Symptoms
There are frequent attacks of asphyxia of varying severity, wheezing breathing. Attacks occur more often during feeding, but sometimes occur when changing position and during rest. The lower jaw is underdeveloped and droops. Upon examination, retraction of the root of the tongue is visible.
Urgent measures during an attack of asphyxia. The lower jaw is pulled forward, the tongue is pulled out with a blunt forceps, it is stitched with a silk thread between the tip and the blind hole and fixed in its normal position (temporarily, for 1 month). If this does not help, a tracheotomy is indicated.
Prevention of tongue retraction comes down to feeding in an upright position and fixing the lower jaw with an adhesive plaster or bandage. For this purpose, a bandage is applied around the crown and lower jaw, secured in a transverse manner around the forehead.
In addition, there are special wire splints that are placed in the mouth to ensure free entry into the pharynx. Severe retrognathia (posterior displacement of the lower jaw due to an abnormality of the masticatory muscles). Asphyxia is eliminated by pulling the lower jaw forward and fixing it.
Treatment is surgical.
"Emergency Pediatrics", K.P. Sarylova
Acute respiratory and circulatory disorders are the leading cause of death due to accident, heart attack or severe trauma. More than 340 thousand people die annually on the roads of various countries alone, more than 140 thousand die on water, and more than 1 million people die from heart attacks.
Nature has determined a strict “time limit” for the life of a victim with severe impairment of vital functions. It is well known that stopping blood circulation for more than 5 minutes under normal conditions leads to irreversible changes in the cells of the cerebral cortex and the process of revival becomes futile. This explains the need to immediately fight for the life of the victim.
First aid to the victim can practically only be provided by someone who happens to be nearby. The arrival of an ambulance is inevitably associated with the loss of valuable time, often exceeding the limits of possible revival. Statistics show that in 30-50% of cases, deaths in emergency conditions can be avoided if assistance is provided to the victims in a timely and correct manner.
The most important task of practical healthcare is to bring first emergency care as close as possible to the population. To a certain extent, this task will be helped by systematic training not only of medical personnel, but also of the organized part of the population in simple and accessible methods of providing emergency care for life-threatening conditions.
EMERGENCY CARE FOR ACUTE BREATHING DISORDERS
There are many reasons that can lead to life-threatening breathing problems. They can be represented as follows.
- Damage to the central mechanisms of respiratory regulation: severe injuries to the brain and spinal cord, electric shock or lightning, cerebral hemorrhage (stroke), poisoning with sleeping pills or narcotic drugs, acute inflammatory diseases of the brain and meninges.
- Staying in an atmosphere with low oxygen content (smoky and gas-filled workshops, garages, silos, abandoned wells and mines, tanks), leading to oxygen starvation (hypoxia), loss of consciousness, convulsions, and subsequently cardiac arrest.
- Complete or partial obstruction of the respiratory tract. It is observed when the root of the tongue and lower jaw are retracted in unconscious patients; when foreign bodies enter the oropharynx, trachea and bronchi, compression of the larynx and trachea (edema, goiter, tumors); drowning, spasm of the glottis (laryngospasm) and bronchi (bronchial asthma, allergies). In these cases, gas exchange is disrupted, suffocation increases, which leads the person to a critical condition.
- Damage to the chest and lungs, noted in severe trauma with multiple fractures of the ribs, compression of the chest, electric shock, convulsive conditions (tetanus, epilepsy, fever), compression of the lungs due to air entering the pleural cavity (thin-walled sac around the lung), fluids, blood. In these cases, patients' normal breathing mechanism is disrupted, hypoxia (oxygen deficiency) increases, which can lead to cardiac arrest.
- Lung disease or damage; inflammation, swelling, bruise of lung tissue. In these conditions, breathing disorders sometimes increase gradually, but despite this, they sometimes pose a threat to life.
- Respiratory disorders due to circulatory and gas exchange disorders: myocardial infarction and cardiac weakness, cardiac arrest, shock, severe blood loss, exhaust gas poisoning (carbon monoxide), aniline dyes, cyanide compounds.
The respiratory disorders indicated in this group are secondary in nature, but when providing first aid, even in these cases it is impossible to do without artificial respiration methods.
The most alarming and dangerous symptom of a life-threatening breathing disorder is respiratory arrest (apnea), which is determined by the absence of respiratory movements of the chest and diaphragm, the absence of breathing sounds and air movement, and increasing bluishness of the face. In case of doubt (there is breathing or not), it should be assumed that there is no breathing.
Signs of respiratory distress are also shortness of breath, frequent and shallow or, on the contrary, rare breathing (5-8 breaths per minute), difficulty breathing with a long inhalation or exhalation, a feeling of suffocation and psychomotor agitation. Important signs of respiratory distress are increasing blueness of the lips, face, fingertips, and confusion (comatosis).
Emergency care for acute breathing problems includes two steps:
- A - clearing the airways from mucus and foreign bodies;
- B - performing artificial respiration.
Both techniques form the basis of first emergency resuscitation care and represent a kind of “alphabet” of revival, in which the sequence of techniques is conditionally determined by the following order of letters: A, B, C.
If the first two resuscitation techniques have no effect, the victim is not breathing and has no pulse, then add a third to the measures taken!
- C - artificial circulation by external cardiac massage.
These revitalization techniques form the basis of first aid. They are available to every person who will learn them. To perform them, no additional conditions or special equipment is required, except knowledge and practical skills.
Airway clearance methods
The most common cause of closure of the airways in unconscious patients or victims is retraction of the root of the tongue and lower jaw due to relaxation of all the muscles supporting the lower jaw. The muscles hang down and the root of the tongue blocks the entrance to the larynx.
More often this occurs when the patient is positioned on his back, since exhalation in these cases is free, but inhalation is impossible, despite the efforts of the chest and abdominal muscles. The volume of air in the lungs progressively decreases, its rarefaction in the respiratory tract increases, and the tongue “sucks in”, sinking even deeper into the oropharynx. If the patient is not helped, he will die.
The technique for clearing the airways consists of maximal extension of the head. To do this, the person providing assistance places one hand on the back of the neck, the other on the forehead and performs a slight but energetic extension of the head backwards. In this case, the muscles of the floor of the mouth and the root of the tongue and the epiglottis associated with it are stretched, shifted upward and open the entrance to the larynx. 
If the patient still has independent breathing, then after eliminating the obstruction in the respiratory tract, it improves significantly and its depth increases. Along with this, the patient’s bluish complexion disappears, and consciousness may become clearer.
If spontaneous breathing is not possible, it is necessary to artificial respiration using the “mouth to mouth” or “mouth to nose” method. Maintaining the position of the patient's head in a state of extension, after a deep inhalation, cover the victim's mouth wide and hold his nose with your fingers, forcefully exhale into his respiratory tract.
The effectiveness of insufflation can be seen by the increase in chest volume and the sound of exhaled air. If, when air is forced into the victim's airways, any resistance occurs, the chest does not straighten, or air goes into the stomach and the bulge in the epigastric region increases, it means that the airways are not cleared and the obstruction remains.
It was noted that in 20% of patients, especially in elderly and senile people, maximum extension of the head does not ensure full opening of the airways. In such cases, the patient needs to move the lower jaw forward. To do this, using the pressure of the thumbs of both hands, it is first shifted downward, and then, using the index fingers located at the corners of the lower jaw, it is pushed forward so that the teeth of the lower jaw are in front of the upper incisors.
Optimal conditions for clearing the airways from retraction of the tongue are achieved by a combined technique: maximum extension of the head, extension of the lower jaw and opening of the patient’s mouth.
In this case, the oral cavity becomes accessible for inspection. If there are liquid contents or pieces of food in the mouth, they should be quickly removed (with a finger wrapped in a napkin) and the mouth should be dried with a towel or improvised material. After toileting the oral cavity, artificial respiration is immediately started.
If an unconscious patient has spontaneous breathing, then to prevent repeated retraction of the root of the tongue and lower jaw, it is necessary to keep his head in a state of extension at all times. If this is not possible (if there are other victims in need of help), the patient should be placed in a stable lateral position.
To do this, the patient is turned on his right side, the right arm is brought to the body, the right leg is bent at the knee joint and brought to the stomach, the left arm is bent at the elbow joint, and its palm is placed under the right half of the patient’s face. At the same time, the head tilts back slightly. In such a stable position on the side, favorable conditions for breathing are created, preventing the tongue from retracting and the flow of mucus or blood into the respiratory tract. The patient should be monitored until the ambulance arrives.
Dangerous breathing disorders occur when foreign bodies, such as poorly chewed meat, enter the respiratory tract. A bolus of food, stuck in the oropharynx, leads to compression of the epiglottis and closure of the entrance to the larynx. The victim stops breathing, has no voice (explained by gestures), and cannot cough because he cannot breathe. Subsequently, suffocation occurs, consciousness disappears, convulsions appear, and death is possible. Such a person needs urgent help.
To remove a bolus of food from the oropharynx, the following technique is proposed: the victim, in a standing position, slightly tilted, is given a strong blow with the base of the palm in the interscapular area. In this case, a powerful artificially induced cough impulse is obtained, which, after 2-3 blows, first helps to displace and then remove the food bolus.
If this technique turns out to be ineffective, the following can be recommended: the rescuer stands behind the victim, covers him with his right hand so that the palm clenched into a fist is located in the epigastric region; with his left hand he grabs his right hand and with an energetic movement squeezes the victim’s torso from bottom to top. The increased pressure thus created in the upper abdominal cavity and airways is transmitted jerkily to the site of the obstruction in the oropharynx and promotes the expulsion of the foreign body. 
If the patient is unconscious and lying on the floor, then the removal of a foreign body from the oropharynx is carried out as follows: his head is extended as much as possible, his mouth is opened, his tongue is pulled out with a napkin, and with the index and middle fingers, immersed deep in the oropharynx, they try to grab or push the food bolus.
If the patient has weakened or no independent breathing, after toileting the oral cavity they begin artificial ventilation of the lungs - artificial respiration using the “mouth to mouth” method.
Under the same conditions, another technique for removing a foreign body from the oropharynx can be used. The patient is turned into a prone position. With the left hand, grab the head in the forehead area and throw it back, and with the palm of the right hand, apply 3-4 beating blows in the middle zone of the interscapular area. Then the patient needs to be turned onto his back, a digital examination of the half of the mouth is made and the foreign body is removed. If necessary, begin artificial ventilation.
If liquid enters the respiratory tract (for example, during drowning), it is necessary to place the victim in a head-down position, hanging his torso over the rescuer’s right knee. With the left hand, the head is extended as far back as possible, and with the palm of the right hand, 3-5 blows are applied to the back. The air push created in this case and the force of gravity contribute to the flow of fluid from the respiratory tract. 
Compression in the stomach area under the weight of the victim’s body promotes the flow of fluid from the digestive canal, which creates more favorable conditions for subsequent revival.
If the rescuer does not have sufficient physical strength, then in such cases you can turn the victim on his right side, tilt his head back and apply 4-5 blows from the back in the interscapular area with the palm of his right hand. Then perform oral hygiene and begin artificial ventilation.
If liquid or mucus gets into the respiratory tract of small children or newborns, it is necessary to lift the child upside down by the legs with your left hand (the liquid flows out due to its gravity). Use your right hand to open the child’s mouth and use a finger wrapped in a napkin to dry the child’s mouth. You can also use the technique of tapping the back. Then you should switch to artificial ventilation, if necessary.
If solid foreign bodies enter the child's respiratory tract, he should be placed face down on his left arm and left thigh, slightly bent at the knee joint, and pressing his legs with his shoulder and forearm to his body, lower him upside down. Apply several tapping blows to the back with your right hand. If a foreign body moves freely in the respiratory tract due to its gravity, it will descend to the vocal cords. During inhalation or during tapping, a foreign body may jump out of the respiratory tract.
It should be remembered that if such emergency procedures are unsuccessful, it is necessary to call an ambulance and take the patient to a hospital, where special instrumental methods will be used to remove foreign bodies. Delay in providing medical care often leads to severe respiratory complications.
When foreign bodies (liquid or solid) enter the respiratory tract in adults, the principle of removing them in normal emergency conditions remains the same as in children: creating an inclined position and tapping the back. An inclined position for an adult can be created using the back of a chair, over which he “hangs” his torso, and with his hands lowered down, he holds and leans on the seat.
This position should be created as long as possible, periodically repeating the tapping of the palm on the lateral surfaces of the chest. The patient should also be sent to a medical facility by calling an ambulance to prevent possible further complications.
Acute breathing disorders include asthmatic attack, which is characterized by an attack of suffocation (bronchospasm), a typical posture of the patient with raised shoulders, a short inhalation and a long painful exhalation with the participation of all muscles. The attack is accompanied by coughing and wheezing in the lungs, severe bluishness of the face.
First aid consists of relieving an attack of bronchospasm with special pharmacological agents, which patients are usually well aware of. The most effective inhalations of aerosols are: salbutamol, euspiran, aetmopent, isadrin, etc. Aerosol inhalations (1-2 procedures) relieve an asthmatic attack in a few minutes.
These are the simplest methods of ensuring airway patency - the first most important component of the “ABC” of revival.
In cases of respiratory arrest or sudden weakening, it is necessary to proceed to the next step (B) - artificial respiration.
Artificial respiration methods
Until the 60s of our century, manual methods of artificial respiration by external impact on the chest were widespread. In terms of their effectiveness, they are significantly inferior to expiratory ones, which are based not on squeezing the chest, but on blowing air into the patient’s respiratory tract using the “mouth to mouth” or “mouth to nose” method. Studies have shown that artificial respiration using insufflation methods has a number of advantages and has practically “displaced” other methods in providing emergency care.
- Firstly, methods of air injection are physiologically justified to ensure gas exchange, since the oxygen content in exhaled air is 16-18 vol.% and is enough to support the life of the victim for a long time.
- Secondly, with this method a sufficiently large volume of air is injected and the efficiency of injection is easy to control. The person providing assistance observes how the victim’s chest rises and straightens.
- Thirdly, the air blowing method is not very tiring and can be used by schoolchildren and teenagers at any time in various situations after receiving brief instructions.
Artificial respiration methods have a drawback: their use is contraindicated if there is a risk of infection (infectious diseases, sexually transmitted diseases).
Mouth-to-mouth artificial respiration technique consists in the fact that the person providing assistance, having performed the technique of straightening the head and opening the airways, after a deep breath, closes the victim’s mouth with a wide open mouth and performs a forced injection of air into his lungs. In this case, he must close the patient’s nasal passages with his cheek or fingers to create a complete seal.
At the same time, the chest excursion is monitored. The first 3-5 injections should be done at a fast pace, and the subsequent ones at a frequency of 12-14 per minute. The inspiratory volume should be approximately 600-700 cm3 for an adult, which is less than half the vital capacity of a middle-aged person.
After the end of the air injection, the person providing assistance moves his head to the side, and the victim passively exhales through the open airways. With each inhalation, the chest should rise, and with exhalation, it should fall.
If there is any resistance in the respiratory tract during insufflation of air or air goes into the stomach, it is necessary to perform the head extension technique more intensively.
It is also necessary to carefully monitor that gastric contents do not appear in the oropharynx, because with the next injection of air it can enter the patient’s lungs and cause complications. The contents of the oral cavity should be immediately removed using a napkin, towel or other available material.
For hygienic purposes, the patient’s mouth should be covered with a clean napkin or handkerchief, which, without interfering with air blowing, isolates the patient’s face from direct contact.
Before carrying out artificial respiration, the victim must be laid on a hard, flat surface, the neck and chest area should be freed from clothing, and the abdominal area should be exposed. These measures are necessary for simultaneous closed cardiac massage.
In some conditions of the victim (convulsive contraction of the jaws, trauma to the lower jaw and soft tissues), mouth-to-mouth artificial respiration cannot be performed. In these cases, artificial respiration is started using the “mouth to nose” method.
His technique is simple. With one hand, located on the scalp and forehead, they tilt the victim’s head back, with the other, lifting his chin and lower jaw, close his mouth. You can additionally cover your mouth with a napkin and your thumb. Air is blown through the nasal passages, covered with a clean napkin or handkerchief.
During the period of passive exhalation, the victim’s mouth should be opened slightly. Then the blowing is repeated in the same rhythm. The effectiveness of air injections is assessed by the degree of respiratory excursions of the chest.
Artificial respiration in children is performed by blowing air into both the mouth and nose at the same time. The frequency of blowing should be 18-20 per minute, but the volume of blowing should be small so as not to damage the lungs by excessive stretching. The volume of blown air is controlled by the amount of chest excursion and depends on the age of the child.
Clearing the airways of mucus and foreign bodies and performing artificial respiration in such an extremely serious complication as cardiac arrest does not ensure successful revival. In addition to ventilation of the lungs, it is necessary to solve another very important problem: how to deliver oxygen from the lungs to vital organs, and primarily to the brain and heart muscle.
This problem is solved by the third technique of the “ABC” of revival, designated by the letter “C”. It is aimed at. 
The main reasons, in addition to trauma to the larynx with subsequent development of edema and asphyxia, are the following:
1) retraction of the root of the tongue (often);
2) entry of a foreign body;
H) flooding of the respiratory tract with liquid.
Let's look at each of them in more detail.
I. Recession of the root of the tongue is a fairly common and absurd cause of the unjustified death of a victim who is unconscious in a supine position.
In this case, the root of the tongue, due to gravity and due to the lack of control from the cerebral cortex, sinks and blocks the flow of air through the oropharynx into the trachea. To restore the patency of the airways, as discussed above, you can do the following: it is necessary to tilt the victim’s head back, creating the so-called hyperextension of the head (Fig. 17).
Throwing back the head is achieved in various ways: the resuscitator is positioned either at the head of the victim or facing him and, holding the back surface of the neck with the fingers of both hands, gently tilts the head of the victim back, while simultaneously fixing the cervical spine; Also, throwing back the head can be done by hyperextending the head, when one hand of the resuscitator is placed on the victim’s forehead, and the second is placed under the neck from the inside (or holding the lower jaw) and movements of the hands are made in mutually opposite directions.
You can also use a cushion from improvised means (scarf, muffler, headdress, etc.), which is placed either under the victim’s neck or under his shoulder blades. This technique in most cases allows the root of the victim’s tongue to move away from the posterior wall of the larynx (Fig. 18).
In order to find out whether the victim’s airway is passable or not, it is necessary to carry out the so-called test diagnostic exhalation(PDV) - i.e., try to inhale into the victim’s airways 2-3 times, feeling the patency of the airways for a stream of air (no resistance when inhaling) and visually checking the rise of the chest (Fig. 19).
However, in almost 20% of people, due to the individual anatomical features of the neck structure, maximum extension of the head does not provide a sufficient degree of patency of the upper respiratory tract. And therefore, if the PDV fails, it is guaranteed to eliminate the retraction of the tongue root if you carry out the so-called Safar triple move (named after the American resuscitator who developed this method), which includes the following three steps
Throwing back the head;
Moving the lower jaw forward;
Opening the mouth.
In this case, the resuscitator can be located either at the head of the victim or facing him.
To move the lower jaw forward, you need to place four fingers of each hand behind the corners of the lower jaw and, resting your fingers on its edge, push it forward so that the lower teeth are in front of the upper teeth.
Moving the lower jaw forward creates conditions for guaranteed departure of the tongue root from the posterior wall of the larynx, thereby eliminating one of the most common causes of airway obstruction.
If in a real situation for some reason it is impossible to perform the “triple technique” in the classical way, then tongue retraction can be eliminated using any of its varieties or modifications: the hook method, in which the resuscitator’s thumb is placed behind the victim’s front lower teeth (second the hand fixes the head by the forehead) and pulls the lower jaw forward (Fig. 20).
Also, the advancement of the lower jaw forward can be achieved with the victim’s head thrown back and fixed back, by grasping his lip and pulling it anteriorly.
It would be more convenient and reliable to eliminate the sunken root of the tongue by using an air duct - a special device that follows the contour of the human oropharynx for artificial ventilation of the lungs. In car first aid kits, as well as in rescue packs, there should be three types of air ducts for the main age categories: children, adolescents and adults.
The technique for introducing the air duct is as follows:: the victim is in a supine position, turn his head to the side and cleanse the mouth; then the victim’s head returns to its original position, the mouth opens and the air duct is inserted with a cut (concave) towards the victim’s palate; after which the air duct is screwed into the victim’s oropharynx and its concavity turns towards his tongue, thereby pushing back the root of the tongue.
With a correctly inserted air duct, retraction of the tongue root is guaranteed to be eliminated and, in addition, the rim of the air duct provides a certain safety for the resuscitator, eliminating contact with the victim’s lips (Fig. 22).
Thus, the most common cause of airway obstruction in a victim who is unconscious in a supine position, recessed tongue root, can be eliminated in the following ways:
2) carrying out the “triple reception of Safar” in the classical way or using its varieties (modifications);
3) introduction of an air duct.
II. Ingestion of a foreign body into the respiratory tract. As you know, the act of inhalation is an active process, in which the surrounding air is “sucked” into the respiratory tract and, ultimately, into the lungs of a person.
During the act of swallowing (liquids, food), the entrance to the respiratory tract is closed with a special device - a tongue located below the root of the tongue and directly connected to it. Therefore, a foreign body or foreign object, being in the human oral cavity, can enter the respiratory tract when the tongue simply does not have time to block the entrance to it. This situation is possible when eating food, when a person coughs, sneezes, laughs, talks, or simply mechanically consumes food while thinking about something. If a foreign body enters the victim’s respiratory tract, he will cough, clutch his throat, and be motorically and emotionally restless (Fig. 24).
In this case, you cannot waste a second, since within 1-2 minutes the victim may lose consciousness due to sudden blockage of the airways and developed hypoxia (oxygen starvation) of the brain. Therefore, if it is recorded that a foreign body has entered the victim’s respiratory tract, it is necessary to immediately begin decisive and competent actions (Fig. 25). It makes sense to ask a short and informative question to the victim (for example, “Are you choking?” or “Do you need help?”) and, having received an affirmative answer (with a nod of the head, for example), perform the following actions:
1) ensure stability for yourself and the victim (position yourself correctly on the side of the victim, grab the shoulder farthest from you);
2) slightly tilt it forward and make 5-6 sharp blows with an open palm between the shoulder blades (Fig. 26). The purpose of this method is to specifically shake the difficult cell, which allows the foreign body to either change its position inside the upper respiratory tract or move in one direction or another, thereby increasing the chance of saving the victim.
In a small child, a foreign body is removed by placing it in a supine position (on the hand or knee of the resuscitator) and gently tapping the palm (or its edge) on the interscapular area (Fig. 27). If this method does not bring the expected success (the victim answers the question “Can you breathe?” in the negative or does not answer at all), the following steps should be taken:
1) ensure stability for yourself and the victim (position your leg correctly, standing behind the victim);
2) clasp it with your hands around the waist and, placing the fist of one hand at a point located above the navel and below the sternum, covering it with the palm of the second hand (Fig. 28), apply push-like pressure on the stomach of the victim of the navel towards the diaphragm (Fig. 29).
When performing this method, increased pressure is created in the abdominal cavity, which is transmitted through the diaphragm to the chest cavity, and, thanks to the residual air always present in the lungs, the foreign body is removed from the victim’s respiratory tract, similar to the principle of operation of the pneumatic mechanism. This method is called the Heimlik maneuver (named after the resuscitator who first successfully used it), or the lock method.
The Heimlik maneuver should not be used on children under 1 year of age or pregnant women!
But if for some reason the victim has lost consciousness (the above methods were ineffective, help was not started in a timely manner, or you are faced with the fact of an existing loss of consciousness as a result of a foreign body entering the respiratory tract), then you can try to remove the foreign body with your fingers, but at the same time being extremely careful not to push a foreign object deeper into the throat; To do this, press the victim’s tongue and lower jaw with your thumb and forefinger, lifting the chin up. In this case, the tongue will move away from the back wall of the pharynx; which will make it possible to see an object stuck there that was not noticed before (Fig. 30).
With one or two fingers of one hand, try to pick up the foreign object from behind, like a hook, and carefully remove it (Fig. 31). If you were unable to pull out the object with your fingers, then you need to perform the following steps:
1. Turn the victim on his side, facing the person providing assistance (to control the result), and perform sliding blows with an open palm between the shoulder blades (Fig. 32).
2. Lay the victim on his back, turn his head to the side, place the base of the palm in the subdiaphragmatic area and, covering it with the other hand, apply sharp pressure to the victim’s stomach (Fig. 33). This method simulates the Heimlik maneuver, and therefore it is also not applicable to children under 1 year of age.
3. Lay the victim on his stomach, place either hand (to create support) under the chest, tilt the victim’s head back, fix it with your hand behind the forehead; make sliding sharp blows with an open palm between the shoulder blades.
After each attempt, try to carefully remove the foreign object and (or) carry out PDV!
If the attempt to remove the foreign body is successful and the diagnostic exhalation is carried out, check the presence of breathing in the victim and, if there is no breathing, immediately begin artificial ventilation of the lungs; in addition, it is also necessary to check the presence or absence of a pulse in the carotid artery.
III. Flooding of the airways with fluid(blood, water, vomit) and emergency measures will be discussed in detail in the lesson “First aid for drowning.”
Airway obstruction by foreign body
New description
Obstruction of the airways by a foreign body causes asphyxia and is a life-threatening condition that occurs very quickly, the patient very often cannot explain what happened to him. If the obstruction is severe, it can lead to rapid loss of consciousness and death if the victim is not treated quickly and successfully. Immediate recognition and management of foreign body airway obstruction is of paramount importance.
Because recognition plays a key role in successful assistance, it is very important to ask the victim, “Are you choking?” This gives him the opportunity to respond with at least a nod if he cannot speak.
You should suspect suffocation, especially if:
- the episode occurred while eating, and its onset was very unexpected;
- an adult victim may grab himself by the neck or point to his throat.4
- In children, clues may include, for example, eating or playing with small objects before the onset of symptoms.
Severity rating
Not severe suffocation:
- the victim can breathe and speak, his cough is effective;
- the child is conscious, cries or answers questions verbally, coughs loudly, and can inhale before coughing.
Severe suffocation:
- the victim cannot speak or make sounds;
- wheezing;
- silent or silent cough;
- cyanosis and gradual deterioration of consciousness (especially in children) until its complete loss.
Urgent Care
In adults:
For mild obstruction, encourage the victim to continue coughing. There is no need to take any action other than monitoring the patient's condition.
In case of severe airway obstruction in a conscious victim:
- stand to the side of and slightly behind the patient, support the chest with one hand and tilt him forward (so that the foreign body enters the mouth and does not fall down the respiratory tract);
- give 5 sharp blows to the back between the shoulder blades with the other hand (check after each blow to see if the obstruction has been released);
- if unsuccessful, perform 5 abdominal thrusts (Heimlich maneuver). Stand behind the victim, lean him forward, place both hands clasped together around the upper abdomen and pull sharply inward and upward;
- continue alternating 5 blows to the back and 5 abdominal blows until they are successful or until the victim loses consciousness.
If the victim is unconscious:
- put him on the floor, on his back;
- call an ambulance immediately;
- Start CPR (even if a pulse is present in a choking patient who is unconscious).
Algorithm for emergency care for foreign body obstruction in adults
In children:
- For mild obstruction, encourage and monitor the child's cough
- In a conscious child with severe airway obstruction by a foreign body:
- Give 5 blows to the child's back
- If back blows do not clear the airway, give 5 chest thrusts to children under 1 year of age or 5 abdominal thrusts to children over 1 year of age. This technique creates an artificial cough, which increases pressure in the chest cavity and can dislodge a foreign body.
- Place the child lying face down on your lap;
- support the child's head by placing your thumb on the corner of the lower jaw, and one or two other fingers of the same hand on the opposite side;
- do not squeeze the soft tissue under the child's lower jaw, as this may increase airway obstruction;
- give 5 sharp blows to the child’s back between the shoulder blades;
- The goal is to clear the airway with any of these strikes, not to do all 5.
Back blows in children over 1 year of age:
- more effective if the child is positioned head down;
- a small child can be placed on the rescuer's lap, just like an infant;
- if this is not possible, tilt the child forward, supporting him, and strike him from behind between the shoulder blades.
If back blows do not dislodge the foreign body and the child is still conscious, use chest thrusts in infants or abdominal thrusts in children over 1 year of age. Do not use abdominal thrusts on infants.
- Turn the child to a supine position, head down. This is safely achieved by placing your free hand along the baby’s back and clasping the back of his head with your hand;
- support the baby with your hand, which is placed on your hip;
- determine the location of chest compressions (in the lower half of the sternum, approximately one finger width above the xiphoid process);
- perform 5 chest thrusts; they are similar to chest compressions, but sharper and less frequent.
Abdominal tremors in children over 1 year of age:
- position yourself behind the child, place your arms around his body, bring them together on the stomach between the navel and the xiphoid process;
- sharply pull your arms inward and upward;
- repeat up to 5 times;
- make sure not to put pressure on the xiphoid process or ribs - this may cause injury to the abdominal organs.
After chest thrusts or the Heimlich maneuver, the child's condition should be re-evaluated. If the foreign body has not been removed and the child is still conscious, alternate blows to the back and chest thrusts or Heimlich maneuvers.
- An unconscious child with severe airway obstruction from a foreign body:
- Airway patency. Open your child's mouth and look for a visible foreign body. If you find it, try removing it with one finger. Do not try “blindly” or make repeated attempts - this may push the foreign body deeper.
- Artificial breaths. Open the airway by extending the head and thrusting the lower jaw, then give 5 rescue breaths. Monitor the effectiveness of each breath in raising the chest.
- Chest compressions and CPR:
- after 5 artificial breaths (if there is no reaction - movements, coughing, spontaneous breathing) proceed to chest compressions without assessing signs of blood circulation;
- if you are alone, perform CPR as recommended for children for 1 minute, and then call an ambulance (if someone else has not done this);
- when the airways are open for artificial respiration, check the oral cavity for the presence of a foreign body;
- if it is visualized, try removing it with one finger;
- if the foreign body is removed, open and check the airway; perform artificial respiration if the child is not breathing;
- If the child regains consciousness and begins to spontaneously breathe effectively, place him in a stable position on his side and monitor his breathing and level of consciousness until the ambulance arrives.
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