Rescue Breathing and Airway Management - Mistakes to Avoid
If you saw someone slump over and stop breathing, would you know how to help? Perhaps someone has an allergic reaction. Maybe they're choking. Maybe they’ve drowned. Whether you're a paramedic, doctor, or parent, having the skill to help someone breathe is invaluable.
Rescue breathing includes mouth-to-mouth, mouth-to-mask (using a pocket mask), and even BVM (bag-valve-mask). Rescue breathing has saved lives—the more people who know this skill, the better.
Why You Should Learn How to Perform Rescue Breathing
From a paramedic’s perspective, it's astounding how many trained providers struggle with airway management. Why is this? Well, it's likely because this skill isn't as glamorous as calling helicopters or performing cricothyrotomies.
Don't be fooled. Rescue breathing and good airway management will save lives.
Here are several reasons to learn rescue breathing:
- More prepared to care for your family in an emergency
- A better understanding of emergencies will help you avoid them
- Familiarizing yourself with the equipment can position you to help professionals
Let's discuss a growing misconception about airway management.
Is Rescue Breathing Obsolete? (It's Still Very Important)
There is an emerging idea that rescue breathing is no longer important. This is wrong. However, we should discuss some nuances.
Here are several reasons some people shy away from rescue breathing:
- CPR hesitant. Some people are slow to start CPR, as they (understandably) don't want to perform mouth-to-mouth for a stranger. In response to this, the AHA has released hands-only CPR guidelines. However, the AHA continues to maintain that trained personal should provide rescue breathing if possible.
- Poorly understood. Airway management is more difficult than some responders expect. For this reason, responders (even trained responders) can inadvertently cause harm. This lack of training has caused some to advocate against serious airway management, particularly in the case of CPR.
- Downsides. There are risks to airway management. Aspiration (contaminating the lungs), gastric insufflation (filling the stomach with air), and barotrauma to the lungs (potentially damaging the lungs) are just a few reasons why some areas have moved away from traditional airway management.
Key takeaway: Airway management is still extremely important. While airway management is evolving for some CPR patients, most patients still require a high level of effective rescue breathing and airway management.
How Do I Know If Someone Needs Rescue Breathing?
The first step in learning how to perform rescue breathing is understanding when you should initiate this skill.
Here are some specifics you can look for:
- Response level. If you're making noise and calling someone's name and they are not responding, it's time to consider if their breathing is adequate.
- Foam, vomit, saliva around the mouth. If someone isn't controlling their airway, they won't clear fluid and solids from their mouth.
- No chest rise and fall. If the chest isn't rising and falling, you can assume someone needs help.
- Color. People turn purple and blue relatively fast if they aren't breathing.
Look for breathing, feel the chest with your hand, feel warm air movement out the mouth and nose, and listen for breath sounds (if you have a stethoscope, use it!).
How Do I Perform Rescue Breathes?
Now, let's explore how to perform rescue breaths. We will focus on how to perform mouth-to-mouth and mouth-to-mask breathing. If you're curious, check out the article on bag-valve-masks vs. CPR masks.
Here are the major steps to rescue breathing and airway management:
- Determine breathing status
- Position the patient
- Open the airway
- Clear the airway
- Provide rescue breathes
Let's go into each of these steps in more depth.
1. Prepare equipment
You can perform rescue breathing with no equipment. However, if you have the equipment, be sure to keep it organized.
Here are several common pieces of airway gear:
- CPR face shield
- CPR pocket mask
- NPA - Nasopharyngeal airway
- OPA - Oropharyngeal airway
- Suction equipment
- Towel roll
Always learn the ins and outs of your equipment. Good equipment can help you; however, you must know how to use it.
2. Determine Breathing Status
Remember to look, listen, and feel for breathing. Use all your senses to determine if someone is having trouble breathing. If you don't see chest rise and fall, or the patient appears to be gasping for breath, then consider helping them breathe.
3. Position the Person
Once you've identified the patient needs rescue breathing, it's time to begin airway management. After ensuring the scene is safe (no fires or bombs), the first step is to position the patient.
The best position for airway management depends on the patient and the situation. Adults, kids, and infants will all require a slightly different position.
Here are the ages and some ideas for positioning each:
- Adults. Adults typically require padding underneath the head. However, those who are obese may require padding under the shoulders and head.
- Children. Often require padding under the shoulders. The goal is to bring the head forward.
- Infants. Padding under the shoulders. However, sometimes you'll need to play around to find what works.
When it comes to airway position, remember: head forward, nose up.
3. Open the Airway
After you've positioned the patient, you need to open the airway. You can open the airway using several techniques.
Here's an overview:
- Jaw thrust. Perform the jaw thrust by lifting the patient's mandible (the lower jaw) forward. This action pulls the tongue off the back of the throat. Some argue that this is the best maneuver to open the airway.
- Head tilt chin lift. This action involves lifting the patient's chin with one hand and holding the forehead with the other. It's critical to implement towel rolls and pillows for this method.
- Triple airway maneuver. This involves combining the head tilt, the chin lift, the jaw thrust, and opening the mouth with your thumbs. You accomplish this by kneeling behind the patient's head.
Once you've opened the airway, it's time to clear the airway.
5. Clear the Airway
After you've positioned the airway and opened the airway, now you have to clear the airway.
Pushing air into the lungs will carry vomit, saliva, and blood with it.
So, here are several steps to keeping the airway clear:
- Roll the patient onto their side
- Use suction device
- Remove large objects
Now that you've ensured the airway is clear, we can begin giving rescue breaths.
6. How to Give a Rescue Breath
Let's cover several ways to administer rescue breathes.
Here are some techniques:
- CPR mask
- Bag valve mask
After you've become familiar with the techniques, it's time to begin breathing for your patient.
Steps to rescue breathing:
- Place the mask over the nose and mouth (make sure to size it correctly)
- Form a seal. One hand on top of the mask and one of the bottom (if you're using a CPR mask)
- For mouth-to-mouth, seal the nose with one hand and lift the chin with the other.
- If you're performing rescue breathing without CPR (the patient has a pulse), give adults a breath about once every 6 seconds. A child will need a breath about once every 3 seconds. And a newborn may need a breath almost every other second (about 40 per minute). These rates can change based on the circumstance.
- If you're providing breaths during CPR, give two breaths every 30 compressions (if you're trained).
If the patient begins breathing on their own, you can then place them in the recovery position.
NOTE: Some people don’t believe in mouth-to-mouth. However, if your spouse or child isn’t breathing, it’s still helpful to know this skill.
Airway Management Mistakes to Avoid
In this section, we discuss several mistakes to avoid.
- Improper positioning
- Overventilation (breathing too fast and too hard)
- Not training
Let’s look a bit closer.
Forgetting to Position the Patient
Use towel rolls, pillows, a T-shirt, whatever you can to ensure the person stays in the sniffing position.
In an emergency, it's easy to forget to hold the patient's airway open. Always try to use something to "prop" the patient's head into a good breathing position.
Breathing Too Fast
One of the biggest beginner mistakes is overventilation. Overventilation means you're giving too much air at a time or breathing too fast.
But the person hasn't been breathing for a while - don't they need a lot of air? Well, not really. They need just enough.
When breathing for a patient with a BVM, squeeze the bag carefully, over about one second. Instead of robotically squeezing the bag (or blowing air into the lungs for mouth-to-mask), try to feel the lungs. With practice, you'll soon regulate your breath based on the amount of resistance you feel.
If you buy a BVM (or any medical gear) and expect yourself to be a superstar life saver, think again. That's like buying a guitar and expecting it to turn you into a rock star. If you buy equipment without training, you're likely to embarrass yourself on the scene - worse; you could harm the patient.
There's nothing wrong with watching videos (or reading articles) - indeed, read and watch as much as you can! However, you also need to include hands-on training in your emergency preparation.
Final Words on Rescue Breathing
Rescue breathing and airway management are right up there with bleeding control. If you learn how to manage an airway effectively, you will be more confident at work and around your family.
Again, training is the key. Learning effective airway management and rescue breathing can take a while - there's a lot to know! Don't give up. It's worth it. It saves lives.