Medical Combat Lifesaver L03 Mouth to Mouth Resuscitation

8/8/2019 Medical Combat Lifesaver L03 Mouth to Mouth Resuscitation

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Combat Life SaverCombat Life Saver

Compiled and edited by,2LT John C. Miller, PA-C

Lesson 3PERFORM MOUTH-TO-MOUTH

RESUSCITATION


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Lesson 3Lesson 3

PERFORM MOUTHPERFORM MOUTH -- TOTO -- MOUTHMOUTH

RESUSCITATIONRESUSCITATION

INTRODUCTION INTRODUCTION

Respiration must be restored to an unconsciousRespiration must be restored to an unconsciouscasualty who is not breathing. Speed is critical incasualty who is not breathing. Speed is critical in

restoring respiration. Checking and restoringrestoring respiration. Checking and restoringrespiration takes priority over any other injuries therespiration takes priority over any other injuries thecasualty may have suffered. The brain can be injuredcasualty may have suffered. The brain can be injuredif without oxygen for as little as four minutes.if without oxygen for as little as four minutes.

Do not attempt to perform mouthDo not attempt to perform mouth --toto --mouthmouthresuscitation if chemical agents are presentresuscitation if chemical agents are present ..


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TASKTASK

Restore respiration by opening the airway,Restore respiration by opening the airway,performing manual thrusts and finger sweeps toperforming manual thrusts and finger sweeps toremove airway obstructions, and administeringremove airway obstructions, and administeringmouthmouth --toto --mouth (or mouthmouth (or mouth --toto --nose) resuscitation.nose) resuscitation.

CONDITIONSCONDITIONS

Given a simulated nonGiven a simulated non --breathing casualty.breathing casualty. STANDARDSTANDARD

Score a GO on the performance checklist.Score a GO on the performance checklist.


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CHECK FOR RESPONSIVENESSCHECK FOR RESPONSIVENESS

Gently shake the person's shoulder and call out:Gently shake the person's shoulder and call out:

"Are you OK?""Are you OK?"

If the casualty does not respond, call for help andIf the casualty does not respond, call for help andbegin resuscitation procedures.begin resuscitation procedures.


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POSITION THE CASUALTY FORPOSITION THE CASUALTY FOR

MOUTHMOUTH --TOTO --MOUTH RESUSCITATIONMOUTH RESUSCITATION

Position the casualty on his back and on a flat, firmPosition the casualty on his back and on a flat, firmsurface. If the casualty is on his stomach, kneel at hissurface. If the casualty is on his stomach, kneel at hisside, grasp his clothing at his far shoulder and hip,side, grasp his clothing at his far shoulder and hip,pull gently, and roll his body toward you.pull gently, and roll his body toward you.

If a spinal injury is suspected, have a helper supportIf a spinal injury is suspected, have a helper supportthe casualty's head and neck as you gently turn thethe casualty's head and neck as you gently turn thecasualty's trunk and legs.casualty's trunk and legs.


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OPEN THE CASUALTY'S AIRWAYOPEN THE CASUALTY'S AIRWAY

The most common cause of airway blockage in anThe most common cause of airway blockage in anunconscious casualty is the casualty's tongue.unconscious casualty is the casualty's tongue.Moving the tongue away from the trachea andMoving the tongue away from the trachea and

performing a quick finger sweep may result in theperforming a quick finger sweep may result in thecasualty's resuming breathing on his own.casualty's resuming breathing on his own.

Note: Learning Event 6 has more on the finger sweepNote: Learning Event 6 has more on the finger sweep


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HeadHead --Tilt/ChinTilt/Chin --LiftLift -- Use the headUse the head --tilt/chintilt/chin --lift methodlift method

unless you suspect that the casualty has suffered aunless you suspect that the casualty has suffered afractured neck or a severe head injury.fractured neck or a severe head injury.

Kneel near the casualty's shoulders.Kneel near the casualty's shoulders. Place one of your hands on the casualty's foreheadPlace one of your hands on the casualty's forehead

and apply firm, backward pressure with your palm toand apply firm, backward pressure with your palm totilt the casualty's head back.tilt the casualty's head back.

Place the fingertipsPlace the fingertips ---- not your thumbnot your thumb ---- of your otherof your other

hand under the tip bony part of the casualty's lowerhand under the tip bony part of the casualty's lower jaw. The fingertips should not press deeply into the jaw. The fingertips should not press deeply into thesoft tissues under the chin since the pressure couldsoft tissues under the chin since the pressure couldmake breathing difficult.make breathing difficult.


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Lift the chin forward until the upper and lower teethLift the chin forward until the upper and lower teeth

are almost brought together. The mouth should notare almost brought together. The mouth should notbe closed.be closed. If needed, depress the casualty's lower lip slightlyIf needed, depress the casualty's lower lip slightly

with the thumb to keep his mouth open.with the thumb to keep his mouth open.


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Jaw ThrustJaw Thrust -- Use the jaw thrust if you suspect thatUse the jaw thrust if you suspect thatthe casualty has suffered a fractured neck or athe casualty has suffered a fractured neck or asevere head injury. The jaw thrust keeps movementsevere head injury. The jaw thrust keeps movementof the neck to a minimum.of the neck to a minimum.

Kneel behind the casualty's head and rest yourKneel behind the casualty's head and rest your

elbows on the surface on which the casualty is lying.elbows on the surface on which the casualty is lying. Place one hand on each side of the casualty's headPlace one hand on each side of the casualty's head

and grasp the angles of the lower jaw with yourand grasp the angles of the lower jaw with yourfingertips.fingertips.

Place your thumbs on the jaw just below the level ofPlace your thumbs on the jaw just below the level ofthe teeth.the teeth.


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Lift with both hands to move the jaw forward andLift with both hands to move the jaw forward and

upward.upward. If the casualty's lips are still closed after the jaw hasIf the casualty's lips are still closed after the jaw has

been moved forward, retract the lower lip with yourbeen moved forward, retract the lower lip with yourthumbs.thumbs.


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INITIATE MOUTHINITIATE MOUTH --TOTO --MOUTHMOUTH


MouthMouth --toto --Mouth ResuscitationMouth Resuscitation Maintain an open airwayMaintain an open airway using the headusing the head --tilt/chintilt/chin --lift orlift or

jaw thrust. jaw thrust. Close the casualty's noseClose the casualty's nose by gently pinching theby gently pinching the

casualty's nostrils shut with the thumb and indexcasualty's nostrils shut with the thumb and index

finger of the hand on the casualty's forehead.finger of the hand on the casualty's forehead. Administer two full breathsAdminister two full breaths to see if the casualty'sto see if the casualty's

airway is actually open. If the airway is open, theairway is actually open. If the airway is open, thecasualty's chest will rise.casualty's chest will rise.

Administering the twoAdministering the two ventilationsventilations should take 2 to 3should take 2 to 3seconds.seconds.


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Open your mouth wide and take a deep breath.Open your mouth wide and take a deep breath.

Seal your mouth over the casualty's mouth.Seal your mouth over the casualty's mouth. Blow into the casualty's mouth. Make sure air doesBlow into the casualty's mouth. Make sure air does

not escape.not escape. As you blow, observe the casualty's chest.As you blow, observe the casualty's chest. Quickly break the seal, take another deep breath,Quickly break the seal, take another deep breath,

seal your mouth over the casualty's mouth, and blow.seal your mouth over the casualty's mouth, and blow. Break the seal over the casualty's mouth and releaseBreak the seal over the casualty's mouth and release

his nose. This will allow the casualty's body tohis nose. This will allow the casualty's body toexhale.exhale.


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MouthMouth --toto --Nose ResuscitationNose Resuscitation If the casualty has injuries to his face or jaw thatIf the casualty has injuries to his face or jaw that

prevent using mouthprevent using mouth --toto --mouth resuscitation, use themouth resuscitation, use themouthmouth --toto --nose variation.nose variation.

Maintain an open airwayMaintain an open airway using the headusing the head --tilt/chintilt/chin --lift orlift or

jaw thrust. jaw thrust. Close the casualty's mouthClose the casualty's mouth so air will not escape.so air will not escape. Administer two full breathsAdminister two full breaths to see if the casualty'sto see if the casualty's

airway is actually open. If the airway is open, theairway is actually open. If the airway is open, thecasualty's chest will rise. Administering the twocasualty's chest will rise. Administering the twoventilationsventilations should take 2 to 3 seconds.should take 2 to 3 seconds.


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Open your mouth wide and take a deep breath.Open your mouth wide and take a deep breath. Seal your mouth over the casualty's nose.Seal your mouth over the casualty's nose. Blow into the casualty's nose. Make sure air does notBlow into the casualty's nose. Make sure air does not

escape.escape. Watch the casualty's chest to see if it rises.Watch the casualty's chest to see if it rises. Quickly break the seal, take another deep breath,Quickly break the seal, take another deep breath,

seal your mouth over the casualty's nose, and blow.seal your mouth over the casualty's nose, and blow. Break the seal over the casualty's nose and open hisBreak the seal over the casualty's nose and open his

mouth. This will allow the casualty's body to exhale.mouth. This will allow the casualty's body to exhale.


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Evaluate Effectiveness of theEvaluate Effectiveness of the VentilationsVentilations

If the casualty begins breathing on his own, check theIf the casualty begins breathing on his own, check thecasualty for injuries. Monitor the casualty in case hiscasualty for injuries. Monitor the casualty in case hisbreathing stops.breathing stops.

If air goes in and out of the casualty's lungs, but heIf air goes in and out of the casualty's lungs, but hedoes not start breathing on his own, check his carotiddoes not start breathing on his own, check his carotidpulse.pulse.

If the casualty's chest did not rise and fall, open theIf the casualty's chest did not rise and fall, open the

casualty's airway more and administer two fullcasualty's airway more and administer two fullbreaths again. If the casualty's chest still does notbreaths again. If the casualty's chest still does notrise, administer finger sweeps and modified thrusts torise, administer finger sweeps and modified thrusts tounblock his airway.unblock his airway.


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PERFORM A FINGER SWEEPPERFORM A FINGER SWEEP

Do notDo not administer a finger sweep if the casualty isadminister a finger sweep if the casualty isconscious or semiconscious. It could trigger his "gagconscious or semiconscious. It could trigger his "gag

reflex" and cause him to vomit.reflex" and cause him to vomit. Open the casualty's mouth. If the casualty's mouthOpen the casualty's mouth. If the casualty's mouth

does not open readily, cross your finger and thumbdoes not open readily, cross your finger and thumband push his teeth apart.and push his teeth apart.

If you can see a foreign object or strongly suspect theIf you can see a foreign object or strongly suspect thepresence of a foreign object, perform a finger sweep.presence of a foreign object, perform a finger sweep.

Grasp the casualty's tongue and lower jaw betweenGrasp the casualty's tongue and lower jaw between

your thumb and fingers and lift the jaw.your thumb and fingers and lift the jaw. Insert the index finger of your free hand down alongInsert the index finger of your free hand down along

the inside casualty's cheek to the base of his tonguethe inside casualty's cheek to the base of his tongueand sweep the throat with a "hooking motion.and sweep the throat with a "hooking motion.


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PERFORM A FINGER SWEEPPERFORM A FINGER SWEEP

Push the object to the side of the casualty's throat,Push the object to the side of the casualty's throat,then pull the object from the casualty's throat.then pull the object from the casualty's throat.

Try to administer two full breaths again and check forTry to administer two full breaths again and check forbreathing.breathing.

If the casualty is breathing on his own, continue yourIf the casualty is breathing on his own, continue yourevaluation.evaluation.

If the casualty's chest rises and falls but he does notIf the casualty's chest rises and falls but he does notbreathe on his own, check his carotid pulse.breathe on his own, check his carotid pulse.

If you are still unable to ventilate the casualty,If you are still unable to ventilate the casualty,perform modified manual thrusts.perform modified manual thrusts.


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ADMINISTER MODIFIED ABDOMINALADMINISTER MODIFIED ABDOMINAL

THRUSTSTHRUSTS

A modified abdominal thrust is the preferred thrustA modified abdominal thrust is the preferred thrust

unless the casualty has a serious abdominal wound,unless the casualty has a serious abdominal wound,is noticeably pregnant, or is extremely overweight.is noticeably pregnant, or is extremely overweight. Kneel astride the casualty's thighs.Kneel astride the casualty's thighs. Place the heel of one hand against the midline of thePlace the heel of one hand against the midline of the

casualty's abdomen slightly above the navel (beltcasualty's abdomen slightly above the navel (beltbuckle) and well below the tip of the breastbonebuckle) and well below the tip of the breastbone((xiphoidxiphoid process).process).

Place the heel of your other hand on top of the firstPlace the heel of your other hand on top of the firsthand and point your fingers toward the casualty'shand and point your fingers toward the casualty'shead.head.


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THRUSTSTHRUSTS

Press into the abdomen using a quick forwardPress into the abdomen using a quick forward

(inward) and upward thrust by locking your elbows(inward) and upward thrust by locking your elbowsand shifting your body weight forward.and shifting your body weight forward.

Release the pressure on the casualty's abdomen byRelease the pressure on the casualty's abdomen byshifting your body weight backward.shifting your body weight backward.


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THRUSTSTHRUSTS

If the obstruction has been dislodged, perform a fingerIf the obstruction has been dislodged, perform a fingersweep to remove the obstruction, administer two full breaths,sweep to remove the obstruction, administer two full breaths,and check for breathing.and check for breathing.If the obstruction was not dislodged, administer anotherIf the obstruction was not dislodged, administer anotherabdominal thrust.abdominal thrust.If you perform six to ten abdominal thrusts without expellingIf you perform six to ten abdominal thrusts without expellingthe obstruction, call for help again, open the airway, andthe obstruction, call for help again, open the airway, andadminister two full breaths. If the casualty's chest does notadminister two full breaths. If the casualty's chest does notrise during therise during the ventilationsventilations , perform a finger sweep and, perform a finger sweep andadminister additional abdominal thrusts. Repeat the cycleadminister additional abdominal thrusts. Repeat the cycle

until the casualty's airway is open.until the casualty's airway is open.If the casualty vomits, turn him onto his side and use a quickIf the casualty vomits, turn him onto his side and use a quickfinger sweep to remove vomitus from his mouth. Thenfinger sweep to remove vomitus from his mouth. Thenadministeradminister ventilationsventilations again.again.


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ADMINISTER MODIFIED CHEST THRUSTSADMINISTER MODIFIED CHEST THRUSTS

The chest thrust is used to remove an airwayThe chest thrust is used to remove an airwayobstruction in an unconscious casualty with a seriousobstruction in an unconscious casualty with a seriousabdominal wound or who is noticeably pregnant orabdominal wound or who is noticeably pregnant orextremely overweight.extremely overweight.

Kneel close beside the casualty's chest.Kneel close beside the casualty's chest.

Locate the lower edge of the casualty's rib cage.Locate the lower edge of the casualty's rib cage. Run the fingers of your hand nearest the casualty'sRun the fingers of your hand nearest the casualty's

feet along the lower edge of the rib cage until youfeet along the lower edge of the rib cage until youcome to the notch where the rib meets thecome to the notch where the rib meets thebreastbone at the center of the lower portion of thebreastbone at the center of the lower portion of thecasualty's chest.casualty's chest.


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Place your middle finger (same hand) on the notch;Place your middle finger (same hand) on the notch;

then place your index finger next to your middlethen place your index finger next to your middlefinger.finger.

Place the heel of your other hand on the casualty'sPlace the heel of your other hand on the casualty'sbreastbone next to and above (toward the casualty'sbreastbone next to and above (toward the casualty's

head) your two fingers.head) your two fingers.Make sure your heel is not resting on the ribs.Make sure your heel is not resting on the ribs.

Remove your fingers from the notch area and placeRemove your fingers from the notch area and placethat hand on top of the hand on the compression site.that hand on top of the hand on the compression site.Either extend or interlace your fingers.Either extend or interlace your fingers.


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Straighten your arms, lock your elbows, and positionStraighten your arms, lock your elbows, and positionyour shoulders directly above your hands.your shoulders directly above your hands.

Using the weight of your body, apply enoughUsing the weight of your body, apply enoughpressure straight down to depress the casualty'spressure straight down to depress the casualty'sbreastbone 1 1/2 to 2 inches.breastbone 1 1/2 to 2 inches.

Do not bend your elbows, rock, or allow your shoulders toDo not bend your elbows, rock, or allow your shoulders tosag while delivering the thrust.sag while delivering the thrust.

Release the pressure by shifting the weight of yourRelease the pressure by shifting the weight of yourbody from your arms.body from your arms. Do notDo not remove your handsremove your handsfrom the compression site.from the compression site.


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If the obstruction has been dislodged, perform a fingerIf the obstruction has been dislodged, perform a fingersweep to remove the obstruction, administer two full breaths,sweep to remove the obstruction, administer two full breaths,

and check for breathing.and check for breathing.If the obstruction was not dislodged, administer anotherIf the obstruction was not dislodged, administer anotherchest thrust. If you perform 6 to 10 thrusts without expellingchest thrust. If you perform 6 to 10 thrusts without expellingthe obstruction, call for help again, open the airway, andthe obstruction, call for help again, open the airway, and

administer two full breaths. If the chest does not rise duringadminister two full breaths. If the chest does not rise duringthethe ventilationsventilations , perform a finger sweep and administer, perform a finger sweep and administeradditional chest thrusts. Repeat the cycle until the casualty'sadditional chest thrusts. Repeat the cycle until the casualty'sairway is open.airway is open.


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CHECK FOR PULSECHECK FOR PULSE

After you have ensured that the casualty's airway isAfter you have ensured that the casualty's airway isopen by successfully delivering two full breaths,open by successfully delivering two full breaths,check for a pulse.check for a pulse.

Slide your index and middle fingerSlide your index and middle finger ----not your thumbnot your thumb ----along the side of the windpipe next to the Adam'salong the side of the windpipe next to the Adam's

apple (larynx) until you locate the carotid artery in theapple (larynx) until you locate the carotid artery in thegroove along the windpipe.groove along the windpipe.


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CHECK FOR PULSECHECK FOR PULSE

Gently press on the artery with your fingers for 5 toGently press on the artery with your fingers for 5 to10 seconds and feel for pulse.10 seconds and feel for pulse.

If a pulse is found, continue with mouthIf a pulse is found, continue with mouth --toto --mouth ormouth ormouthmouth --toto --nose resuscitation.nose resuscitation.

If no pulse is found, seek medical help immediately.If no pulse is found, seek medical help immediately.


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CONTINUE MOUTHCONTINUE MOUTH --TOTO --MOUTHMOUTH


If the casualty's airway is open, he has a pulse, andIf the casualty's airway is open, he has a pulse, andhe is not breathing on his own, continue to administerhe is not breathing on his own, continue to administerventilationsventilations ..

Open the casualty's airway.Open the casualty's airway. Take a deep breath.Take a deep breath. Pinch the casualty's nostrils closed.Pinch the casualty's nostrils closed. Seal your mouth over the casualty's mouth.Seal your mouth over the casualty's mouth. Blow the breath into the casualty's lungs.Blow the breath into the casualty's lungs. ObserveObserve

the rising of the casualty's chest to ensure that thethe rising of the casualty's chest to ensure that theventilation is effective.ventilation is effective.


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Break your seal over the casualty's mouth andBreak your seal over the casualty's mouth and

release his nose. Observe the casualty's chest fallrelease his nose. Observe the casualty's chest falland listen for exhale.and listen for exhale.If the chest does not rise and fall, reposition his airway (tiltIf the chest does not rise and fall, reposition his airway (tilthead back more) and try again until the chest rises and falls.head back more) and try again until the chest rises and falls.

RepeatRepeat ventilationsventilations at the rate of one ventilationat the rate of one ventilation(breath) every 5 seconds (12(breath) every 5 seconds (12 ventilationsventilations per minute).per minute).

You may need to take a breath betweenYou may need to take a breath between ventilationsventilations ..


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After one minute (12After one minute (12 ventilationsventilations ), stop administering), stop administering

ventilationsventilations and check the carotid pulse again.and check the carotid pulse again.Observe for spontaneous breathing (chest rising andObserve for spontaneous breathing (chest rising andfalling) as you feel for the pulse. The procedurefalling) as you feel for the pulse. The procedureshould take 3 to 5 seconds.should take 3 to 5 seconds.

If the casualty has no pulse, seek medical help.If the casualty has no pulse, seek medical help.If the casualty has a pulse and is breathing on his own,If the casualty has a pulse and is breathing on his own,continue your evaluation.continue your evaluation.If the casualty has a pulse but is not breathing on his own,If the casualty has a pulse but is not breathing on his own,

continue to administercontinue to administer ventilationsventilations at the rate of oneat the rate of oneventilation every 5 seconds. Continue to check the casualty'sventilation every 5 seconds. Continue to check the casualty'spulse after every 12pulse after every 12 ventilationsventilations ..


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MONITOR THE CASUALTYMONITOR THE CASUALTY

Once you have established that the casualty isOnce you have established that the casualty isbreathing on his own, continue to monitor thebreathing on his own, continue to monitor thecasualty's breathing. Ensure that the casualty'scasualty's breathing. Ensure that the casualty'sairway remains open. If breathing difficulties arise,airway remains open. If breathing difficulties arise,call for help and repeat the steps for clearing thecall for help and repeat the steps for clearing the

airway and performing mouthairway and performing mouth

--toto

--mouth resuscitation,mouth resuscitation,

as needed.as needed. Have a medical person examine the casualty even ifHave a medical person examine the casualty even if

he appears to recover fully.he appears to recover fully.


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CLOSING CLOSING

MouthMouth --toto --mouth resuscitation is used to restoremouth resuscitation is used to restorebreathing to a casualty whose heart is beating, butbreathing to a casualty whose heart is beating, but

who is not breathing. If the casualty's heart is notwho is not breathing. If the casualty's heart is notbeating, that is, no pulse is present, cardiopulmonarybeating, that is, no pulse is present, cardiopulmonaryresuscitation needs to be administered. CPR is notresuscitation needs to be administered. CPR is notpart of the combat lifesaver program.part of the combat lifesaver program.


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Medical Combat Lifesaver L03 Mouth to Mouth Resuscitation