First Responder EMS Curriculum for Training Centers in Eurasia

help. Monitor the victim, particularly for impairment of blood flow in the lowermost arm. If thevictim remains in the recovery position for > 30 minutes, turn the victim to the opposite side.Although no single specific recovery position can be recommended, the one illustrated is suitablefor training purposes.Provide Rescue BreathingWhen providing rescue breathing, you must inflate the victim's lungs adequately with eachbreath.Mouth-to-Mouth BreathingMouth-to-mouth rescue breathing is a quick, effective way to provide oxygen and ventilation tothe victim. Your exhaled breath contains enough oxygen to supply the victim's needs. To providerescue breaths, hold the victim's airway open, pinch the nose, and make a seal with your mouthover the victim's mouth. Rest the palm of one hand on the victim's forehead and pinch thevictim's nose closed with your thumb and index finger. Pinching the nose will prevent air fromescaping through the victim's nose. Take a deep breath and seal your lips around the victim'smouth, creating an airtight seal. Give slow breaths, delivering each breath over 2 seconds,making sure the victim's chest rises with each breath. Be prepared to deliver approximately 10 to12 breaths per minute (1 breath every 4 to 5 seconds) if rescue breathing alone is required.Figure 11. Mouth-to-mouth rescuebreathing.The number of breaths delivered to initiate rescue breathing/ventilation varies throughout theworld, and there is no data to suggest superiority of one number over the other. In the UnitedStates, 2 breaths are provided. In Europe, Australia, and New Zealand, 5 breaths are provided toinitiate resuscitation. Each approach has its advantages. Delivery of fewer breaths will shortenthe time to assessment of circulation/pulse and attachment of an AED (and possibledefibrillation), but delivery of a greater number of breaths may help to correct hypoxia andhypercarbia. In the absence of data to support one number of breaths over another, it isappropriate to deliver 2 to 5 initial breaths, according to local custom.Gastric inflation frequently develops during mouth-to-mouth ventilation. Gastric inflation canproduce serious complications, such as regurgitation, aspiration, or pneumonia. It also increasesintragastric pressure, elevates the diaphragm, restricts lung movements, and decreases respiratorysystem compliance. Gastric inflation occurs when the pressure in the esophagus exceeds thelower esophageal sphincter opening pressure, causing the sphincter to open so that air deliveredduring rescue breaths enters the stomach instead of the lungs. During cardiac arrest, thelikelihood of gastric inflation increases because the lower esophageal sphincter relaxes. Factorsthat contribute to creation of a high esophageal pressure and gastric inflation during rescuebreathing include a short inspiratory time, a large tidal volume, and a high peak airway pressure.332 First Responder EMS Curriculum/AIHA, July 2002