Even though most Germans have taken a first aid course at least once for their driver’s license, many do not dare to perform resuscitative measures in an emergency. But in an emergency, fast help is crucial. In the following, you can refresh your knowledge of first aid measures for respiratory arrest, unconsciousness and other medical emergencies.
First aid for unconsciousness
When someone is unconscious, the whole body goes limp. Unconsciousness can be assumed if the person does not respond to being spoken to loudly and to careful shaking of the shoulders, as well as if his or her muscles are slack. If the patient is supine, there is a risk that the tongue will sink back into the throat and block the airway.
- Here it is important to first call for help, to make bystanders aware of the situation, and check breathing.
- If the injured person is breathing, you put him in the recovery position. Thus, one ensures that the mouth of the victim becomes the lowest point of the body, so that vomit and blood can drain and not enter the airway.
- Then call 911. Unconscious people should never be left alone, because breathing may stop.
Check breathing, detect respiratory arrest
To check breathing, you overstretch the head of the victim backwards, preferably a helper kneels at shoulder height sideways next to him. With one hand, grasp the unconscious person’s forehead; with the other, grasp his or her chin. This allows you to carefully bend the patient’s head toward the neck and lift his chin. The patient’s mouth can then be opened slightly to remove any visible food remnants or pieces of denture. It is usually noticeable at the first closer inspection when a person stops breathing:
- The chest no longer rises.
- No more breathing is visible or audible at the nose and mouth.
- You can put your hands on your chest or hold your cheek in front of your mouth and nose and no longer feel any breathing movements.
The control of breathing should last no more than 10 seconds. If you do not intervene now, it may be too late for the affected person. If no breathing is detectable, the emergency call should be dialed immediately and resuscitation should be started.
Cardiac arrest: rapid action is required
Cardiac arrest is the cessation of heart activity, a condition that leads to circulatory failure with loss of consciousness, pulselessness, respiratory failure and a blue-gray coloration of the skin. If resuscitative measures are taken quickly, resumption of cardiac function is possible. If no intervention is taken, cardiac arrest leads to death. Damage to the brain occurs after only about three minutes, and death occurs a few minutes later. In myocardial infarction or stroke, cardiac arrest occurs in the worst case.
Resuscitation: first do chest compressions 30 times, then give 2 breaths.
For a victim who stops breathing, one should first refrain from resuscitation – also called rescue breathing. The former ABC rule of resuscitation (A: clear airway, B: ventilation, C: cardiac massage, English: circulation) no longer applies. This is to ensure that more resuscitations are successful in the future. First, the unconscious person should be spoken to loudly and, for example, gently shaken by the shoulders, and then breathing should be checked. If there is no response and no breathing can be detected, the emergency call should be dialed immediately and chest compressions started. Cardiac massage is performed 30 times each, alternating with 2 times of ventilation. However, ventilation is of secondary importance; the decisive factor is cardiac massage. Anyone who is disgusted by mouth-to-mouth resuscitation or is unsure how to perform it should perform chest compressions in any case.
Cardiac massage: here’s how!
When the heart stops beating or stops beating effectively, circulation collapses within a short period of time. To prevent this, cardiac massage is performed. In this process, squeezing the heart muscle between the sternum and spine provides some blood circulation. Also, when squeezing, the pressure changes throughout the chest, which further drives blood circulation by creating a suction effect. Cardiac massage should be performed according to the following instructions:
- The affected person must lie with his back flat on a hard surface, preferably the floor, then remove the clothes over the chest.
- The correct point of pressure: the point of reference is the lower end of the bony sternum. The easiest way is to feel along the lowest rib to the middle of the body with your finger. The correct pressure point is then exactly in the middle of the rib cage about three transverse fingers (five to seven centimeters) above the lower end of the sternum. To find it quickly, it is useful to mark it with your fingernail or a pen.
- Now the helper kneels sideways next to the affected person, places the heel of one hand exactly on this point, the second hand is placed parallel or crossed on the one placed on the pressure point. His shoulders are bent over the pressure point, his arms are stretched out so that the pressure can be applied vertically from top to bottom. This is the only way to apply sufficient force, because in an adult the sternum must be pressed in at least five centimeters (maximum six centimeters). In the relief phase, it is important to release the pressure completely so that the rib cage can return to its original position. The heels of the hands remain at the pressure point.
- About 100 times per minute should be pressed and released again. This takes a lot of strength, so it is best to alternate with another helper.
Sometimes the heart also starts beating again by itself. If this is not the case, the chest compressions should be continued in any case until the doctor or paramedic arrives and takes care of the victim. Tip: To find the right rhythm for chest compressions, it may help to follow the rhythm of one of the following songs:
- Stayin’ Alive (Bee Gees)
- Breathless (Helene Fischer)
- Dancing Queen (ABBA)
Mouth-to-mouth or mouth-to-nose resuscitation.
Breath donation should be given only after chest compressions have begun. Here, in respiratory and circulatory arrest, the ratio of chest compressions to breaths should be 30:2: 30 chest compressions for every two breaths given by mouth-to-mouth or, alternatively, mouth-to-nose ventilation.
- Mouth-to-nose resuscitation: in this procedure, the rescuer kneels at shoulder level to the side of the unconscious person lying on his or her back. One hand grasps the forehead, the other under the chin. Now the head is stretched back, the lower jaw is pushed forward and the mouth is closed by pressing with the thumb on the area between the lower lip and the chin. Then surround the nose of the affected person with the lips and breathe air into it.
- Mouth-to-mouth resuscitation: again, the patient’s head is hyperextended, but one opens the mouth with the thumb located above the tip of the chin. The thumb and index finger of the other hand close the nose. The patient’s own mouth is then placed as close as possible over that of the patient and the air is blown in as in the mouth-nose technique.
Tips for breath donation
The following tips for breath donation should be followed:
- The responder inhales normally and places his mouth over the nostrils or mouth of the unconscious person so that his lips are tight and airtight around the person’s nose or mouth. He then blows his exhaled air into the nose or mouth with gentle pressure, sets down, inhales again, and repeats the breath-dispensing process at a rate of about 10 to 15 times a minute. As a rule of thumb, breathe air steadily into the mouth or nose for about one second.
- That the air also arrives in the lungs, can be seen by the fact that the patient’s chest rises. Since this does not always work immediately, you should not give up. Rather, you should then stretch the head a little further and carefully increase the ventilation pressure.
In any case, the breath should be continued until the doctor or a paramedic takes over. Often, patients also begin to breathe again independently. Even then, they must not be left alone in any case, but should stay with it and check the breathing regularly. The best way to do this is to place the affected person in the stable lateral position.
Using the defibrillator correctly
A recommended resuscitative measure is also the use of a defibrillator (AED device). A defibrillator is used to deliver a jolt of electricity to the heart, for example in life-threatening ventricular fibrillation, so that it can beat again in its normal rhythm.These devices are often found in public buildings and are very easy for first responders to use, as they are fully automatic and provide voice instructions for proper operation. However, in the event of cardiac arrest, chest compressions should come first. Do not waste valuable time looking for a defibrillator instead, but start resuscitation immediately. If other helpers are present, they can start looking for a defibrillator in the meantime.
Heart attack: what to do?
Cardiovascular diseases continue to be the most common cause of death in Germany. Right at the top of the statistics are heart attacks and strokes. The cause of a heart attack is the sudden occlusion of a coronary artery. The heart muscle is supplied with oxygen and nutrients through these vessels. Symptoms: severe pain behind the breastbone, often radiating into the left arm, shoulder or upper abdomen. Sufferers experience anxiety. Face is pale gray, sometimes sweaty. Nausea, sometimes with vomiting, may be added. It is not uncommon for the cardiovascular system to collapse. Most sufferers are afraid of being alone. One should avoid anything that agitates the affected person. Important: Immediately notify the rescue service and request an emergency physician. At no time should the patient be left unattended; he or she must be reassured. If the patient is conscious, he should be gently positioned with the upper body elevated.
Stroke: first aid
Stroke is one of the most common causes of death in Germany. In apoplexy, as the medical term is, circulatory disorders of the brain occur with acute functional disorders of the nervous system. The brain cells are particularly dependent on an uninterrupted supply of oxygen and nutrients. Oxygen and nutrients are transported to the brain cells via the blood system. In the event of a circulatory disorder of the brain, the nerve cells of the brain die very quickly. An interruption of the blood supply of just a few minutes is sufficient for this. Symptoms that point to a stroke include hemiplegia or numbness, drooping corners of the mouth, speech and language disorders, or visual disturbances such as hemifacial blindness or visual field loss. Important: Until the doctor arrives, first aid must be administered: If the patient can breathe and is conscious, lay him flat on the floor and support his head. If he is unconscious, he must be placed in the recovery position to prevent stomach contents from entering the lungs.
When do you need the stable lateral position?
The stable lateral position is used when the victim is unconscious but breathing sufficiently so that resuscitation is not required. It is intended to help the unconscious person breathe so that he or she cannot choke on blood, vomit, or his or her tongue, because reflexes that otherwise make us cough involuntarily in such cases do not work when the person is unconscious. Therefore, the airways must be kept clear and the mouth must be the lowest point of the body.
Stable lateral position: instructions
To place an unconscious person in the stable lateral position, follow these instructions:
- Kneel sideways next to the unconscious person and extend his legs.
- The arm of the person facing you is placed with the elbow bent upward, perpendicular to the body (with the palm facing up).
- Grasp the arm facing away from you by the wrist, guide the arm across the chest and place the back of the hand on the cheek of the person facing you (for example, right hand on left cheek). Hold the hand there (Figure 1).
- Grasp the affected person’s thigh facing away from you to bend the leg (Figure 2).
- Now pull the affected person over to you in the lateral position. The leg above is bent so that the thigh forms a right angle to the hip.
- Hyperextend the neck (head bent neckward) to clear the airway and open the unconscious person’s mouth. The hand resting on the cheek should stabilize this position so that the mouth is the lowest point (Figure 3).
- The unconscious person now lies in the stable lateral position. Check breathing, consciousness and vital signs again and again and do not leave the victim unattended (Figure 4).
First aid is crucial
Especially in the case of cardiovascular arrest, the simple resuscitative measures in the first few minutes are the most crucial, because otherwise all further efforts by the rescue service and in the hospital may remain unsuccessful. Every minute without treatment reduces the chances of survival by ten percent. Cardiac massage always comes first – breathing should be given in addition if possible, but is not mandatory. Anyone who is afraid of mouth-to-mouth resuscitation can therefore omit it. Even the fear of breaking the victim’s ribs during chest compressions should not prevent you from taking resuscitative measures and providing first aid: broken ribs will heal.
