Rescue Breathing

Assess the patient’s breathing for up to ten seconds. While maintaining an open airway, place your ear a few inches above the patient’s nose and mouth, and look at the patient’s chest. Look, listen, and feel for breathing. Look for the rise and fall of the chest. Listen for air moving in and out of airway. Feel for air escaping on the side of your face.

If the patient is not breathing, rescue breathing is needed. Rescue breathing is the simple skill of blowing air into the non-breathing patient. Give the patient two show initial breaths and then check for circulation. If the pulse is present but the patient is not breathing, you must continue to breathe for the patient. Give one breath every five seconds for an adult. Give one breath every three seconds for a child.

As you breathe into the patient’s mouth, watch for the chest to rise. If it does not, reposition the head and try rescue breathing again. If this still does not work, suspect an airway obstruction that needs to be cleared.

Rescue breathing can be done with mouth-to-barrier ventilation devices, more advanced ventilation devices, or just your mouth. When you are not on duty, you may not have ventilation devices readily available. In this situation, you must weigh the potential good to the patient against the limited chance of contracting an infectious disease through unprotected mouth-to-mouth breathing.

There are several methods for performing rescue breathing, including:

• Mouth-to-mask. Follow these steps when performing mouth-to-mask rescue breathing.
  1. Position yourself at the patient’s head.
  2. Open the patient’s airway using either the head tilt-chin lift or the jaw thrust maneuver.
  3. After determining that the patient is not breathing, place the mask over the patient’s mouth and nose.
  4. Using both hands, grasp the mask and the patient’s jaw. Press down on the mask with your thumbs, as you lift up on the jaw with your fingers. This will create a good seal on the mask and face.
  5. Breathe into the one-way valve. Give slow breaths. Each breath should be just enough to make the chest slowly rise.
  
  
• Mouth-to-mouth method. If you do not have muscle or other ventilation barrier device, follow these steps to perform mouth-to-mouth rescue breathing:
  1. Position yourself are the patient’s head.
  2. Open the patient’s airway using either the head tilt-chin lift or the jaw thrust maneuver.
  3. After determining that the patient is not breathing, pinch the patient’s nose closed using the fingers of your hand that is resting on the patient’s forehead.
  4. Make a tight seal by placing your mouth over the patient’s mouth.
  5. Give slow breaths as previously explained. Remove your mouth between breaths to allow air to come out.
  
  
• Mouth-to-nose method. Certain complications necessitate breathing through the patient’s nose, a method known as mouth-to-nose breathing. This is appropriate when you cannot open the patient’s mouth, when you cannot make a good seal around the mouth, when the mouth is severely injured, or when the patient’s mouth is too large or has no teeth. Mouth-to-nose rescue breathing is done like mouth-to-mouth breathing, except that you force the air through the patient’s nose, as you hold the mouth closed. Open the mouth whenever possible to allow the air to escape.
  
  
• Mouth-to-stoma method. A special situation involves a non-breathing patient who has had a laryngectomy. This patient no longer has a connection between the upper airway and the lungs. Instead, the patient breathes through a small, permanent opening in the front of the neck called a stoma. To check for breathing, keep the patient’s head in a level position. Place your ear over the stoma. If this patient is not breathing, perform mouth-to-stoma breathing. When you breathe into the stoma, the patient’s mouth and nose must be closed to prevent air from flowing into the upper airway.