Variations in cardiopulmonary resuscitation techniques

Mouth-to-nose ventilation
There are several situations in which mouth-to-nose ventilation may be preferable to mouth-to-mouth ventilation:

• if mouth-to-mouth ventilation proves technically difficult, for example because of unusual or absent dentition
• if mouth obstruction cannot be relieved
• during rescue of a client from the water, when one hand is required to support the body and cannot be used to close the nose
• when resuscitation is being carried out by a child whose mouth may not be large enough to seal an adult’s mouth.

To carry out mouth-to-nose ventilation:
1 Release the client’s nose and close his mouth.
2 Seal your mouth around his nose and blow in steadily as for the mouth-tomouth technique.
3 Allow his mouth to open to let the breath out.

Cervical spine injury:
If spinal cord injury is suspected (for example if the client has sustained a fall, been struck on the head or neck, or has been rescued after diving into shallow water) particular care must be taken during handling and resuscitation to maintain alignment of the head, neck, and chest in the neutral position. A spinal board and/or cervical collar should be used if available. As hypotension often accompanies spinal cord injury, care should be taken to maintain the client in a horizontal position during rescue. When opening an airway, head tilt may be employed, but the tilt should be kept to a minimum, that is, just enough to allow unobstructed
ventilation or intubation. Jaw thrust rather than chin lift is preferable. During resuscitation, assistance from others may be required to maintain head, back, and chest alignment if adequate splinting is not available. Remember that successful resuscitation that results in paralysis is tragic, but failure to carry out adequate ventilation in cases of respiratory arrest will result in death (Resuscitation Council UK Guidelines 2000).