Deputy Director, University of Missouri–Kansas City School of Medicine
In the first few minutes after cardiac arrest acne vulgaris icd 10 purchase generic cleocin pills, a victim may be barely breathing skin care heaven coupon buy cleocin 150mg visa, or taking infrequent acne kit generic 150 mg cleocin with visa, noisy, gasps. Look, listen, and feel for no more than 10 sec to determine if the victim is breathing normally. Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum (breastbone). Repeat at a rate of about 100 times a minute (a little less than 2 compressions a second). Then return your hands without delay to the correct position on the sternum and give a further 30 chest compressions. Initial rescue breaths During the first few minutes after non-asphyxial cardiac arrest the blood oxygen content remains high. It is also recognised that rescuers are frequently unwilling to carry out mouth-to-mouth ventilation for a variety of reasons, including fear of infection and distaste for the procedure. Jaw thrust The jaw thrust technique is not recommended for lay rescuers because it is difficult to learn and perform. Therefore, the lay rescuer should open the airway using a head-tilt-chin-lift manoeuvre. It should be emphasised during training that agonal gasps occur commonly in the first few minutes after sudden cardiac arrest. Mouth-to-nose ventilation Mouth-to-nose ventilation is an effective alternative to mouth-to-mouth ventilation. It may be considered if the victim’s mouth is seriously injured or cannot be opened, the rescuer is assisting a victim in the water, or a mouth-to-mouth seal is difficult to achieve. Bag-mask ventilation Considerable practice and skill are required to use a bag and mask for ventilation. The lone rescuer has to be able to open the airway with a jaw thrust whilst simultaneously holding the mask to the victim’s face. It is a technique that is appropriate only for lay rescuers who work in highly specialised areas, such as where there is a risk of cyanide poisoning or exposure to other toxic agents. There are other specific circumstances in which non-healthcare providers receive extended training in first aid which could include training, and retraining, in the use of bag-mask ventilation. The same strict training that applies to healthcare professionals should be followed and the two-person technique is preferable. Chest compression In most circumstances it will be possible to identify the correct hand position for chest compression without removing the victim’s clothes. In Guidelines 2000 a method was recommended for finding the correct hand position by placing one finger on the lower end of the sternum and sliding the other hand down to it. It has been shown that the same hand position can be found more quickly if rescuers are taught to ‘place the heel of your hand in the centre of the chest with the other hand on top’, provided the teaching includes a demonstration of placing the hands in the middle of the lower half of the 6 sternum. Whilst performing chest compression: a) Each time compressions are resumed, the rescuer should place his hands without delay ‘in the centre of the chest’. Recovery position There are several variations of the recovery position, each with its own advantages. The position should be stable, near a true lateral position with the head dependent, and with no pressure on the chest to impair breathing. If the victim has to be kept in the recovery position for more than 30 min turn him to the opposite side to relieve the pressure on the lower arm. The signs and symptoms enabling differentiation between mild and severe airway obstruction are summarised in the table below.
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