Mouth-to-mask is a reliable form of ventilationsince it allows the rescuer to use two hands to create aseal. Follow the steps below to perform themouth-to-mask technique.Step 1—Place the mask around the patient’smouth and nose, using the bridge of the nose as a guidefor correct position. Proper positioning of the mask iscritical because gaps between the mask and the facewill result in air leakage.Step 2––Seal the mask by placing the heel andthumb of each hand along the border of the mask andcompressing firmly to provide a tight seal around themargin of the mask.Step 3––Place your remaining fingers along thebony margin of the jaw and lift the jaw whileperforming a head tilt.Step 4––Give breaths in the same sequence and atthe same rate as in mouth-to-mouth resuscitation;observe the chest for expansion.Gastric DistentionSometimes during artificial ventilation, air is forcedinto the stomach instead of into the lungs. The stomachbecomes distended (bulges), indicating that the airwayis blocked or partially blocked, or that ventilations aretoo forceful. This problem is more common in childrenbut can occur with adults as well. A slight bulge is oflittle worry, but a major distention can cause two seriousproblems. First, it reduces lung volume: the distendedstomach forces the diaphragm up. Second, there is astrong possibility of vomiting.The best way to avoid gastric distention is toposition the head and neck properly and/or limit thevolume of ventilations delivered.NOTE: THE AMERICAN RED CROSS(ARC) STATES THAT NO ATTEMPTSHOULD BE MADE TO FORCE AIR FROMTHE STOMACH UNLESS SUCTIONEQUIP- MENT IS ON HAND FORIMMEDIATE USE.If suction equipment is ready and the patient has amarked distention, you can turn the patient on his sidefacing away from you. With the flat of your hand, applygentle pressure between the navel and the rib cage. Beprepared to use suction should vomiting occur.CIRCULATIONCardiac arrest is the complete stoppage of heartfunction. If the patient is to live, action must be takenimmediately to restore heart function. The symptomsof cardiac arrest include absence of carotid pulse, lackof heartbeat, dilated pupils, and absence of breathing.A rescuer knowing how to administercardiopulmonary resuscitation (CPR) greatlyincreases the chances of a victim’s survival. CPRconsists of external heart compression and artificialventilation. External heart compression is performedon the outside of the chest, and the lungs are ventilatedby the mouth-to-mouth, mouth-to-nose, mouth-to-stoma, or mouth-to-mask techniques. To be effective,CPR must be started within 4 minutes of the onset ofcardiac arrest. The victim should be supine on a firmsurface.CPR should not be attempted by a rescuer who hasnot been properly trained. If improperly done, CPRcan cause serious damage. It must never be practicedon a healthy individual. For training purposes, use atraining aid instead. To learn this technique, see yourmedical education department or an American HeartAssociation- or American Red Cross-certifiedHospital Corpsman, nurse, or physician.One-Rescuer CPRThe rescuer must not assume that a cardiac arresthas occurred solely because the victim is lying on thefloor and appears to be unconscious. First, try to rousethe victim by gently shaking the shoulders and tryingto obtain a response (e.g., loudly ask: “Are you OK?”).If there is no response, place the victim supine on afirm surface.Always assume neck injuries inunconscious patients. Kneel at a right angle to thevictim, and open the airway using the head tilt-chin liftor jaw-thrust methods described previously. Attemptto ventilate. If unsuccessful, reposition the head andagain attempt to ventilate. If still unsuccessful, deliverfive abdominal thrusts (Heimlich maneuver) or chestthrusts to open the airway. Repeat the thrust sequenceuntil the obstruction is removed.DETERMINING PULSELESSNESS.—Oncethe airway has been opened, check for the carotidpulse. The carotid artery is most easily found bylocating the larynx at the front of the neck and thensliding two fingers down the side of the neck towardyou (fig. 4-13). The carotid pulse is felt in the groovebetween the larynx and the sternocleidomastoid4-18
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