First Responder EMS Curriculum for Training Centers in Eurasia

one-way valves are available for use during ventilation. It is recommended that FirstResponders always use these devices rather than the mouth-to-mouth technique. The useof a mouth-to-mask/barrier device does not replace training in mouth-to-mouthventilation. The decision to perform mouth-to-mouth ventilation is a personal choice.Whenever possible, First Responders should use a barrier device or mouth-to-masktechnique.Technique1. Keep the airway open by the head tilt-chin lift or jaw-thrust maneuver.2. Gently squeeze the patient's nostrils closed with the thumb and index finger of yourhand on the patient's forehead.3. When ventilating an infant, cover the infant’s mouth and nose.4. Take a deep breath and seal your lips to the patient's mouth, creating an airtightseal.5. Give one slow (1 ½ - 2 second) breath of sufficient volume to make the chest rise.Too great a volume of air and too fast an inspiratory time are likely to allow air toenter the stomach.6. Adequate ventilation is determined by:• Observing the chest rise and fall• Hearing and feeling the air escape during exhalation7. Continue at the proper rate.• 12 breaths per minute for adults• 20 breaths per minute for children and infants• 40 breaths per minute for newborns8. If the ventilation cannot be delivered, consider the possibility of an airwayobstruction.9. Foreign Body Airway Obstructions in the AdultAn obstruction of the airway by a foreign body may be the cause of cardiac arrest. If theairway becomes blocked as a result of choking on food, bleeding into the airway, orregurgitated stomach contents, the resulting lack of oxygen can lead to cardiac arrest.Conversely, an obstruction of the airway can also be the result of a cardiac arrest. Patientswith cardiac arrest frequently vomit, with resulting obstruction of the airway from stomachcontents. Dentures may become dislodged or the tongue may fall back in the throat in theunconscious patient, obstructing the airway.a. Types of Airway ObstructionsWhen a patient is suffering from a partial airway obstruction there may be good airexchange or poor air exchange. Patients with good air exchange remain responsive andmay be able to speak. They can often cough forcefully, but may be wheezing betweencoughs. Patients with poor air exchange often have a weak or ineffective cough. Theymay have a high-pitched noise on inhalation (stridor) and show increased respiratorydifficulty. They may also appear cyanotic (blue). In patients with complete airwayobstruction, no air can be exchanged. The patient will be unable to speak, breathe, orcough. The patient may clutch the neck with thumb and fingers — the universal distresssignal. Death will follow rapidly if prompt action is not taken.First Responder EMS Curriculum/AIHA, July 2002 69