Rescue Breathing and Airway Management
Effective ventilation requires an open airway and a seal that delivers air to the lungs. The primary maneuvers are head tilt–chin lift (for most victims) and jaw thrust (when a head or neck injury is suspected). For infants, use a neutral or slightly extended position to avoid overextension. Each breath should be delivered over about 1 second with just enough volume to produce visible chest rise; excessive volume or force causes gastric inflation, regurgitation, and aspiration.
Devices and technique
- Pocket mask: provides a barrier and a good seal; the rescuer delivers breaths through the one-way valve.
- Bag-mask: requires two rescuers for best effect-one to hold the mask with both hands (E-C clamp) and one to squeeze the bag. A common trap is a single rescuer attempting bag-mask ventilation and losing the seal.
- Mouth-to-mouth or mouth-to-nose: acceptable when no barrier device is available; mouth-to-nose is useful when the mouth cannot be sealed.
Recognizing problems
If the chest does not rise, reposition the head and try again. Persistent failure suggests an obstruction; in an unresponsive victim, begin CPR and look in the mouth for a visible object-do not perform blind finger sweeps. For a responsive choking adult or child, give abdominal thrusts; for a responsive choking infant, give back slaps and chest thrusts.
Worked example: During two-rescuer bag-mask ventilation, the chest does not rise. The correct first step is to reposition the head (reopen the airway) and reseat the mask, then reattempt the breath-not to increase the squeeze force.
Rule of thumb: If the chest doesn't rise, fix the airway and seal before you push harder.