In this lesson, we're going to look at how and when to use rescue breathing on an unconscious adult patient.
The main factor when it comes to rescue breathing is whether or not you can find a pulse. As you know, if the patient isn't breathing normally and doesn't have a pulse, you go immediately into CPR.
However, if when assessing the patient, you do find a pulse and are confident that it is a pulse, that's when you'll use rescue breathing.
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive.
Are you OK? Can you hear me?
If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps.
- Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc.
- Check for the carotid pulse, located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse.
- Look one more time for signs the patient is breathing normally.
- If you've determined at this point that the victim is unresponsive, not breathing normally (as you now know from previous lessons, agonal respiration is not breathing normally and should be considered the same as NO respirations), but does have a pulse, continue immediately with rescue breathing.
Rescue Breathing Technique for Adults
- Grab the rescue mask and seal it over the victim's face and nose.
- Lift the victim's chin and tilt his or her head back slightly.
- Breathe into the rescue mask and count out loud – one one-thousand, two one-thousand, three one-thousand, four one-thousand, five one-thousand …
- On six one-thousand, breathe into the rescue mask again.
- Continue using the rescue breathing technique until help arrives or the patient revives. If you have an AED, consider preparing it for use just in case the patient loses his or her pulse.
Pro Tip #1: You're going to continue to perform one rescue breath every six seconds for two minutes. At that time, reassess the patient. If you still detect a pulse but the patient isn't breathing normally, continue with one rescue breath every six seconds for two more minutes. And so on.
Pro Tip #2: Make sure the patient's chest rises as you perform your rescue breaths. If it doesn't, this could indicate an airway obstruction.
Warning: If at any point you discover that the patient's pulse is gone, go immediately into full CPR and use an AED if you have one available.
A Word About the Respiratory System
The respiratory system is divided into two parts – the upper airway tracts and the lower airway tracts.
The lower airway tracts access the respiratory system through the nose and mouth. As air is inhaled through the nose, it's warmed and humidified. Air inhaled through the mouth goes over the tongue and into the pharynx.
The pharynx is divided into three parts – the nasopharynx, the oropharynx, and the laryngopharynx. The nasopharynx lies behind the nasal cavity. The oropharynx is located behind the oral cavity and is the shared passageway for both food and air.
The laryngopharynx is the lowest part of the throat and divides into two passageways. The back portion is the entrance to the esophagus, which is the passageway for food. The front portion is the larynx, which is the continuation of the respiratory system.
Above the larynx is the epiglottis – a flap of cartilage that folds down over the larynx to close it off to the trachea during swallowing, so that food doesn't enter. Incidentally, this only works if the person is conscious.
After air travels through the pharynx, it then passes through the larynx. At the top of this structure is the hyoid bone (a horseshoe-shaped bone that helps support the structure of the larynx), made mostly of cartilage, muscle, and membranes. Below the hyoid bone are the thyroid and cricoid cartilages, which form the larynx.
The lower airway tract begins below the vocal cords and consists of the trachea, bronchi, and lungs. The trachea is a hollow tube that's supported by rings of cartilage. It extends downward until it divides into two branches called bronchi, that connect with each lung. The two bronchi are also hollow tubes and supported by cartilage. And they, too, divide – into lower airways called bronchioles.
Bronchioles are thin hollow tubes that remain open and lead to the alveoli. The alveoli – small sacs that form the end of the airway – number in the millions. Each alveolus shares a wall with capillary blood vessels. This point, where the walls of the alveoli and the walls of the capillaries come into contact, is where external respiration takes place – that all-important exchange of oxygen and carbon dioxide between the respiratory and circulatory systems.
