Blocked airway
If the patient’s chest does not rise with inflation, check:
- the head is tilted back, and the jaw is lifted correctly
- there is no leak from the seal of your mouth or resuscitation mask
- there is no foreign material in the airway
- enough air is being blown in (although over-inflation is more common in CPR)
Vomiting and regurgitation
Vomiting is an active process in which muscular action makes the stomach eject its contents upwards. It is nearly always accompanied by a loud noise. You will usually know when a patient is vomiting or is about to vomit.
Regurgitation is the silent flow of stomach contents into the mouth and nose. It is the silence that makes regurgitation dangerous, as it may be very difficult to detect.
Both may occur during resuscitation, especially in cases of drowning where large amounts of water may be swallowed, however, are fairly uncommon in the majority of cardiac arrests. Every patient who has vomited or regurgitated should immediately be rolled into the lateral position and their airway cleared.
A person who regurgitates or vomits while lying on their back (supine position) is likely to aspirate (inhale) some of the stomach contents into the lungs, which may lead to serious lung damage and infection. Once a patient has regurgitated or vomited, it is essential that the patient be rolled onto their side immediately to clear their airway, then assess the breathing.
Distension of the stomach
In cases of drowning, the patient’s stomach is often swollen at the time of rescue. This swelling of the stomach most often occurs because they have swallowed water and air in the process of drowning. Stomach swelling may be made worse if rescue breathing is performed with the airway partially blocked by the tongue or foreign material, if you blow too hard, or if you blow too much air.
A distended stomach can be recognised by a persistent and possibly increased swelling in the upper part of the patient’s abdomen. It leads to increased upward pressure on the diaphragm, making rescue breathing and compressions more difficult. It also greatly increases the risk of regurgitation.
No attempt should be made by lifesavers to reduce the swelling of a patient’s abdomen; treatment of this condition should be left to trained healthcare professionals. Check that the ANZCOR guidelines for correct rescue breathing are being followed and that the airway is not blocked.
Further stomach distension can be prevented by:
- following the ANZCOR guidelines for maintaining a clear airway
- deliver breaths only until you see the chest rise