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By M.D. Peter G. Bourne

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T h e h a n d s should r e m a i n in place w h e n the pressure is released. d. R e p e a t at a s m o o t h rate of a b o u t 6 0 / m i n , with a b o u t equal time for compression and r e l a x a t i o n . e. T h e presence of a palpable carotid pulse indicates a d e q u a t e cere­ bral b l o o d flow. This should also be reflected in t h e pupils. Dilated pupils m a y indicate h y p o x i a a n d i m p e n d i n g d e a t h if n o t reversed. 2. ADEQUATE OXYGEN AND BLOOD SUPPLY T o maintain b o t h a d e q u a t e o x y g e n a t i o n and b l o o d flow it is best t o have t w o persons—one providing t h e e x t e r n a l cardiac compression, at 6 0 / m i n ; t h e o t h e r , m o u t h t o m o u t h resuscitation b e t w e e n t h e fifth and sixth compression or a rate of 12 lung inflations/min.

EMERGENCY T h e p a t i e n t should be assessed p r o m p t l y u p o n arrival in t h e emer­ gency r o o m , a n d t h e need for i m m e d i a t e i n t e r v e n t i o n d e t e r m i n e d . If t h e p a t i e n t is apneic, he should b e i n t u b a t e d ( p r o c e d u r e of c h o i c e : p r e s t r e t c h e d P o r t e x nasotracheal t u b e ) a n d a t t a c h e d t o a respirator. If t h e p a t i e n t is h y p o t e n s i v e , an intravenous line should be inserted, and fluid r e p l a c e m e n t b e g u n .

T h e chin should p o i n t almost straight u p . Pull t h e t o n g u e forward so t h a t it is n o t blocking t h e o r o p h a r y n x . c. Oral airway. An oral airway w i t h o u t a pharyngeal e x t e n s i o n is simple t o use and e x p e d i t e s m o u t h t o m o u t h resuscitation. S o m e physicians prefer an o r o p h a r y n g e a l airway if t h e o r o p h a r y n g e a l reflexes are absent. However, as t h e p a t i e n t regains consciousness, such an airway m a y i n d u c e vomiting.

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