10

ly over the nose and mouth, any ex-
pired air can be easily detected.
Massage, heat and stimulation of re-
flexes should be applied. If an as-
sistant operator is available he
should call the doctor and apply sup-
plemental treatment.

Schafer method

A brief description of the Schafer
method of resuscitation is given as
follows:

1. The subject is placed in the
prone position with the head turned
to one side and placed over the back
of the hand or over a handkerchief
or other garments. The mouth should
be cleaned and the tongue pulled
forward.

2. The operator kneels astride one
or both legs so that his knees are
about even with the subject’s knees.
The hands are placed on the body
about 4 inches apart with the fingers
together and following the line of
conformation of the lower ribs.

3. The pressure is forward and
downward with straight arms for
about 3 seconds, followed by a quick
removal of the hands and relaxation
on the part of the operator for 2 sec-
onds. This alternation of pressure
and relaxation is continued at 12
respirations per minute.

4. Supplemental treatment should
be applied by an assistant operator,
who telephones the doctor, secures
warm clothing and a blanket, cuts
off the wet clothing, assists with
massage and stands by to change po-
sition with the operator performing
the resuscitation.

Mechanical methods

Doctor C. K. Drinker and Doctor
Lewis A Shaw of Harvard Univer-
sity constructed a heavy resuscitator
(1929) about six feet in length and
two and one-half feet in width and
a depth which accommodates the
body with the exception of the head,
which is exposed and insulated from
within by a collar. It was considered
the first satisfactory appliance for
administering artificial respiration
over long periods.

A regular rhythmic respiration is
produced at about 15 to 25 breaths
per minute by air pressure which is
alternately fed in and forced out in
imitation of the act of breathing.
The incoming air current bears down
on the chest and abdomen of the pa-
tient and causes him to exhale, and

the diminished pressure causes his ~

lungs to inflate. Mechanical resusci-
tators of a much improved form for
portable use have been introduced
by the E & J Manufacturing Com-
pany and the McKesson Appliance
Company. These are widely used in

American hospitals and are abso-
lutely approved.

An excellent technical report has
been prepared by Dr. Coryllos* who
maintains that the apparatus is easily
effective in the hands of non-med-
ical rescue squads. These new com-
bination inhalators and resuscita-
tors have been subjected to exacting
experimental investigation with fa-
vorable results. It is maintained that
in the presence of apnea and begin-
ning relaxation of the muscular sys-
tem that only the mechanical meth-
ods of forcible insufflation of oxygen
into the lungs can produce success-
ful resuscitation. The modern meth-
ods permit forceful mechanical in-
sufflation-suction until respiratory
movements begin. Then the device
is changed by a valve to a steady
stream as an inhalator.

Supplemental treatment

Steinhaus has pointed out that the
circulatory system has a great deal
to do with the chances of recovery.
When the heart is beating feebly the
pressure in the capillaries is less
than 10 per cent of the original pres-
sure imparted to the blood by the
heart (5 to 10 m.m. Hg.). It is high-
ly important to do anything possible
to aid the return flow of blood to the
heart. The two principal methods
are (1) the contracting and relaxing
of skeletal muscles and the (2)
forceful respiratory movements.

Steinhaus recommends exercising

 

__ *P. N. Coryllos, “Mechanical Resuscitation
in Advanced Forms of Asphyxia,” Surgery,
foe ee & Obstetrics, 66: 698-722 (April,

 

SCHOLASTIC COACH

the arms and the legs and exerting
pressure on the abdomen during the
inspiratory phase of respiration. The
arm exercise involved in the Sil-
vester method is possibly helpful
and in addition, the legs may be ex-_
ercised by pushing the knees up to-
ward the chest a number of times
while holding the feet. This circu-
latory viewpoint of resuscitation in-
dicates that it is highly important to
have the subject placed so that the
head is downhill and gravity assists
the return flow of blood to the heart.
Another point is that pressure
should be gradually applied to mini-
mize the effect of increasing the in-

- tra-thoracic pressure and checking

the return flow of blood to the heart.
With the patient on the back the legs
may be lifted or exercised as sug-
gested. This is the strong reason for
methods which use the supine po-
sition.

Circulation may be assisted by
massage toward the heart. The rub-
bing should be over the big veins by
stroking movements continuously
applied in the direction of the heart.
A strong slap should be given on the
back before starting pressure in the
prone position. It may also be help-
ful to slap the bottoms of the feet
and the face, pull the hair and apply

rectal dilation. Colonel Nielsen em-

phasizes that it is better to rough up
the body and it should never be al-
lowed to lie quietly.

Vibratory tapping (100 times per
minute) over the heart area may
provide stimulation to the heart. Re-

(Continued on page 24)

Nielsen Resuscitation Method, arms bent at elbows, hands crossed under face.