Different kinds of Asphyxia
Swelling within the throat
Suffocation by smoke
Suffocation by poisonous gases
External Heart Compression
Drowning is the result of complete immersion of the nose and mouth in water (or any other liquid). Water enters the windpipe and lungs, clogging the lungs completely.
The aim of first aid is to drain out water (or other matter) from lungs and to give artificial respiration.
Act quickly. Remove seaweeds and mud from the nose and throat. Start artificial ventilation immediately. This is possible even when the casualty is in water.
Turn the victim face down with head to one side and arms stretched beyond his head. Infants or children could be help upside down for a short period.
Raise the middle part of the body with your hands round the belly. This is to cause water to drain out of the lungs.
Give artificial respiration until breathing comes back to normal. This may have to go on for as long as two hours.
Remove wet clothing.
Keep the body warm, cover with blankets.
When victim becomes conscious, give hot drinks viz coffee or tea.
Do not allow him to sit up.
After doing the above, remove quickly to hospital as a stretcher case.
B. Strangulation and Hanging
- Cut or remove the band constricting the throat.
- If suspended, raise the body and loosen or cut the rope.
- Give artificial respiration.
- To do the above do not wait for the policeman.
C. Choking (Asphyxia due to obstruction in wind pipe)
This is most common with children. A marble, a weed or a button may get stuck in the air passage. In adults too, food may go down the wrong way and cause choking.
Management in the case of an adult.
When victim is standing, the First Aider should stand behind to 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 manoeuvre. 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 naval and the ribcage. Press into the victim's abdomen with a quick upward thrust repeat several times, if necessary. Should the patient vomit, 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 case of an infant
- Hold the child upside down by the legs and smack his/her back hard three or four times.
- If not successful, lay the child prone with his head hanging downwards over the knee and give sharp smacks between shoulders.
- It still not successful, induce vomiting by passing two fingers right to the back of the throat.
D. Swelling within the throat
Swelling within the throat may occur as a result of trying to drink very hot liquids or swallowing corrosive poisons or may be due to inflammation.
Make the patient sit up.
If breathing continues to be normal or is restored to normal give ice to suck, or cold water to sip.
Butter, olive oil or medicinal paraffin may also be given.
Apply cloth wrung out of hot water to the front of the neck.
If breathing has stopped, give artificial respiration.
E. Suffocation by smoke
- Protect yourself by a towel or a cloth (preferably wet) over your mouth and nose.
- Keep low and remove the casualty as quickly as possible away from the area.
F. Suffocation by Poisonous Gases
Carbon Monoxide (lighter than air)
This gas is present in car-exhaust fumes, in household coal gas: during incomplete combustion of 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.
Carbon-dioxide and other (heavier than air)
This gas is found in coal mines, deep unused wells and sewers. Various other gases such as leaking refrigerator gases; compressed gases used for cooking and lighting may also cause suffocation.
Observe all the precautions mentioned above.
Enter in an 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.
This is a condition where sudden constriction of airways causing difficulty in breathing, especially in breathing out. Allergy, infection, anxiety or tension can trigger an attack.
- Reassure the patient
Make them sit up in bed or chair and allow him to lean forward with a couple of pillows and/or a small table on which to rest his head.
- Ensure fresh air by opening the windows.
- Seek medical aid from a nearby doctor.
Artificial Respiration (Respiratory Resuscitation)
There have been several methods of artificial respiration practiced in First Aid. Up to the II World War, Sylvester’s method was felt to be the best. During this war mouth-to-mouth (to-nose) method was discovered and found to be the best and easiest method to be used under most conditions.
Asphyxia of a severe degree is found along with unconsciousness. General causes are:
The tongue may have fallen back into the throat.
Vomit or spittle may have collected in the throat, or
Some foreign material (like weeds, mud etc.), may have collected and obstructed the air passages. Therefore, when a casualty is unconscious make sure he is breathing freely.
Begin to work immediately as every minute counts. Do not delay.
Treatment when not breathing.
Loosen all clothing at waist, chest and neck.
Tilt the head backwards, while supporting the back of neck with your palm. This will lift the tongue to its normal position. Thus the air passage will be cleared and the casualty may begin to breathe after a gasp. Pass resuscitube if one is available readily.
If breathing does not being after the above treatment, help movements of chest and lungs four or five times. This will be usually enough to start breathing. If breathing does not start even now, mouth-mouth (to-nose) breathing should be begun.
Place the casualty on his back. Hold his head tilted back.
Take a deep breath with mouth open widely.
Keep nostrils of casualty pinched.
Cover the mouth of the casualty with your mouth snugly.
Watching the chest, blow into his lungs, until the chest expands. Withdraw your mouth; note that the chest falls back (It is hygienic to cover the mouth of casualty with your handkerchief or some clean cloth).
Repeat the above 15 to 20 times a minute.
If the casualty is young (baby or a child), the operations are as above, but your open mouth should cover both the mouth and nose of the casualty. Blow gently.
If the chest does not rise (as in 5 above) look for an obstruction.
- Turn the casualty to a side and thump his back. This will make the obstructing material come to the front of throat. Open the mouth and remove it with your finger covered with a piece of cloth.
- If a child, hold it up by the feet and thump the back.
Use mouth-to-nose respiration if mouth-to-mouth is not possible, but now the casualty's mouth should be closed by the First Aider's thumb.
If the heart is working, continue artificial respiration until normal breathing occurs. Send for an ambulance.
If the heart is not working, you will notice the following
- The face is blue or pale.
- Pupils are dilated.
- Heart beats and pulse at root of neck (carotid) are not felt
Then treat as follows:
Place the casualty flat on his back on a hard surface (bench, table etc.)
Give a smart hit with the edge of your hand on the lower and left angle of the sternum. This usually stimulates the heart to work.
In case the heart does not work, persist the striking for 10-15 seconds, at the rate of one stroke a second, feel for the pulse becomes regular and continuous to stop beating.
All the while artificial respiration has to go on.
- Even if the casualty is breathing, but the breathing is not normal, it is wise to start artificial respiration.
- Do not begin thumping the heart or compression until you are sure that the heart has stopped beating.
External Heart Compression (if there are two trained person)
This should go on along with artificial respiration therefore ask the First Aider giving mouth-to-mouth breathing to sit to the right of the casualty and place yourself on the left side.
Feel and mark the lower part of the sternum.
Place the heel of your hand on the body, making sure that the palm and fingers are not in contact with the Chest.
Place the heel of the other hand over it.
With your right arm, press the sternum backward towards the spine. (It can be pressed back 1 to 1.5 inches in adults.)
- Adults should be given about 60 pressures a minute.
For children from two to ten years 3 pressures with one hand (heel) will be enough; but pressure should be 80-90 times a minute.
For babies up to two years, 2 pressures with two fingers are good enough applied 100 times per minute.
- Press firmly but carefully; carelessness may cause injury to ribs and deeper tissues.
- If the treatment is effective,
- Colour will become normal
- Pupil will contract as improvement begins and
- Carotid pulse begins with each pressure.
When pulse is not restored, continue compression till the patient reaches hospital.
Inflation's of lungs to heart pressure should be as 2:15. If there is only one First Aider, he has to be very smart and active. Finish 15 heart compressions, rush to head-side, give two inflation's to the lungs, and get back to the heart and give 15 compressions.
If there are two First Aiders, No.1 makes 5 heart compressions and then No.2 given one lung inflation. These are repeated, At the same time No.1 can watch the pupils and No.2 can feel the carotid pulse.