Forum: Author Hangout

So if the right hand lifts the neck or cups the neck, as the story says, you have to curl your left hand all the way around above the mouth to hold the nose, is that it?

~ JBB

So if the right hand lifts the neck or cups the neck, as the story says, you have to curl your left hand all the way around above the mouth to hold the nose, is that it?

You're imagining the kneeling person on the wrong side of the woman. Move that person to the other side of the woman and the hand pinching the nose is not blocking the mouth.

I don't see how that makes a difference. On either side, with your free hand you're still going to have to curl around on the far side of her mouth to reach her nose so that you could get your mouth on hers.

~ JBB

you're still going to have to curl around on the far side of her mouth to reach her nose

Woman is lying on her back. Man is kneeling on her right side (her right arm side). He cups the back of her neck with his right hand. He pinches her nose with his left hand, the palm on the forehead and the fingers pinching the nose. Nothing is blocking access to the mouth.

I would think the right hand wouldn't be cupping the back of the neck but on the chin pulling the mouth open. But the book you read had it cupping the neck.

Really gets interesting if you also have to do chest compressions.

Way back when I was medic in my youth, we figured that, in most cases, after the initial blow in the mouth to make sure the airways are clear with no obstruction, you don't need to do the mouth thing while doing chest compressions.

Compressing the chest deep enough to squeeze the heart moves enough air as you push and release, so you just do compressions.

For certain things, like drowning, or a collapsed lung from an open chest injury, where there may not be enough lung capacity, then you should do mouth-to-mouth assistance too.

Isn't this all a moot point anyway? I am under the impression that mouth to mouth has not been taught or recommended in the UK for over twenty years. Other countries may differ.

Near drowning is a special case…

The current CPR guidelines indicate that CPR should begin with chest compressions. Due to the conditions associated with near-drowning, the AHA advises rescuers to deliver two rescue breaths first, and then begin the cycles of compressions and breaths as directed. This especially applies to BLS-trained EMS professionals, but is advised for all rescuers. Breaths may be given mouth-to-nose if the rescuer and victim are both still in the water, as mouth-to-mouth ventilations may be difficult to perform.

See: CPR with rescue breaths vital to resuscitation after drowning, new guidelines say
[Published in Nov 2024]

In cases of drowning, near-drowning, or suffocation, where the airway is obstructed or filled with water, performing mouth-to-mouth rescue breaths is crucial. By clearing the airway and providing oxygen, you can prevent further damage and increase the chances of survival.

See, e.g. What is the Indication for Mouth-To-Mouth Rescue Breaths?

Don't forget the asymmetrical breathing and compressions after intubation, too. There was a shift, IIRC, from the "under the neck" thing to the "tip their head back by pulling back (up) on their forehead" to open the airway, or that's what I remember.

It's been 9 years since I did a code, and I tubed people when I got there. I rarely did mouth-to-mouth except in CPR training…

Common misconception. It IS still taught in ALL countries

A year ago (in the UK) I attended the mandatory first aid course (box ticking exercise) and that came up. The course was given by actual NHS paramedics (not on call ones!) and their response to the question was "No. You don't know the casualties medical history, nor whether they have experienced chest trauma which has resulted in bleeding in the airways (punctured lung etc) or if they are suffering from previous long term respiratory problems that would result in blood being present in the airways. You could if the individual was your partner or someone whose medical history you knew (like your child), but for a stranger? No, just no.". I'm paraphrasing there a little.

The risk of cross contamination of infection, not just blood related like HIV, but in oral ones like Herpes, was far too great a risk. And it was them who said that the oxygen content was not sufficient, especially if the recipient was also a heavy smoker (or had a workplace illness like miners lung).

They also had remarkably disturbing footage of mechanical CPR in action (with someone in cardiac arrest in the back of an ambulance) and commented that if you weren't breaking the casualties ribs, you weren't doing it right.

I know that over ten years ago, CPR was being taught as hands free only (for the above reasons) and the British Heart Foundation even made a video about it starring the (ex) footballer Vinnie Jones, which can no doubt be found on Youtube.

In fact, given all that we've been through, what with Covid, that anyone medical would recommend giving a total stranger mouth to mouth. Hell, even lawyers now recommend that you don't give any aid to an individual at an incident unless you are medically trained. (Yes I know there is the good Samaritan clause. Social Action Responsibility and Heroism (SARAH) law in the UK) but that is only a defence in a court of law and while it might be enough to get the case thrown out, it doesn't shield you from the hassle and financial burden of finding a lawyer to represent you in court for your charge to be overturned.

We live in a world that is becoming more insane with every passing year.

Edited to spell 'lung' correctly.

The physician who was also present couldn't figure out how to use the oxygen tank brought to the scene until they found a nurse in the crowd.

I learned over the years that nurses and techs do things. Most doctors just write orders...

There's also the "implied consent" law here in Massachusetts (and in other places, I'm sure) that a victim (or their parents, if a minor) would want anything and everything done, up to saving their life, if the victim is (or their parents are) unable to provide verbal consent (unconscious or whatever)...

Looks like a plunger? Or the facemask things? I used a bag-valve mask primarily and rarely (if ever) had to do mouth-to-mouth.

I stopped watching EMS shows after Johnny and Roy in "Emergency!" (which we called "training videos…") because the other shows usually got stuff wrong. (What paramedic from our generation doesn't flip the caps of medicines off like Johnny?)

Never give CPR to a person with a heartbeat!

There may be exceptions to that rule. I believe I read that it's one option if the patient has atrial fibrillation.

AJ

A provider (any level) may not feel A-fib, not until the victim goes on a monitor, so that could be so...

It's been over 9 years since I stopped working the road, so protocols may have chaged since.