It is sometimes necessary to use the index finger to
push a foreign body against the opposite side of the
throat to dislodge and remove it. Be careful not to
force the object deeper into the airway. If the foreign
body comes within reach, grasp and remove it.
The second aspect of basic life support is to restore
breathing in cases of respiratory arrest. Failure of the
breathing mechanism may be caused by various
factors. They include complete airway obstruction,
insufficient oxygen in the air, inability of the blood to
carry oxygen (e.g., carbon monoxide poisoning),
paralysis of the breathing center of the brain, and
external compression of the body. Respiratory arrest is
usually but not always immediately accompanied by
cardiac arrest. Periodic checks of the carotid pulse
must be made, and you must be prepared to start
cardiopulmonary resuscitation (CPR).
Signs of respiratory arrest are an absence of
respiratory effort, a lack of detectable air movement
through the nose or mouth, unconsciousness, and a
cyanotic discoloration of the lips and nail beds.
To assess the presence or absence of breathing
(fig. 4-9), you should use the following procedures:
Step 1¾Place your ear over the patients mouth
and nose, while maintaining an open airway.
Step 2¾While observing the patients chest,
look for the chest to rise and fall,
listen for air escaping during exhalation, and
feel for the flow of air.
If the patient is unresponsive, has no evidence of
trauma, and is obviously breathing adequately, place
the patient in the recovery position. See figure 4-10.
In the recovery position, the airway is more likely to
remain open, and an unrecognized airway obstruction
caused by the tongue is less likely to occur. It is
important to continue close observation of the patient
who has been placed in the recovery position until he
To place a patient in the recovery position, roll the
patient onto his side so that the head, shoulders, and
torso move simultaneously without twisting. If the
patient has sustained trauma or trauma is suspected,
the patient should NOT be moved.
If a patient is in respiratory arrest, artificial
ventilations must be started immediately. Any delay
could result in brain damage or death. The purpose of
artificial ventilation is to provide air exchange until
natural breathing is re-established.
ventilation should be given only when natural
breathing has been suspended; it must not be given to
a person who is breathing naturally. Do not assume
that a persons breathing has stopped merely because
the person is unconscious or has been rescued from
water, from poisonous gas, or from contact with an
Techniques of artificial ventilation include
mouth-to-mouth, mouth-to-nose, mouth-to-stoma,
and mouth-to-mask. These techniques as they apply
to adult patients are discussed in the following
with the mouth-to-mouth technique is a quick,
effective way to provide oxygen to the patient. The
exhaled air contains enough oxygen to supply the
To perform mouth-to-mouth ventilation, the
airway must be open. To open the airway, perform the
head tilt-chin lift or jaw-thrust maneuver. If there is no
spontaneous breathing, start artificial ventilation by
pinching the nose closed with your thumb and index
Figure 4-9.Determining breathlessness.