Mouth-to-mouth resuscitation
Mouth-to-mouth resuscitation | |
---|---|
![]() Mouth-to-mouth insufflation | |
ICD-9-CM | 93.93 |
MeSH | D012121 |
Mouth-to-mouth resuscitation, a form of
Pulmonary ventilation (and hence external respiration) is achieved through manual insufflation of the lungs either by the rescuer blowing into the patient's lungs, or by using a mechanical device to do so. This method of insufflation has been proved more effective than methods which involve mechanical manipulation of the patient's chest or arms, such as the Silvester method.[4] It is also known as expired air resuscitation (EAR), expired air ventilation (EAV), rescue breathing, or colloquially the kiss of life. It was introduced as a life-saving measure in 1950.[5]
Mouth-to-mouth resuscitation is a part of most protocols for performing cardiopulmonary resuscitation (CPR)[6][7] making it an essential skill for first aid. In some situations, mouth-to-mouth resuscitation is also performed separately, for instance in near-drowning and opiate overdoses. The performance of mouth-to-mouth resuscitation on its own is now limited in most protocols to health professionals, whereas lay first-aiders are advised to undertake full CPR in any case where the patient is not breathing sufficiently.
History
In 1773, English physician
Gradually, branches of the Royal Humane Society were set up in other parts of the country, mainly in ports and coastal towns where the risk of drowning was high and by the end of the 19th century the society had upwards of 280 depots throughout the UK, supplied with life-saving apparatus. The earliest of these depots was the Receiving House in
The society distributed money-rewards, medals, clasps and testimonials, to those who saved or attempted to save drowning people. It further recognized "all cases of exceptional bravery in rescuing or attempting to rescue persons from asphyxia in mines, wells, blasting furnaces, or in sewers where foul gas may endanger life."[8]
Insufflations
![](http://upload.wikimedia.org/wikipedia/commons/thumb/e/e8/CPR-oxygen-defibrillator.jpg/220px-CPR-oxygen-defibrillator.jpg)
Insufflation, also known as 'rescue breaths' or 'ventilations', is the act of mechanically forcing air into a patient's respiratory system. This can be achieved via a number of methods, which will depend on the situation and equipment available. All methods require good airway management to perform, which ensures that the method is effective. These methods include:[citation needed]
- Mouth-to-mouth - This involves the rescuer making a seal between his or her mouth and the patient's mouth and 'blowing', to pass air into the patient's body
- Mouth-to-nose - In some instances, the rescuer may need or wish to form a seal with the patient's nose. Typical reasons for this include maxillofacialinjuries, performing the procedure in water or the remains of vomit in the mouth
- Mouth-to-face - Used on both animal muzzles and infants under 2, as this forms the most effective seal on both the mouth and nostrils
- Mouth-to-mask – Most organisations recommend the use of some sort of barrier between rescuer and patient to reduce cross infection risk. One popular type is the 'pocket mask'. This may be able to provide higher tidal volumes than a Bag Valve Mask.[9]
Adjuncts to insufflation
![](http://upload.wikimedia.org/wikipedia/commons/thumb/d/d8/Beatmungsmaske_von_Laerdal.jpg/220px-Beatmungsmaske_von_Laerdal.jpg)
Most training organisations recommend that in any of the methods involving mouth-to-patient, that a protective barrier is used, to minimise the possibility of cross infection (in either direction).[10]
Barriers available include pocket masks and keyring-sized face shields. These barriers are an example of
These barriers should provide a one-way filter valve which lets the air from the rescuer deliver to the patient while any substances from the patient (e.g. vomit, blood) cannot reach the rescuer. Many adjuncts are single use, though if they are multi use, after use of the adjunct, the mask must be cleaned and autoclaved and the filter replaced. It is very important for the mask to be replaced or cleaned because it can act as a transporter of various diseases.
The CPR mask is the preferred method of ventilating a patient when only one rescuer is available. Many feature 18 mm (0.71 in) inlets to support supplemental oxygen, which increases the oxygen being delivered from the approximate 17% available in the expired air of the rescuer to around 40-50%.[12]
Efficiency of mouth-to-patient insufflation
Normal atmospheric air contains approximately 21% oxygen when inhaled. After
This means that there is more than enough residual oxygen to be used in the lungs of the patient, which then enters the blood.
Oxygen
The efficiency of artificial respiration can be greatly increased by the simultaneous use of oxygen therapy. The amount of oxygen available to the patient in mouth-to-mouth is around 16%. If this is done through a pocket mask with an oxygen flow, this increases to 40% oxygen. If either a bag valve mask or a mechanical ventilator is used with an oxygen supply, this rises to 99% oxygen. The greater the oxygen concentration, the more efficient the gaseous exchange will be in the lungs.[14]
See also
- Mechanical ventilation - using mechanical devices to assist or replace spontaneous breathing
- Medical emergency
References
- ^ "Definition of mouth-to-mouth resuscitation". Merriam-Webster Dictionary. Retrieved 4 February 2021.
- ^ Tortora, Gerard J; Derrickson, Bryan (2006). Principles of Anatomy and Physiology. John Wiley & Sons Inc.
- ^ "Artificial Respiration". Encyclopædia Britannica. Archived from the original on 14 June 2007. Retrieved 2007-06-15.
- ^ "Artificial Respiration". Microsoft Encarta Online Encyclopedia 2007. Archived from the original on 2004-01-04. Retrieved 2007-06-15.
- ^ Stathis Avramidis, Facts, Legends and Myths on the Evolution of Resuscitation, page 27
- ^ "Decisions about cardiopulmonary resuscitation model information leaflet". British Medical Association. July 2002. Archived from the original on 2007-07-05. Retrieved 2007-06-15.
- .
- ^ a b public domain: Chisholm, Hugh, ed. (1911). "Humane Society, Royal". Encyclopædia Britannica (11th ed.). Cambridge University Press. One or more of the preceding sentences incorporates text from a publication now in the
- ^ Dworkin, Gerald M (Winter 1987). "Mouth-to-Mask rescue breathing and comparisons of personal resuscitation masks". Rescue Squad Quarterly. Archived from the original on 2007-06-02. Retrieved 2007-06-15.
- ^ "Emergency Cardiovascular Care Revisions for the professional rescuer" (DOC). American Red Cross. Retrieved 2007-06-15.
- .
- PMID 9133531.
- ^ "Physical Intervention: Life Support (Rescue Breathing)". Archived from the original on 25 January 2006. Retrieved December 29, 2005.
- PMID 25063240.
External links
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