ofthe anesthetist and of the fire or policeemergency crew, all mechanical devicesmust always be considered as adjunctsto and not substitutes for manualmethods."The doctors, however, pointed outseveral advantages to a mechanical resuscitator.Some of the advantages are:less skill is required; it is not fatiguing;it can deliver pure oxygen; It can beused where physical manipulation ofthe body is impossible or would beharmful as during major surgical procedures,in accidents with extensive