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Emergency life support Q&As

Published by Bupa's health information team, September 2009.

Answers to questions about emergency life support

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

Can I catch anything from doing mouth-to-mouth breathing (rescue breaths)?

The chance of developing an infection from giving rescue breaths is very small. However, if you don't want to do mouth-to-mouth breathing, just give chest compressions.

Explanation

When you're in a situation where you need to give rescue breaths you may find that you're reluctant to do so because you're worried about catching an infection. Some people don't like the idea of doing rescue breaths and find it difficult to perform mouth-to-mouth breathing on a complete stranger. You may also not want to do rescue breaths if the person has vomited or is bleeding around the mouth or lips.

The chance of catching an infection after giving someone mouth-to-mouth breathing is small. A very small number of people in the world have developed tuberculosis (TB) or severe acute respiratory distress syndrome (SARS) after giving rescue breaths to someone. No one has ever become infected with human immunodeficiency virus (HIV) as a result of giving rescue breaths.

You can buy face shields and masks that allow you to do mouth-to-mouth breathing without making direct contact with the person's face or mouth.

If you don't want to do mouth-to-mouth breathing, just give chest compressions. During the first few minutes after someone collapses the oxygen levels in the body stay high, so chest compressions alone can help to keep the blood flowing around the body until more help and equipment arrive.

Further information

Sources

  • Handley AJ, Koster R, Monsieurs K, et al. European Resuscitation Council guidelines for resuscitation 2005: section 2. Adult basic life support and use of automated external defibrillators, 2005. www.erc.edu
  • Resuscitation guidelines. Resuscitation Council (UK), 2005. www.resus.org.uk
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Why has the number of rescue breaths to chest compressions changed?

The guidelines in the UK changed in 2005 and now state that you should do two rescue breaths for every 30 chest compressions.

Explanation

The UK Resuscitation Council guidelines for doing emergency life support if you're alone and not in hospital have changed. Until 2000, the guidelines for emergency life support said that for every 15 chest compressions you should do two rescue breaths. However, in 2005 the guidelines in the UK changed and now state that you should do two rescue breaths for every 30 chest compressions. This is mainly because the fewer interruptions there are in chest compressions, the better the chance of survival for the injured person (casualty).

Recent research has found that if chest compressions are interrupted, for example to get your hands in the right place or do rescue breaths, the chance of survival is reduced. If you're doing fewer rescue breaths, you will do more chest compressions, which has a better effect on the casualty's heart and blood circulation.

Research also shows that when doing rescue breaths people tend to take too long and give too big a breath. This means that time is lost when chest compressions could be done instead. Therefore, the number of breaths to chest compressions has decreased. The length of time recommended for each rescue breath has also reduced from two seconds to one. This means you must breathe out into the casualty's mouth for one second instead of two, so the breath is shorter and less air goes into his lungs.

Guidelines now also suggest that when starting emergency life support the rescuer needs to start chest compressions straight away rather than starting with rescue breaths. This is so that the most vital part of life support - the chest compressions - start as soon as possible.

Further information

Sources

  • Resuscitation guidelines. Resuscitation Council (UK), 2005. www.resus.org.uk
  • New guidelines for resuscitation (CPR). European Resuscitation Council, 28 November 2005. www.erc.edu
  • Arawwawala D, Brett S. Changes to the European Resuscitation Council cardiac arrest management guidelines - a commentary. Br J Cardiol 2006; 13:425-29. www.bjcardio.co.uk
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What should I do if someone is choking?

If someone is choking, it means that an object has got stuck at the back of their throat and he or she may be having trouble breathing. Your aim is to get the object out and, if you need to, get medical help quickly. If the person can't breathe and the object is large, the two main ways to get it out are by giving blows to the back or by using abdominal thrusts (called the Heimlich manoeuvre).

Explanation

Choking is the body's response to an object stuck at the back of the throat that blocks it or causes the muscles there to go into spasm. This means that the person may be unable to breathe properly. If the object is large enough, he or she may become unconscious and stop breathing. This is why it's important to be able to recognise when someone is choking and be able to take the right steps to help.

Choking often happens when someone is eating and many people will look distressed and clutch at their neck. Choking can happen to anyone but for simplicity we have referred to the person choking in the male gender throughout.

First you need to find out whether the person is choking and how bad it is. Go up to him and ask him if he is choking. If the object is small and the choking is mild he will be able to answer you, breathe and cough. In these circumstances you don't need to do anything apart from encouraging him to cough until the object comes out. If he can't speak to you and can only nod, the object may be large and the choking more severe. Other signs of severe choking are:

  • his breathing sounds wheezy or he can't breathe at all
  • when he tries to cough you can't hear anything
  • he becomes unconscious

Your aim now is to get the object out and get medical help quickly if necessary. To get the object out you will need to dislodge it either by using back blows or by using a procedure called the Heimlich manoeuvre.

  • Back blows - these are sharp blows to the person's back. Stand slightly behind and to the side of him. Lean him forward so that the object will come out when it's loosened. Support him with one hand and then give up to five sharp blows between his shoulder blades with the other hand. In between each blow, check his mouth and remove any obvious blockage. If after five back blows the object hasn't come out, and he is still choking, you need to do the Heimlich manoeuvre.
  • Heimlich manoeuvre (abdominal thrusts) - stand behind the person, wrap your arms around his waist and lean him forward slightly. Make a fist with one hand and place the thumb side of it against the upper part of his abdomen (tummy) between the bottom of his ribcage and his navel. Hold your fist with your other hand and pull it sharply inwards and upwards. Make sure you don't squeeze his ribcage by mistake. Do this five times, checking in between each thrust whether the object has come out.

Keep doing back blows followed by abdominal thrusts until the object comes out. If the object hasn't come out after three cycles of five back blows and five abdominal thrusts, call for emergency help. Keep giving back blows and thrusts until it arrives.

If you have used the Heimlich manoeuvre, once the person has recovered it's important that he gets medical help straight away because abdominal thrusts can cause injury.

If he becomes unconscious, lower him gently to the floor, call for emergency help and start cardiopulmonary resuscitation (CPR) immediately.

The techniques described above are for treating adults. It's important to be aware that the treatment for babies and children is different.

Further information

Sources

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How can I tell if a casualty's breathing is normal?

Normal breathing is consistent, regular and rhythmical. It's effortless and quiet. You should be able to see the chest rise and if you place your cheek next to the casualty's mouth, you should feel their breath on your skin.

If you're in any doubt whether a casualty's breathing is normal, act as if it isn't.

Explanation

A person who has had a cardiac arrest where the heart has stopped or is beating so slowly that it can't support life may gasp for air. These are called agonal gasps and people performing emergency life support frequently misdiagnose these for normal breathing.

Up to four out of 10 people who have a cardiac arrest have agonal gasps. They often occur in the first few minutes after sudden cardiac arrest. Don't confuse these with normal breathing - they are a sign that you must start cardiopulmonary resuscitation (CPR) immediately. If you're in any doubt whether the casualty is breathing normally, assume he isn't and start CPR.

Further information

Sources

  • Resuscitation guidelines. Resuscitation Council (UK), 2005. www.resus.org.uk
  • Personal communication, Bart's city life saver's basic life support course, April 2009
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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: September 2009

 

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