Evaluation of methods of resuscitation

Abstract

The anaesthetist is well qualified as a specialist to train other doctors and lay personnel in methods of resuscitation. A plea is set forth for a widespread training programme. The prevention and treatment of respiratory obstruction can be a life-saving procedure in itself, and simple methods for maintaining a clear airway are described. Cases of severe respiratory obstruction in imminent danger of death can be saved by the introduction of a number fourteen trocar through the crico-thyroid membrane, thus providing more ideal conditions for a low tracheotomy. The time factor is insisted upon in starting manual artificial resuscitation in drowning victims. Should apparent cardiac arrest accompany cessation of respiration, simple methods of heart stimulation are recommended to be applied simultaneously with artificial respiration. In an emergency, artificial respiration should be started with immediately available methods such as manual artificial respiration or mouth to mouth breathing. It is explained that mechanical methods of artificial respiration are intended to replace the operator who has initiated resuscitation by manual methods. Different types of mechanical devices are described and the advantages of self-contained units not requiring a source of compressed air or oxygen to become operative, are made evident. It is suggested that a bag and mask device be incorporated in all types of automatic resuscitators to meet individual exigencies of lung compliance. The use of a Nomogram for patients undergoing long-term maintenance of artificial respiration in a tank respirator is a simple practical means of avoiding consequences of overventilation or hypoventilation. Cuirass type respirators and the rocking bed are considered as weaning devices and are not recommended for use in apneic patients with low lung or thoracic compliance. A new type of infant resuscitator incorporating the Fink modification of the Stephen-Slater valve is presented and described. The resuscitator is a selfcontained easily transportable unit which is simple in design and operation. It is intended for routine use and is operated at controlled pressures. It is not to be confused with the G.B.L. hand resuscitator which operates at high mask pressures and time limited impulses.