OCR Text |
Show of all insufflation methods, which also applies to mouth breathing, is that the helper is forced to continually see to it that the air passages are kept open. The effect of breathing can be judged at all times by the movements of the thorax, the exhaled air and by the general appearance of the patient. Atmospheric air is in almost all cases sufficient for the revival. The oxygen saturation in the arterial blood, which normally in lowlands and in normal spontaneous breathing amounts to about 97 percent, begins to drop below 90 percent only at an elevation of 11,500 feet above sea level. In this instance, the addition of oxygen becomes advisable. However, in the usual respiration cases, it is possible to obtain a sufficient blood- oxygen saturation with light, forced breathing with air alone up to an elevation of about 19,000 feet. Air is present everywhere and there is never any shortage. If oxygen is available it may also be administered as an extra measure at high altitudes, but the resuscitator, not the oxygen bottle, is the important equipment to get to the victim first. There is an additional reason to make sure a resuscitator is on hand when the victim is located. If no such equipment is available and mouth- to- mouth resuscitation must be used, the deleterious effects of high altitude are apt to appear much more quickly in the operator than in the reviving victim. Above 10,000 feet the operator administering mouth- to- mouth resuscitation very quickly becomes exhausted. If prolonged resuscitation without equipment is required, the rescue team should rotate operators at the respiration task every few minutes. The type of resuscitator using a self- inflating bag ( AMBU, Hope, etc.) is preferred because it is less fatiguing to the operator and offer greater tactile sensitivity. In addition, the breathing rhythm is forced within certain limits by the elasticity of the bag, so that the danger of under or over- respiration is lessened over a long period of time. The breathing bag and its accompanying equipment also function properly where extensive soiling exists and under the most varied weather conditions. Respiration must be continued without interruption until natural breathing sets in fully again, or until unmistakable signs of death occur. Even if the victim shows slight signs of life ( swallowing, bumping, slight movements) or if he breathes weakly, one must continue with the artificial- in this case supported- respirat ion. Simultaneously, the appearance of the lips, tongue and fingernails is observed. Respiration and circulation are substantially improved if the blue discoloration disappears and the normal rosy color returns. If an avalanche victim is recovered in a state of cardiac arrest ( no pulse or heartbeat, pupils dilated) the chances of successful resuscitation may be augmented by closed- chest heart massage. This procedure should be undertaken only by a properly- trained person ( preferably a physician) and should begin immediately along with artificial respiration ( cardiopulmonary resuscitation). Because this technique involves the possibility of such injuries to the victim as broken ribs or liver damage, current medical opinion in the United States ( and in Switzerland) does not advocate teaching cardiopulmonary resuscitation procedures to the general public. 59 |