Artificial respiration

Basic methods and first aid

In situations where medical equipment is unavailable, classical methods of artificial ventilation are used. The main techniques include mouth-to-mouth or mouth-to-nose air insufflation. If assistance is provided to a small child, the rescuer can use the mouth-to-mouth and nose method simultaneously.

Special attention must be paid to the algorithm of actions in case of electric shock. It is necessary to act in strict sequence:

1. Ensuring safety. The primary task is to immediately release the victim from contact with the current source.
2. Ensuring rest. If the current exposure did not cause fatal injuries, the person must be placed strictly horizontally and provided with complete physical rest.
3. Restoration of breathing. If the absence of breathing is established, APV must be started immediately using the mouth-to-mouth method.
4. Circulatory support. In the event of cardiac arrest, ventilation must necessarily be supplemented with chest compressions.

Two-rescuer resuscitation technique

Cardiopulmonary resuscitation requires significant physical effort, so it is most effective when performed in pairs. The roles between participants are strictly distributed:

• The first rescuer takes over chest compressions.
• The second rescuer performs artificial pulmonary ventilation.

A key rule is to maintain the proportion: for every 1 breath of air, there must be exactly 5 sternal compressions (a 1:5 ratio).

During the process, the participants must monitor the effectiveness of each other's actions. The rescuer performing APV assesses the correctness of compressions by the presence of a pulse in the carotid artery during compressions. In turn, the rescuer performing compressions continuously monitors the patient's pupil response. Since the procedure is extremely energy-intensive, rescuers must periodically rotate (switch places) to maintain adequate effort.

Use of an S-shaped airway

To prevent airway obstruction and reliably keep the tongue base from falling back, a special S-shaped airway tube is used.

The insertion technique includes the following steps:

1. The airway is inserted into the oral cavity with the curved end facing upward, sliding gently along the surface of the hard palate.
2. Upon reaching the level of the tongue base, the tube must be rotated 180 degrees around its axis.
3. After correct positioning, the special flange of the airway should securely cover the victim's mouth.

When performing artificial ventilation through an inserted tube, the patient's nose is tightly pinched with fingers, and the rescuer delivers breaths directly into the open lumen of the airway.

Using a face mask with a bag-valve-mask (Ambu bag)

Mechanical respiratory support is often provided using an Ambu bag. For a successful procedure, the victim's head must be tilted back, and the mask must create an airtight seal over the mouth and nose.

Proper mask fixation requires a specific finger placement for the rescuer:

• The thumb (digit I) firmly holds the narrow nasal part of the mask.
• The index finger (digit II) securely fixes its lower half.
• The remaining fingers (digits III, IV, and V) are positioned underneath and actively lift the mandible upward.

The device's mechanism is based on manual air insufflation. Rhythmic compression of the elastic bag provides active inspiration. Exhalation occurs passively: exhaled air is vented into the surrounding atmosphere through a special valve. In clinical practice, the bag's design allows for easy connection to an additional oxygen source.

Class and exam questions

What else to study on this topic

• Anatomical prerequisites for tongue base retraction and mechanisms of airway obstruction.
• Pathophysiology of respiratory arrest development in electrical injury.
• Features of artificial respiration in infants (the «mouth-to-mouth and nose» method).
• Differences between direct and indirect cardiac massage during clinical death.
• Design of breathing valves and rules for connecting oxygen to an Ambu bag.

Other topics from the section "CHAPTER 4. EMERGENCY CARE IN CRITICAL CONDITIONS"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.