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RESPIRATION AND ASPHYXIA
Respiration means breathing in and breathing out of air. This function is necessary to supply oxygen (of the air) to all the organs in the body. Stoppage of oxygen supply to the organs may result in death.
Asphyxia is a condition in which the lungs do not get sufficient supply of air for breathing. If this continues for a minute, breathing and heart action stops and death occurs.
Conditions affecting the air passage.
Water getting into air passage as in drowning.
Irritant gases (coal gas, motor exhaust fumes, smoke, sewerage and closed granary gas and gas in deep unused well etc.) getting into the air passages.
Mass of food or foreign body like artificial teeth etc. in the air passage.
Tongue falling back in an unconscious patient.
Swelling of tissues of the throat as a result of scalding (boiling water) or injury burns and corrosives.
Sea weeds or mud in case of drowning.
Tying a rope or scarf tightly around the neck causing strangulation.
Hanging or throttling (applying pressure with fingers on the windpipe)
Smothering like overlaying an infant, and unconscious person lying face downwards on a pillow or plastic bags covering face completely for some time.
II. Conditions affecting the respiratory mechanism
Epilepsy, Tetanus, Rabies etc.
Nerve diseases causing paralysis of chestwall or diaphragm.
Poisonous snake bite (e.g. Cobra)
III. Conditions affecting respiratory centre
Morphia, Barbiturates (Sleeping tablets)
IV. Compression of the chests
Fall of earth or sand in mines, quarries, pits or compression by grain in a silo or big beam and/ or pillars in house-collapse.
Crushing against a wall or other barrier or pressure in a crowd (stampede)
V. Lack of oxygen at high altitudes with low atmospheric pressure: Acclimatisation (gradual ascent) is necessary.
Signs and symptoms of asphyxia
Patient shows signs of restlessness.
Rate of breathing increases.
Breath gets shorter.
Veins of the neck become swollen.
Face, lips, nails, finger and toes turn blue,
Pulse gets faster and feebler.
Note : Even after breathing has stopped the heart may continue to beat for ten to twelve minutes. In such cases artificial respiration must be undertaken immediately, which can prevent death.
Remove the cause, if possible or remove the casualty.
Loose the tight clothing e.g. collar belt etc. and expose the chest and neck.
Opening the Airway
Checking the breathing
Clearing the Airways
Artificial Respiration - mouth to mouth respiration.
Circulation - External chest compressions
All unconscious casualties who are breathing or those who have been resuscitated must be placed in the recovery position. The aim of this position is to ensure the jaw and tongue fall forwards, keeping the airway open allowing vomit or secretions to drain freely.
Kneel facing the casualty's chest and remove any spectacles or bulky objects from their pockets.
Ensure the airway open by lifting their chin, straighten his legs
Position the arm, which is nearest to you at right angles to the casualty's body. With the elbow bent and palm facing out.
Bring the casualty's other arm across their chest placing the back of their hand against the cheek which is nearest to you and holding it there.
With your other hand grasp the leg which is farthest from you at the thigh, pulling the casualty's knee up with their foot flat on the ground
Still with your hand keeping the back of their hand against their cheek, gently press down on the lower thigh or pull with your other hand, thus rolling the casualty towards you on their side.
Again ensure that air way is open by tilting the casualty's head back. Adjust the upper most leg so that the hip and knee are bent at Right angles for stability.
Check pulse and breathing.
Different kinds of Asphyxia
Drowning causes asphyxia by water weeds and mud entering the lungs or by causing the throat to go into spasm so constricting the air passage:
Quickly remove any obstructions such as weed from the casualty's mouth and begin artificial respiration immediately. If he is still in the water, it may be possible to begin artificial respiration there.
If possible use one arm to support the casualty's body and use your other hand to support his head and seal his nose while you perform mouth-to-mouth respiration.
If in deeper water give the occasional breath of air while towing the casualty ashore.
When you can place him on a firm surface, check breathing and pulse and continue resuscitation if necessary.
As soon as the casualty begins breathing, place him in the recovery position.
Keep him warm. If possible remove wet clothing and dry him off. Cover with spare clothes and / or towels and if necessary treat for hypothermia.
Arrange removal to hospital. Transport as a stretcher case maintaining the treatment position.
Strangulation and hanging
Strangulation is usually the result of throttling by hands or a rope or scarf being tied round the neck
In hanging, the fracture of spine causing compression of tear of the spinal cord is more important.
Cut or remove the band constricting the throat.
If suspended raise the body and loosen or cut the rope.
Give artificial respiration.
To do above do not wait for the policeman.
Choking (Asphyxia due to obstruction in windpipe)
This is most common with children. A marble, a seed or button may get struck in the air passage. In adults too, food may go down the wrong way and choke him.
The aim of first aid is to remove the foreign body or obstruction.
Management in the case of an Adult
When victim is standing, the first aider should stand behind the victim and wrap his arms around the waist. Grasp the fist with your other hand and place the thumb of the fist against the abdomen (belly) slightly above the navel and below the rib cage.
Press your fist into the victim's abdomen with a quick upward thrust. Repeat several times if necessary till the foreign body is expelled out of the windpipe. When the victim is sitting the first aider stands behind the chair and performs the same method. Tell the casualty to bend forward so that her head is lower than her chest. If she cannot cough, give upto five sharp blows (slaps) between the shoulder blades with the heel of your hand. Repeat these back slaps upto four times if necessary. If the victim is lying turn him supine (face up). Facing the victim kneel astride the victim's legs. With your hands one on top of another place the heel of your bottom hand over the abdomen (belly) between the navel and rib cage. Press into the victim's abdomen with a quick upward thrust, repeat; Place him on his side and wipe to prevent asphyxia. Following the expulsion of food particle / foreign body it may be necessary to give artificial respiration.
Management in the case of an Infant
Hold him upside down by the legs and smack his back hard three or four times.
If breathing continues normal or is restored to normal give ice to suck, or cold water to sip.
Butter, olive oil or medical paraffin may also be given in small quantity.
Apply cloth wrung out of hot water to the front of the neck.
If breathing has stopped, give artificial respiration.
Suffocation by poisonous gases
Carbon-monoxide (Lighter than Air)
This gas is present in car-exhaust fumes, in house hold coal gas during incomplete combustion, charcoal stoves and in coal mines.
The First Aid treatment consists in removing the person from the area applying artificial respiration and giving pure oxygen, if available.
Ensure circulation of fresh air before entering the room by opening the doors and windows.
Before entering the enclosed space take two or three deep breaths and hold your breath as long as you can.
Crawl along the floor (as the gas is Lighter than air).
Remove-the casualty as quickly as possible to fresh air.
Loosen his clothes at neck and waist and give artificial respiration, if asphyxiated.
Carbondioxide and other gases (Heavier than Air)
This gas is found in coal mines, deep unused wells and sewerages. Various other gases such as leaking refrigerator gases, compressed gases used for cooking and lighting may also cause suffocations.
Observe all the precaution mentioned above.
Enter in upright position (as the gas is heavier than air and collects near the floor).
Remove the casualty as quickly as possible to fresh air.
Wherever ventilation is not possible and deadly poisonous gas is suspected, use a gas mask to protect yourself.
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