b. Artificial Respiration, Mouth-to-Mouth Method

instructional guide.

One-person CPR will be the procedure described. In this procedure, the person performing

it will provide both artificial breathing and blood circulation. When two persons are available,

each person can take the responsibility for one of these functions and can switch from time to

time to relieve fatigue.

a.



Initial Steps

1. Check for breathing. Do this by placing your hand under the victim’s neck and the

other on the forehead. Lift with the hand under the neck and tilt the head back. While

doing this, place your ear near the victim’s mouth and look toward the chest. If the

victim is breathing, you should be able to feel air on your skin as it is being exhaled,

you should be able to hear the victim breathe, and you should be able to see the chest

rise and fall. Do this for at least 5 seconds.

2. If the victim is not breathing, while holding the victim as in step one and pinching the

nostrils closed, open your mouth widely, place it over the victim’s mouth, and give

two quick full breaths into the victim’s mouth.

3. After step 2, repeat step 1 to see if breathing has started. If not, proceed to step 4.

4. Check the victim’s pulse with the hand that had been under the victim’s neck. Keep

the head tilted back with the other hand on the forehead. Check the pulse by sliding

the tips of the fingers into the groove on the victim’s neck to the side of the Adam’s

apple nearest you. Again, check for at least 5 seconds.



b.



Formal CPR Procedures

The victim must be on a firm surface. Otherwise, when pressure is applied to the chest, the

heart will not be compressed against the backbone as the backbone is pressed into a yielding

soft surface. The head of the victim should not be higher than the heart, in order for blood to

flow to the brain, as is needed to avoid brain damage. Although the brain averages about 2%

of your body weight, it requires 20% of the oxygen you breathe, as well as at least 40 mgm per

cent of blood dextrose. Any concentration less will result in unconsciousness and

progressive brain damage. Preferably, the feet and legs should be adjusted to be higher than

the heart to facilitate blood flowing back to the heart, but this has a lower priority than

commencing CPR procedures.

1. Kneel beside the victim, at breast height. Rest on your knees, not your heels.

2. Locate the victim;s breastbone. Place the heel of one of your hands on the breastbone

so that the lower edge of the hand is about two finger-widths up from the bottom tip

of the breastbone. Put your other hand on top of the first hand. Lift your fingers or

otherwise keep from pressing with them. Improper placement of the hands can cause

damage during the compression cycle.

3. Place your shoulders directly over the breastbone. Keep your arms straight.

4. To initiate the compression cycle, push straight down, pivoting at the hips.

5. Push firmly and steadily down until the chest has been compressed about 4 to 5 centimeters. Then smoothly relax the pressure until the chest rebounds and is no longer

compressed, then start the compression cycle again. The compression-relaxation cycle

should be a smooth, continuous process.

6. Continue the chest compression procedure for 15 cycles at the rate of 80 per minute.

This should take between 11 and 12 seconds. Then quickly place your mouth over the

mouth of the victim and give two quick full breaths. Then return to compressing the

chest for another 15 cycles. Be sure to locate your hands properly and compress the

chest as in steps 4 and 5.

7. Continue step 6, alternately compressing the chest and providing artificial respiration.

8. Quickly check for a pulse after 1 minute and then every few minutes thereafter. Watch

for any signs of recovery.

9. If a pulse is found, then check for breathing. If necessary give artificial respiration

only, but check frequently to be sure that the heart is still beating.

10. Continue with whatever portion of the procedure is neces sary until the victim is

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functioning on his own, emergency medical personnel arrive, or it is obvio u s t h a t

efforts will not succeed. A half hour is not unreasonable as a period of actively using

CPR.

Thus, to repeat once more, the techniques for artificial respiration and CPR are not difficult

but require training and practice. Familiarity with these techniques is likely to be of value at

any time.

c. First Aid

i. Severe Bleeding

A person may bleed to death in a very short time from severe or heavy bleeding.

Whenever this problem is involved in an accident, it is extremely important to stop it as soon

as possible. Arterial bleeding may be frightening, but the muscular artery wall usually

contracts to diminish or stop the flow. Venous bleeding is more insidious as it flows steadily

The relative absence of muscle in the vein wall does not help to stem the flow. Try to be calm

and try to keep the victim calm as well. Bleeding may cause the victim to panic or become

overwrought.

1. The most effective treatment is pressure applied directly to the wound over which a

sterile dressing has been placed (Figure 2.8).

2. If possible, wash your hands thoroughly both before and after treating a bleeding

wound. It would be desirable to wear a latex glove. Apply a sterile dressing if immediately

available (a handkerchief for some other cloth to the wound, if not). Then plac e the palm of

the hand directly over the wound and apply pressure. If nothing else is available use your

bare hand, but try to find something to use as a dressing as soon as possible.

3. A dressing will help staunch the flow of blood by absorbing the blood and permitting

it to clot. Do not remove a dressing if it becomes blood soaked, but leave it in place

and apply an additional one on top of the first in order not to disturb any clotting that

may have started. Keep pressure on with the hand until you have time to place a

pressure bandage over the dressing to keep it in place.

4. Unless there are other injuries, such as a fracture or the possibility of a spinal injury,

cases for which the victim should be disturbed as little as possible, the wound should

be elevated so that the injured part of the body is higher than the heart. This will

reduce the blood pressure to the area of the wound.



Figure 2.8



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Apply pressure directly to a wound to control bleeding.



Figure 2.9 Pressure points to control bleeding at the extremities.



5. If bleeding persists and cannot be stopped by direct pressure, putting pressure on the

arteries supplying the blood to the area may be needed. In this technique, pressure is

applied to the arteries by compressing the artery between the wound and the heart

against a bone at the points indicated in Figure 2.9. Since this stops all circulation to

points beyond the point of compression, it can cause additional injuries if continued

too long. For this reason, it should be discontinued as quickly as possible and the use

of direct pressure and elevation to control the bleeding should be resumed, unless this

is the only effective technique.

6. A s a last resort, since it stops the flow of blood to the limb beyond the point of application, a tourniquet, which should be at least two inches wide, can be applied. An

example where the use of a tourniquet might be indicated is to stop bleeding from a

severed limb.

ii. Shock

Shock may accompany almost any type of severe injury, exposure to toxic chemicals, a

heart attack, loss of blood, burns, or any other severe trauma. It can be recognized from a

number of characteristic symptoms: skin cold to the touch (possibly clammy and bluish or

p ale), weakness, a rapid weak pulse, rapid irregular breath, restlessness, and exhibition o f

unusual signs of thirst. A s the condition worsens, the victim will become unresponsive and

the eyes may become widely dilated. The treatment for shock is:

1. The victim should be lying down, although the type of injuries may determine what

precisely is the best position. If uncertain, allow the victim to lie flat on his back.

Unless it is painful or it makes it harder for the victim to breathe, it will help if the feet

are raised 20 to 30 centimeters high.

2. Use blankets to keep the victim from losing body heat, but do not try to add heat.

3. If the victim is conscious and is not vomiting, nor appears likely to do so, then about

h alf a glass of liquid every 15 minutes or so will be helpful. However, do not give

fluids if the victim is unconscious or nauseated.

iii. Poisoning by Unknown Chemicals

The rationale in limiting this section to unknown chemicals is that first aid information is

readily found when the chemical is known, either immediately on the label of the container or

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in the MSDS for the chemical (note that current law requires chemical producers to provide

MSDSs to those who purchase chemicals from them). An MSDS file should be maintained in

every laboratory.

Even if the chemical causing the injury is not known and the victim is unconscious so that

no direct information is available, an examination of the circumstances of the accident and an

examination of the victim’s lips, skin, mouth, and tongue could provide helpful information on

whether the victim swallowed a poisonous substance or inhaled a toxic vapor, or whether the

injury was due to absorption through the skin. If the abdomen is distended and pressing on it

causes pain, the likelihood is that a corrosive or caustic substance has been ingested. Various

other symptoms such as nausea, vomiting, or dizziness can occur if the person has ingested

or inhaled a toxic substance. If there are blisters or discoloration of the skin, then external

exposure is likely. Any information on the nature of the harmful material will be helpful to the

emergency personnel or physician who will treat the victim.

iv. Poisoning by Inhalation

1. When poisoning by inhalation is suspected, evacuate the victim to a safe area as soon

as possible. If there are fumes still suspected to be present, a rescuer should wear a

self-contained respirator. Do not take a chance which might result in a second

victim.

2. Check for unusual breath odors if the victim is breathing.

3. Loosen tight clothing around the victim’s neck and waist.

4. Maintain an open airway.

5. If the victim is not breathing, perform artificial respiration using the manual method. It is

dangerous to the person providing aid to give mouth-to-mouth artificial respiration if

the toxic material is not known.

v. Poisoning by Ingestion

1. Examine the lips and mouth to ascertain if the tissues are damaged as a possible

indicator that the poison was ingested, although the absence of such signs is not

conclusive. Check the mouth and remove any dentures.

2. If the victim is not breathing, perform manual artificial respiration.

3. If the victim becomes conscious, try to get the victim to vomit, unless it is possible

tha t the poisoning is due to strong acids, caustics, petroleum products, or hydrogen

peroxide, in which case additional injuries would be caused to the upper throat

esophagus, and larynx. Vomiting may be induced by tickling the back of the throat.

Lower the head so that the vomit will not reenter the mouth and throat. Dilute the

poison in the stomach with water or milk.

4. If the victim has already vomited, collect a sample of the vomit, if possible, for

analysis.

5. If convulsions occur, do not restrain the victim, but remove objects with which he

might injure himself or orient the victim to avoid his striking fixed, heavy objects.

6. Watch for an obstruction in the victim’s mouth. Remove if possible, but do not force

fingers or a hard object in between the victim’s teeth. If a soft pad can be inserted

between the victim’s teeth, it will protect the tongue from being bitten. A badly

bleeding tongue immensely complicates the patient’s problems.

7. Loosen tight clothing, such as a collar, tie, belt, or waistband.

8. If the convulsions cease, turn the victim on his side or face down so that any fluids in

the mouth will drain.

9. Treat for shock if the symptoms for shock are noted.

vi. Poisoning by Contact

1. If the chemical got into the victim’s eyes, check for and remove any contact lenses.

Take the victim immediately to an eyewash station (if one is not available, to a shower

or even a sink) and wash the eyes, making sure that the eyelids are held widely open.

Wash for at least 15 minutes. If the chemical is caustic rather than acidic, the victim



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