If the airway to the lungs (mouth, throat, or windpipe) is obstructed, the person will not be able to breathe (see Asphyxia). Breathing can also cease because the lungs are damaged or full of fluid, or contain gases other than air. Or there may be a brain or heart malfunction. If breathing stops, the brain becomes starved if oxygen and irreversible damage may occur. Hold your ear close to the casualty's nose and mouth for 10 seconds. If he or she is breathing you should hear or feel the movement of air. While you are doing this, look at the chest wall to see if it is rising and falling. If the skin looks very pale, or bluish, especially around the lips, this is more evidence that breathing has stopped or that circulation is impaired. If you are in any doubt as to whether someone is breathing normally, contact emergency medical services immediately (sending a helper if possible) and commence CPR. If you are dealing with a child or a case of drowning on your own, carry out cardio pulmonary resuscitation for one minute before getting emergency help.
Cardio Pulmonary Resuscitation (CPR)
Put the patient on his or her back and kneel beside their chest. Press the heel of your hand in the centre of their chest, and place the heel of your other hand on your lower hand, keeping pressure in the centre and not on the ribs. Holding your arms straight and leaning over the casualty, press straight down, springing the breastbone down by about 5 cm (2 in) for an adult then allowing it to come back up fully. Do thirty of these chest compressions at a rate of about 100 per minute, then give two rescue breaths:
- Open the patient’s airway by tilting the head back and lifting the chin up to open the throat and mouth.
- Close the patient’s nostrils, using your index finger and thumb. Allow the mouth to open, but maintain chin lift.
- Take a normal breath and place your lips around his mouth, making sure that you have a good seal.
- Blow steadily into his mouth whilst watching for his chest to rise; take about one second to make his chest rise as in normal breathing; this is an effective rescue breath.
- Maintaining head tilt and chin lift, take your mouth away from the victim and watch for his chest to fall as air comes out.
- Take another normal breath and blow into the victim’s mouth once more to give a total of two effective rescue breaths. Then return your hands without delay to the correct position on the sternum and give a further 30 chest compressions.
- Continue with chest compressions and rescue breaths in a ratio of 30:2. Stop to recheck the victim only if he starts breathing normally; otherwise do not interrupt resuscitation.
- If your rescue breaths do not make the chest rise as in normal breathing, then before your next attempt:
- Check the victim's mouth and remove any visible obstruction.
- Recheck that there is adequate head tilt and chin lift.
- Do not attempt more than two breaths each time before returning to chest compressions.
- If there is more than one rescuer present, another should take over CPR about every 2 minutes to prevent fatigue. Ensure the minimum of delay during the changeover of rescuers.
- Continue CPR until the casualty is breathing again un-aided, then put him or her in the recovery position (see Unconsciousness).
If the Casualty is a Child
- Clear the mouth of any obvious obstructions and tilt the head back as above.
- Give five initial rescue breaths then commence the cycle above (30 chest compressions then 2 rescue breaths), compressing the chest by one-third of its depth only.
- If the first breaths aren’t effective in making the chest rise, check the mouth again but make no more than five attempts at rescue breaths each time before commencing chest compressions.
- For chest compressions on small children, use the heel of one hand only and on infants under a year old, use your fingers only.
Chest-Compression-Only CPR
- If you are not able, or are unwilling, to give rescue breaths, give chest compressions only. If chest compressions only are given, these should be continuous at a rate of 100 a minute.
Homeopathic remedies if you are on your own, do not give any remedies until the casualty is breathing regularly and unaided. However, if there is someone else present who can carry on with the resuscitation, select a remedy from the list below.
Specific remedies to be given every 60 seconds for up to 10 doses
- Skin cold and marbled-looking, cold sweat on forehead, face pale, casualty retches on recovery Veratrum 30c
- Face puffy and bluish, cold sweating, great hunger for air (yawning), desire to be fanned with cold air especially after carbon-monoxide poisoning from car exhaust Carbo veg. 30c
- Person unconscious, noisy or irregular breathing, face hot and puffy, pupils very small Opium 30c
- Breathing difficulties due to bubbling oral or nasal secretions, rattly breathing, frothy phlegm, face cold, blue, and clammy Antimonium tart. 30c
- Obstructed breathing due to severe reaction to a bee sting or insect bite, throat or tongue swollen Apis 30c
- Where breathing difficulties come on after injury Arnica 30c
- Casualty panicky and afraid once normal breathing is re-established Aconite 30c
- If none of the remedies above seem appropriate Carbo veg. 30c
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