It is sometimes necessary to use the index finger topush a foreign body against the opposite side of thethroat to dislodge and remove it. Be careful not toforce the object deeper into the airway. If the foreignbody comes within reach, grasp and remove it.BREATHINGThe second aspect of basic life support is to restorebreathing in cases of respiratory arrest. Failure of thebreathing mechanism may be caused by variousfactors. They include complete airway obstruction,insufficient oxygen in the air, inability of the blood tocarry oxygen (e.g., carbon monoxide poisoning),paralysis of the breathing center of the brain, andexternal compression of the body. Respiratory arrest isusually but not always immediately accompanied bycardiac arrest. Periodic checks of the carotid pulsemust be made, and you must be prepared to startcardiopulmonary resuscitation (CPR).Signs of respiratory arrest are an absence ofrespiratory effort, a lack of detectable air movementthrough the nose or mouth, unconsciousness, and acyanotic discoloration of the lips and nail beds.Determining BreathlessnessTo assess the presence or absence of breathing(fig. 4-9), you should use the following procedures:Step 1¾Place your ear over the patient’s mouthand nose, while maintaining an open airway.Step 2¾While observing the patient’s chest,look for the chest to rise and fall,listen for air escaping during exhalation, andfeel for the flow of air.Recovery PositionIf the patient is unresponsive, has no evidence oftrauma, and is obviously breathing adequately, placethe patient in the “recovery position.” See figure 4-10.In the recovery position, the airway is more likely toremain open, and an unrecognized airway obstructioncaused by the tongue is less likely to occur. It isimportant to continue close observation of the patientwho has been placed in the recovery position until hebecomes responsive.To place a patient in the recovery position, roll thepatient onto his side so that the head, shoulders, andtorso move simultaneously without twisting. If thepatient has sustained trauma or trauma is suspected,the patient should NOT be moved.Artificial VentilationIf a patient is in respiratory arrest, artificialventilations must be started immediately. Any delaycould result in brain damage or death. The purpose ofartificial ventilation is to provide air exchange untilnatural breathing is re-established. Artificialventilation should be given only when naturalbreathing has been suspended; it must not be given toa person who is breathing naturally. Do not assumethat a person’s breathing has stopped merely becausethe person is unconscious or has been rescued fromwater, from poisonous gas, or from contact with anelectric wire.Techniques of artificial ventilation includemouth-to-mouth, mouth-to-nose, mouth-to-stoma,and mouth-to-mask. These techniques as they applyto adult patients are discussed in the followingsections.MOUTH-TO-MOUTH.—Artificial ventilationwith the mouth-to-mouth technique is a quick,effective way to provide oxygen to the patient. Theexhaled air contains enough oxygen to supply thepatient’s needs.To perform mouth-to-mouth ventilation, theairway must be open. To open the airway, perform thehead tilt-chin lift or jaw-thrust maneuver. If there is nospontaneous breathing, start artificial ventilation bypinching the nose closed with your thumb and index4-16Figure 4-9.—Determining breathlessness.
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