Name: basic life support: airway and breathing
Uploaded: 2023-04-30T06:47:39.000Z
Duration: 8 min 20 s
Channel: JoVE

K12 Standards

new-york-state-science-learning-standards

New York State Science Learning Standards

High School

Life Science

Structure and Function

HS-LS1-3.

basic-life-support-part-ii-airwaybreathing-continued-cardiopulmonary

Basic Life Support Part II:  Airway/Breathing and Continued Cardiopulmonary Resuscitation

Please note that ventilation requires a second rescuer. While the first rescuer performs continuous, high-quality chest compressions, the second rescuer performs all the steps needed to ventilate the patient. Ventilation should never be allowed to interfere with chest compressions. If there are insufficient personnel to do both, then compressions are the priority.
1. While chest compressions are in progress, prepare ventilation equipment
<ol>
	<li>Obtain a bag-valve-mask (BVM) device, which is readily available in most hospitals.
	<ol>
		<li>Mouth-to-mouth rescue breathing is no longer recommended except in certain extreme circumstances, and should not be performed in the hospital setting.</li>
	</ol>
	</li>
	<li>Attach the BVM device to oxygen, setting the flow at 10-15 L/min</li>
</ol>
2. While chest compressions are in progress, open the airway.
3. Proper positioning of both patient and rescuer is crucial to effectively open the airway.
<ol>
	<li>Position the patient in a supine and flat position, and remove pillows and other items that may obstruct positioning.</li>
	<li>Stand directly at the head of the bed. It is not possible to properly perform BVM ventilation from the side, or from any other position.</li>
	<li>Assuming there is no concern for trauma, use the &#34;head tilt/chin lift&#34; maneuver to open the airway. Do this by placing the palm of one hand on the patient&#39;s forehead and the fingers of the other under the chin. Use the fingers to lift the chin, extending the neck.</li>
	<li>In some patients, a prominent occipital bone may make it difficult to adequately extend the neck. If this is the case, use a shoulder roll to lift the shoulders, thereby extending the neck.</li>
	<li>If there is concern for trauma, it is important to avoid manipulating the cervical spine if possible. In this case, use the &#34;jaw thrust&#34; maneuver. Do this by placing your fingers behind the angle of the mandible, and displacing the mandible anteriorly. Please note that this maneuver is not always effective, in which case a chin lift maneuver must be performed to open the airway. Remember that cervical spine injury is a theoretical concern, whereas airway occlusion is an imminent life threat.</li>
</ol>
4. While chest compressions are in progress, place the mask over the patient&#39;s mouth and nose.
<ol>
	<li>The pointed part of the mask fits over the nasal bridge, and the rounded part rests on the chin. The mask should not hang over the point of the chin, and should not cover the orbits.</li>
</ol>
5. While chest compressions are in progress, seal the mask firmly to the patient&#39;s face. This is necessary to allow air from the bag to enter the lungs, rather than leaking out into the room. The best way to do this is by using the &#34;C/E&#34; technique.
<ol>
	<li>Using your dominant hand, make a &#34;C&#34; with your thumb and forefinger around the stem of the mask.</li>
	<li>Make an &#34;E&#34; with your 3rd-5th fingers along the patient&#39;s mandible, taking care to place the 5th finger behind the angle of the mandible.</li>
	<li>Use your 3rd-5th fingers to pull the patient&#39;s face up into the mask. Do not push the mask down on the face, as this will most often make ventilation more difficult.</li>
</ol>
6. Pause chest compressions to begin ventilations.
<ol>
	<li>While maintaining your mask seal on the patient&#39;s face, squeeze the bag with your opposite hand to inflate the lungs.</li>
	<li>Give two slow breaths, squeezing the bag over one second, and releasing it over another second.</li>
	<li>Observe for chest rise with each breath. This will be your only indication of effective ventilation! You will not be able to follow pulse oximetry, as the patient has no pulse.</li>
	<li>Avoid hyperventilating the patient - you should only insufflate enough air to produce visible chest rise. Hyperventilating raises interthoracic pressure and decreases blood flow to the heart.</li>
</ol>
7. If you do not see chest rise, resume chest compressions, and prepare to troubleshoot your BVM technique on the next pause for ventilations.
<ol>
	<li>First, check your positioning. Are you standing directly at the head of the bed? Is the patient supine, with no pillow or other obstructions?</li>
	<li>If patient and rescuer positioning are appropriate, reposition your hands, and try again to open the airway using head tilt/chin lift and/or jaw thrust, then attempt to ventilate again.</li>
	<li>If this is not successful, switch to the two-person technique.
	<ol>
		<li>Use the C/E technique to seal the mask to the face using both hands. This will allow you to seal the mask more effectively, and add a jaw thrust to your chin lift.</li>
		<li>Have an assistant squeeze the bag to inflate the lungs.</li>
	</ol>
	</li>
	<li>If this is not successful, insert an oropharyngeal airway (OPA).
	<ol>
		<li>Select the correct size of OPA by choosing one that extends from the corner of the patient&#39;s mouth to his earlobe.</li>
		<li>Insert the hooked end into the mouth, over the base of the tongue. This will pull the tongue forward, out of the hypopharynx.</li>
		<li>You may insert the OPA straight into the pharynx, or insert it upside-down, turning it as it passes over the base of the tongue.</li>
		<li>Take care not to push the tongue farther back into the hypopharynx. You may need to manually displace the tongue with your gloved hand or with a tongue depressor in order to do this.</li>
	</ol>
	</li>
</ol>
8. Coordinate chest compressions with ventilations.
9. Resume chest compressions immediately after two breaths are given.
10. Give 30 chest compressions. Count out loud to keep track of the number of compressions administered.
11. After 30 chest compressions, give two more breaths.
12. Continue CPR, using a 30:2 compression:breath ratio. Do this for 5 cycles of 30:2, or two minutes timed by a clock or automated defibrillator, at which point it will be time to pause for reassessment.
13. Pause CPR for rhythm check.
<ol>
	<li>As discussed in the first video, you must pause chest compressions in order to accurately assess the rhythm - this is because chest compressions create electrical interference that will obscure the underlying rhythm.</li>
	<li>Determine if the rhythm is shockable - i.e., if it is ventricular fibrillation or ventricular tachycardia. These rhythms were discussed in the first video.</li>
	<li>If the rhythm is shockable, then administer a shock as discussed in the first video. Immediately after shocking, resume chest compressions.</li>
	<li>If the rhythm is not shockable, then resume chest compressions without shocking.</li>
	<li>If you don&#39;t have a defibrillator available, which may be the case in remote locations, perform a carotid pulse check during these scheduled pauses. You may also assess the carotid pulse at the same time as you&#39;re checking the rhythm.</li>
</ol>
14. Continue CPR for as long as clinically indicated.
<ol>
	<li>Perform 30 compressions for every two breaths.</li>
	<li>Pause every 5 cycles or two minutes for a rhythm/pulse check.</li>
	<li>Stop CPR only when it is no longer clinically indicated. Indications for terminating CPR include:
	<ol>
		<li>The patient regains consciousness</li>
		<li>The patient remains unconscious but regains a pulse</li>
		<li>Further resuscitation is futile and you intend to pronounce the patient dead</li>
	</ol>
	</li>
</ol>
15. Consider advanced life support measures (like intubation or vascular access) only once help arrives and if these maneuvers can be performed without detracting from the quality and continuity of CPR.

Quality CPR is absolutely essential to cardiac arrest survival, and must be perfected by all healthcare providers. While chest compressions and defibrillation are more important than respiratory support, patients with prolonged resuscitations will benefit from ventilation, and it should be performed whenever there is sufficient manpower and equipment to do so. BVM ventilation is a much more difficult skill than it would seem at first glance, and rescuers must perfect their technique in order to be effective. Knowledge...

basic life support part ii:  airway/breathing and continued cardiopulmonary resuscitation

Source: <a href="https://www.jove.com/author/Julianna_Jung">Julianna Jung</a>, MD, FACEP, Associate Professor of Emergency Medicine, The Johns Hopkins University School of Medicine, Maryland, USA
High-quality cardiopulmonary resuscitation (CPR) and defibrillation are the most important interventions for patients with cardiac arrest, and should be the first steps that rescuers perform. This is reflected in the American Heart Association's new "CAB" mnemonic. While rescuers were once taught the "ABCs" of cardiac arrest, they now learn "CAB" - circulation first, followed by airway and breathing. Only once CPR is underway (and defibrillation has been performed, if a defibrillator is available) do we consider providing respiratory support. This video will describe the correct technique for providing respiratory support to a patient in cardiac arrest, and how to continue basic life support over the period of time until help arrives.
This video assumes that all the steps described in "Basic Life Support Part I: Cardiopulmonary Resuscitation and Defibrillation" have already been completed. This video does NOT depict the initial steps taken when arriving at the scene of a cardiac arrest.

Source: Julianna Jung, MD, FACEP, Associate Professor of Emergency Medicine, The Johns Hopkins University School of Medicine, Maryland, USA
High-quality ...

Continued CPR with integrated respiratory support is essential to ensure that your patient remains perfused and oxygenated until such time as spontaneous circulation is restored. CPR and defibrillation, discussed in the previous Basic Life support video, are the most important interventions for patients with cardiac arrest. Respiratory support, which includes establishing an airway and rescue breathing, is begun only after cardiac compressions are underway and defibrillation has been performed.This video describes how to establish an airway using a bag-valve-mask, or BVM, and how to coordinate ventilation and CPR. Lastly, we'll also discuss some troubleshooting steps, which includes using an oropharyngeal airway, or OPA. "Note that ventilation requires a second rescuer. While the first rescuer performs continuous, high-quality chest compressions, the second rescuer performs all the steps needed to ventilate the patient. Ventilation should never be allowed to interfere with chest compressions. If there are insufficient personnel to do both, then compressions are the priority." While chest compressions are in progress, the first step is to attach the BVM to oxygen and set the flow rate to 10-15 liters per minute. Next, position the patient supine and flat, and remove pillows and other items that may obstruct positioning. Now stand directly at the head of the bed, as it not possible to properly perform BVM ventilation from the side, or from any other position. Now, to open the airway, place the palm of one hand on the patient's forehead and the fingers of the other hand under the chin. Then, using the fingers, lift the chin thereby extending the neck. This is called the "head tilt-chin lift" maneuver, which should only be performed if there is no concern for cervical trauma. If there is concern for cervical trauma, try to open the airway by placing your fingers behind the angle of the mandible and displacing it anteriorly. This is known as the "jaw thrust" maneuver, which will not cause neck extension. If the jaw thrust is not effective at opening the airway, the chin-lift should be utilized, as cervical spine injury is a theoretical concern, but airway occlusion is imminently life threatening. After opening the airway, place the mask over the patient's mouth and nose, with the pointed part over the nasal bridge and the rounded part on the chin. The mask should not hang over the point of the chin, and should not cover the orbits. Next, use the C/E technique to seal the mask. To do this, make a C with the dominant thumb and forefinger around the stem of the mask, and make an E with the third through fifth fingers of the same hand along the patient's mandible, placing the fifth finger behind the angle of the mandible. Then, using your 3rd to 5th fingers, pull the patient's face up into the mask. Do not push the mask down on the face, as this will make ventilation more difficult. With the mask firmly sealed against the patient's face, air from the bag will enter the lungs and not leak out into the room.At this point, with the mask sealed against the patient's face, chest compressions should be paused to begin ventilations. While maintaining the mask seal, squeeze the bag with the opposite hand to inflate the lungs. Give two slow breaths, squeezing the bag over one second and then releasing it over one second. Watch the patient to see the chest rise with each breath. This is the only indication of effective ventilation since pulse-oximetry cannot be used when the patient does not have a pulse. Insufflate only enough air to produce a visible chest rise, as hyperventilation will raise the intrathoracic pressure, which in turn impedes blood return to the heart and reduces cardiac output.Immediately after the first two breaths are administered, resume chest compressions. Counting out loud, give 30 chest compressions and pause for 2 breaths. Continue this ratio of 30 compressions and 2 breaths for 5 cycles, or 2 minutes -- timed by a clock. At this point, pause CPR for a rhythm check, and if the rhythm is shockable, perform defibrillation as described in the previous video on basic life support. If the rhythm is not shockable, continue with the CPR.If the patient's chest did not rise with ventilation, then one should resume chest compressions and perform some troubleshooting steps. Knowledge of how to troubleshoot ineffective ventilation is essential for all providers, as the standard technique often does not produce the necessary chest rise.First, check the positioning. Are you standing directly at the head of the bed? Is the patient supine with no pillow or other obstructions? If patient and rescuer positioning are appropriate, reposition your hands, and try again to open the airway using head tilt-chin lift and/or jaw thrust maneuver, and then attempt to ventilate again.If still unable to ventilate, switch to the two-person technique, in which the rescuer uses both hands to perform the C/E technique to seal the mask to the face and opens airway using both chin lift and jaw thrust technique, while an assistant squeezes the bag to inflate the lungs.If the two-person technique is not successful, insert an oropharyngeal airway, or OPA. The first step is to select the correct size OPA, which is the one that extends from the corner of the mouth to the earlobe. Insert the hooked end into the mouth, over the base of the tongue. This will pull the tongue forward, out of the hypopharynx. An alternative method is to insert it upside-down, while simultaneously turning it as it passes over the base of the tongue. Take care not to push the tongue farther back into the hypopharynx."While chest compressions and defibrillation are more important than respiratory support, patients with prolonged resuscitations will benefit from ventilation, and it should be performed whenever there is sufficient manpower and equipment to do so. The rescuer should continue performing 30 compressions for every two breaths, and pause every 5 cycles or two minutes for a rhythm check." "One should stop CPR only when it is no longer clinically indicated. Indications for terminating CPR include: the patient regains consciousness, the patient remains unconscious but regains a pulse, or further resuscitation is futile and you intend to pronounce the patient dead.""Advanced life support measures like intubation or vascular access should be considered only once help arrives and you're sure that these maneuvers can be performed without detracting from the quality and continuity of CPR."You have just watched a JoVE video describing how to ventilate a patient for whom CPR is already underway, how to coordinate chest compressions with ventilation, and how to troubleshoot when the ventilation does not produce adequate chest rise. As always, thanks for watching!

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JoVE Science Education

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Emergency Medicine and Critical Care

basic life support: airway and breathing

Basic life support for cardiac arrest includes airway and breathing support after CPR is already underway. The American Heart Association now uses the CAB sequence, which means circulation comes first, followed by airway and breathing. In this approach, rescuers start with high-quality chest compressions and defibrillation, if a defibrillator is available, before moving to respiratory support.

Airway care and breathing support are considered only after the first CPR steps have been completed. Airway means the passage that lets air reach the lungs. Breathing support helps move air into a patient who is in cardiac arrest while other basic life support measures continue.

This lesson shows the correct way to provide respiratory support during a cardiac arrest response. It also explains how to keep giving basic life support until help arrives. The scene begins after the initial steps from Basic Life Support Part I, so it does not show the first actions taken when a rescuer reaches the patient.

Basic Life Support: Airway and Breathing

basic life support:  cardiopulmonary resuscitation and defibrillation

basic-life-support-cardiopulmonary-resuscitation-and-defibrillation

High-Quality CPR for Cardiac Arrest

High-quality CPR is a critical response for cardiac arrest. It helps support blood flow and can improve the chance of intact survival. This page focuses on the key steps that make CPR effective and the reasons each step matters. The video explains the essential parts of high-quality cardiopulmonary resuscitation, or CPR. It also describes the physiologic basis for each step. In other words, it connects the actions taken during resuscitation with the body’s need for oxygen and circulation. The...

Basic life support for cardiac arrest includes airway and breathing support after CPR is already underway. The American Heart Association now uses the CAB sequence, which means circulation comes first, followed by airway and breathing. In this approach, rescuers start with high-quality chest compressions and defibrillation, if a defibrillator is available, before moving to respiratory support. Airway care and breathing support are considered only after the first CPR steps have been completed.

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emergency medicine and critical care

This collection delves into a wide range of procedures employed in emergency and intensive care settings, ranging from basic life support methods such as CPR and rescue breathing to other common procedures performed during emergency situations.

Learn how airway and breathing support fit into the CAB sequence of basic life support after CPR and defibrillation have begun during cardiac arrest.

Basic Life Support: Airway and Breathing | JoVE K12

Julianna Jung

The Johns Hopkins University School of Medicine

Overview

Essential Steps

Troubleshooting Steps

Summary

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explant-culture-for-developmental-studies

Explant Culture for Developmental Studies

Explant culture is a technique in which living cells or tissues are removed from an embryo for continued development outside of the organism. This ex vivo ...

DNA Methylation Analysis

Methylation at CpG dinucleotides is a chemical modification of DNA hypothesized to play important roles in regulating gene expression. In particular, the ...

Expression Profiling with Microarrays

Microarrays are important tools for profiling gene expression, and are based on complementary binding between probes that are attached to glass chips and ...

Density Gradient Ultracentrifugation

Density gradient ultracentrifugation is a common technique used to isolate and purify biomolecules and cell structures. This technique exploits the fact ...

F&#246;rster Resonance Energy Transfer (FRET)

F&#246;rster resonance energy transfer (FRET) is a phenomenon used to investigate close-range biochemical interactions. In FRET, a donor photoluminescent ...

detecting-environmental-microorganisms-with-polymerase-chain-reaction

Detecting Environmental Microorganisms with the Polymerase Chain Reaction and Gel Electrophoresis

Source: Laboratories of Dr. Ian Pepper and Dr. Charles Gerba - Arizona University
Demonstrating Author: Bradley Schmitz
Polymerase chain reaction (PCR) is ...

Gel Purification

Gel purification is used to recover DNA fragments after electrophoretic separation. DNA recovery from an agarose gel includes three basic steps: binding, ...

Detecting Reactive Oxygen Species

Reactive oxygen species are chemically active, oxygen-derived molecules capable of oxidizing other molecules. Because of their reactive nature, there are ...

Gene Silencing with Morpholinos

Morpholino-mediated gene silencing is a common technique used to study roles of specific genes during development. Morpholinos inhibit gene expression by ...

development-and-reproduction-of-the-laboratory-mouse

Development and Reproduction of the Laboratory Mouse

Successful breeding of the laboratory mouse (Mus musculus) is critical to the establishment and maintenance of a productive animal colony. Additionally, ...

Genetic Crosses

To dissect genetic processes or create organisms with novel suites of traits, scientists can perform genetic crosses, or the purposeful mating of two ...

Construct an explanation based on evidence for how the structure of DNA determines the structure of proteins which carry out the essential functions of life through systems of specialized cells.

HS-LS1-1.

Basic Life Support: Airway and Breathing

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