# Rescue Breaths

## Overview

This module describes how to give rescue breaths in a patient who is unable to breathe independently.

## Indications

1. Continuous rescue breaths for any patient who has stopped breathing

2. Rescue breaths between cycles of CPR for patients in cardiac arrest

## Contraindications

See Patient information and consent.

## Patient information and consent

This procedure is done when a patient is unresponsive, so consent is generally implied. But patients with “Do Not Resuscitate” (DNR) orders, “Not For Max” orders, or living wills that specify that no resuscitation may be performed, should not be resuscitated.

## Preparation

#### Equipment

1. Facemasks: the mask should seal well and cover the nose and mouth, but not extend over the chin.

2. Self-inflating bag/BVM resuscitator: check that it is working by placing your hand over the outlet and checking that no air leaks when squeezing the bag. Use the correct size bag for adults, children or infants to prevent barotrauma.

3. CPR protective devices: one-way valves used during mouth-to-mouth resuscitation, allowing you to blow air into the lungs, but preventing air, secretions, or vomit from travelling through to your side of the device. Avoid touching the device with soiled hands; maintain your head-tilt chin-lift grip underneath the flaps of the device.

## Site & Positioning

To perform rescue breaths, a patient should be lying flat on their back on a firm surface. There should be space behind the head of the bed for staff to stand.

## Procedure

1. Open the airway.

   1. In adults , tilt the head back using a head-tilt chin-lift technique, or a jaw thrust. For suspected c-spine/head injury, perform jaw-thrust.
   2. In children, hold the head in a “sniffing the air” position.
   3. In infants, keep the head in neutral.

2. If using a bag valve mask, fit the mask over the patient’s mouth and nose using the

   “EC” grip
   “EC” grip

   Curl your thumb and index finger into a C and use it to place downward pressure on the mask. The last three fingers (the E) grip the patient's jaw and pull it up against the bag.

   . If no bag valve mask, cover the patient’s mouth with a protective device, pinch the nose and seal your mouth over the patient’s mouth.

3. If using a bag valve mask, squeeze the bag gently for one second, then pause for 5 seconds and 2 seconds for children and infants.

   If no bag valve mask , blow air into the patient’s mouth using the same timing.

4. Each breath should result in visible chest rise. Only squeeze enough to achieve chest rise.

5. Timing: For continuous ventilation, give 1 breath over 1 sec every 5-6 sec for adults, or every 2-3 sec for children and infants. In CPR without advanced airway, give 1 breath per second (puff quickly with a very short pause), to minimise interruptions to chest compressions.

## Troubleshooting

I don’t see chest rise.

Don’t panic or try to force air by squeezing harder.

- Adjust the patient’s head position
- Ensure optimal positioning of ear lobe to sternal notch
- Use an oropharyngeal or nasopharyngeal airway
- Re-adjust your EC grip and feel for leaks
- Try a two handed EC grip with another person squeezing the BVMR to ventilate
- Add a PEEP valve to your BVMR

If unsuccessful, call for help with the airway.

The valve on the bag is making squeaking noises.

This means the valve is “popping” open, which releases air because the pressure in the mask is dangerously high. Air may not be entering the patient’s lungs. Check that you are not over-squeezing the bag, and check the steps for chest rise above.

## Risks

1. Facial bruising or other injuries

2. Pneumothorax

3. Bronchospasm or laryngospasm

4. Healthcare worker exposure to aerosolised infections

## References

1. Resuscitation Council of Southern Africa. Advanced Cardiac Arrest Algorithm, Adult and Paediatric. 2021.