STUDENT HANDOUT (JUL 2004)

OUTLINE

LESSON PURPOSE

Generally, Cardiac Compression in order to save a life will not be done on the battlefield. CPR is time consuming and must be followed up with defibrillation and/or Advanced Cardiac Life Support, which is not feasible in the field environment. Furthermore, chest compressions are of unknown value in victims of trauma-associated cardiac arrest. However, the emergency techniques for recognizing and treating upper airway obstruction and failures of the respiratory system and heart are useful in other kinds of environments. Additionally, performing a good Primary Survey on an injured person involves using a good working knowledge of the A, B, C’s of Basic Life Support: Maintaining an open airway to counter upper airway obstruction; restoring breathing to counter respiratory arrest and restoring circulation to counter cardiac arrest.

a. TERMINAL LEARNING OBJECTIVE:

(1) While functioning as a Combat Lifesaver, without the aid of reference materials, demonstrate sound knowledge of the basics of Life Support utilizing the A, B, C’s.

b. ENABLING LEARNING TECHNIQUES:

Without the aid of reference materials the student will be able to:

(1) Demonstrate the Head-Tilt, Chin Lift technique.

(2) Demonstrate the Modified Jaw Thrust and describe circumstances under which it should be used.

(3) Demonstrate Heimlich Maneuver on a standing victim then on a victim lying down.

(4) Demonstrate the steps that must follow the abdominal thrusts on a supine victim of complete airway obstruction.

(5) Demonstrate the Carotid pulse check.

(6) Demonstrate proper chest compressions to include locating the landmark and explaining the depth necessary for adequate compressions.

(7) Demonstrate the Recovery Position and describe the characteristics of a victim who should be placed in this position.

I. A FOR AIRWAY

1. ASSESSMENT OF THE AIRWAY:

a. The first step in assessing the victim is to assess the airway.

b. Although the airway has everything to do with breathing, you are not checking the breathing yet when you check the airway.

c. The primary step in assessing the airway is to make sure the airway is clear and open.

d. “A” stands for open and assess the airway.

2. OPEN THE AIRWAY:

a. Head Tilt, Chin Lift

            (1) For victims with no associated neck trauma.

(2) Place one of your hands on the victim’s forehead and apply gentle, firm, backward pressure using the palm of your hand.

            (3) Place the fingers of the other hand under the bony part of the chin.

            (4) Lift the chin forward and support the jaw, helping to tilt the head back.

b. Modified Jaw Thrust

            (1) For victims with suspected neck injury.

(2) Allows a rescuer to open the airways yet keep the spinal column in alignment to prevent further injury to a broken neck or back.

(3) Kneel near the top of the victim’s head, grasping the angles of the victim’s lower jaw and life with both hands, one on each side.

            (4) This will displace the mandible (jawbone) forward while tilting the head backward.

3. OTHER CAUSES FOR UPPER AIRWAY OBSTRUCTION:

a. Improperly chewed food that becomes lodged in the airway (an event commonly called “café coronary”).

4. PARTIAL AIRWAY OBSTRUCTION:

a. The signs of a partial airway obstruction include:

            (1) Unusual breathing sounds.

            (2) Cyanosis.

            (3) Changes in breathing pattern.

(4) Conscious people will usually make clutching motions toward their neck, even when the obstruction doesn’t prevent speech.

b. With partial airway obstruction, the victim may be capable of:

            (1) A “good air exchange.”

                        a. The victim remains conscious

                        b. Can cough forcefully.

                        c. Although frequently there is wheezing between coughs.

d. As long as good air exchange continues, the victim should be encouraged to continue spontaneous coughing and breathing efforts.

                        e. Do not interfere with the victim’s efforts to expel the foreign body.

            (2) A “poor air exchange”

a. May occur initially or begin as a good air exchange and turn into a poor air exchange.

                        b. Indicated by a weak, ineffective cough.

                        c. High-pitched noise while inhaling.

                        d. Increased respiratory difficulty.

                        e. Possible cyanosis.

f. A partial obstruction with a poor air exchange should be treated as a complete airway obstruction.

5. COMPLETE AIRWAY OBSTRUCTION:

a. Conscious people with a complete airway obstruction will attempt to speak, but cannot.

b. Nor will they be able to speak.

c. An unconscious person with a complete airway obstruction will exhibit none of the normal signs of breathing: rise and fall of the chest and air exchange through the nose and/or mouth.

d. You can also tell that the airway is obstructed if you try to rescue breathe for an unconscious, non-breathing victim and the breath does not go into the lungs.

6. RELIEVING FOREIGN BODY AIRWAY OBSTRUCTION:

a. Foreign Body Airway Obstruction.

(1) Foreign body air obstruction should be considered in any victim who suddenly stops breathing.

            (2) Becomes cyanotic (turns blue).

            (3) Or loses consciousness for no apparent reason.

(4) The Heimlich maneuver (or subdiaphragmatic abdominal thrusts) is recommended for relieving foreign body airway obstructions.

a. By elevating the diaphragm, the maneuver can force air from the lungs to create an artificial cough intended to expel a foreign body out of the airway.

b. To perform the Heimlich maneuver on a victim who has a partial airway obstruction with a poor air exchange or a complete airway obstruction and who is standing up:

            (1) Make a fist with one hand.

(2) Place thumb side of your fist against the victim’s abdomen, in the midline slightly above the naval and well below the tip of the xiphoid process.

(3) Grasp the fist with the other hand and press the fist into the victim’s abdomen with a quick upward thrust.

(4) Repeat thrusts and continue until the object is expelled from the airway or until the victim becomes unconscious.

c. To perform the Heimlich maneuver on a victim who has a complete airway obstruction and is lying down:

            (1) Make sure the victim is lying face up.

(2) Kneel astride the victim’s thighs and place the heel of one hand against the victim’s abdomen, in the midline slightly above the naval and well below the tip of the xiphoid.

            (3) Place the second hand directly on top of the fist.

            (4) Press into the abdomen with a quick upward thrust.

            (5) Repeat until you have performed five abdominal thrusts.

(6) Abdominal thrusts done on the unconscious victim must be followed by a manual finger sweep.

d. The finger sweep will remove the foreign body you may have expelled into the back of the throat with the abdominal thrusts:

            (1) With the victim’s face up, open the mouth by grasping both the tongue and lower jaw between the thumb and fingers and lifting the jaw.

            (2) This action draws the tongue away from the back of the throat and away from a foreign body that may be lodged there. This step alone may partially relieve the obstruction.

            (3) Insert the index finger of the other hand down along the inside of the cheek and deeply into the throat to the base of the tongue.

            (4) Use a hooking action to dislodge the foreign body and maneuver it into the mouth so that it can be removed.

            (5) It is sometimes necessary to use the index finger to push a foreign body against the opposite side of the throat to dislodge and remove it.

            (6) Be careful not to force the object deeper into the airway. If the foreign body comes within reach, grasp and remove it.

II. B FOR BREATHING

1. ASSESSMENT OF BREATHING:

a. The second aspect of Life Support is to restore breathing in cases of respiratory arrest.

b. Failure of the breathing mechanism may be caused by various factors. They include:

            (1) Complete airway obstruction.

            (2) Insufficient oxygen in the air.

            (3) Inability of the blood to carry oxygen (e.g. carbon monoxide poisoning).

            (4) Paralysis of the breathing center in the brain.

            (5) External compressions of the body.

(6) Respiratory arrest if usually but not always immediately accompanied by cardiac arrest.

            (7) Signs of respiratory arrest are:

                        a. An absence of respiratory effort.

                        b. A lack of detectable air movement through the nose or mouth.

                        c. Unconsciousness.

                        d. A cyanotic (blue) discoloration of the lips and nail beds.

2. DETERMINING BREATHLESSNESS:

a. To assess the presence or absence of breathing you should use the following procedures:

            (1) While holding the victim’s airway open, place your ear over the mouth and nose.

            (2) Look for the chest to rise and fall.

            (3) Listen for air escaping during exhalation.

            (4) Fell for the flow of air from the nose and/or mouth.

                        a. If the victim is not breathing, artificial respirations must be started immediately.

                        b. Any delay could result in brain damage or death.

c. The purpose of artificial respirations is to provide air exchange until natural breathing is restored.

d. This is why rescue breathing and chest compressions are not normally done in a combat environment.

e. Mouth-to-mouth rescue breathing is an effective way to supple the victim with oxygen because exhaled breath contains enough oxygen for another person to live off of.

b. To provide rescue breaths to a victim who is not breathing:

(1) Take deep breath and seat your lips around the victim’s mouth, creating an airtight seal.

            (2) Be sure to hold the airway open.

            (3) Give two slow ventilations (1½  to 2 seconds per breath).

            (4) Allow enough time for the lungs to deflate during ventilations.

(5) If the victim still does not respond, continue to ventilate at a rate of 10-12 breaths per minute or one breathe every five seconds.

(6) If the victim’s lungs cannot be ventilated, reposition the head by repeating the head tilt, chin lift or modified jaw thrust.

            (7) Attempt to ventilate again.

            (8) If the lungs still cannot be ventilated, the airway is obstructed.

            (9) Treat the obstruction with five abdominal thrusts (discussed above).

            (10) Follow the thrusts with a finger sweep (manual removal of the foreign body).

            (11) After the finger sweep (whether an object was removed or not) attempt to ventilate.

(12) If the victim’s lungs cannot be ventilated, reposition the head by repeating the head tilt, chin lift or modified jaw thrust.

            (13) Continue the process until the lungs can be ventilated.

III. C FOR CIRCULATION

1. CARDIAC ARREST:

a. Cardiac arrest is the complete stoppage of the heart function.

b. The symptoms of cardiac arrest include:

            (1) The absence of carotid pulse.

            (2) Lack of a heartbeat.

            (3) Dilated pupils.

            (4) The absence of breathing.

c. To be effective, CPR must be started within four minutes of the onset of cardiac arrest.

d. The victim should be supine (flat on their back) and on a firm surface.

2. CPR:

a. Never assume that a cardiac arrest has occurred because a person is lying on the ground and appears to be unconscious. Always try to rouse the person first by shaking the shoulders and trying to obtain a response.

b. If there is no response, place the victim supine (flat on their back) on a flat surface.

c. Open the airway.

d. Check for breathing.

e. If no breathing, attempt to ventilate.

f. Once the airway is open, you have determined victim is not breathing, and you have delivered two ventilations that adequately filled the lungs, check the circulation by feeling the carotid artery on the side of the neck.

            (1) If a pulse is present, continue to rescue breath for the victim.

            (2) If no pulse is present, locate the sternum and begin chest compressions.

3. CHEST COMPRESSIONS:

a. To locate the sternum:

(1) Use the middle and index fingers of your lower hand to locate the lower margin of the victim’s ribcage on the side closest to you.

(2) Then move your fingers up along the edge of the ribcage to the notch where the ribs meet the sternum in the center of the lower chest.

            (3) Place your middle finger on the notch and your index finger.

            (4) Place the heel of you other hand next to your index finger.

            (5) Place the heel of your other hand directly on top of the first.

            (6) Interlock your fingers and keep them straight out.

(7) Effective compressions are accomplished by locking your elbows into position, straightening your arms, and positioning your shoulders directly above your hands so that the thrust for each compression is straight down on the sternum.

            (8) The sternum should be depressed approximately 1½ to 2 inches.

(9) Release chest compression pressure between each compression to allow blood to flow into the chest and heart.

            (10) When releasing compression pressure, do not remove your hands from the chest.

4. CYCLES OF CPR:

a. Chest compressions should be performed at a ratio of 15 compressions to two ventilations if only one rescuer is present.

b. Five compressions to every one ventilation can be performed with two rescuers.

c. The victim’s heart should be compressed between 80 and 100 times per minute.

5. RECOVERY POSITION:

a. If at any time during your A, B, C assessment you find an unconscious victim who is breathing and has a pulse, place the victim in the recovery position.

b. If a breathless victim regains spontaneous respirations, or if a pulseless victim regains spontaneous pulse and spontaneous respirations, place in the recovery position.

(1) Roll the victim onto his side so that the head, shoulders, and torso move simultaneously without twisting.

            (2) Place on hand under the victim’s chin.

            (3) Bend the top leg forward and tuck the toe behind the heel of the other foot.

(4) Observe the victim closely to be sure he/she maintains spontaneous breathing and circulation.

REFERENCE(S):

1. First Aid for Soldiers                                         FM 21-11

2. Survival                                                             FM 21-76

3. First Aid                                                            FMFRP 4-52

4. First Aid                                                            MCRP 3-02G