Apply the Heimlich maneuver if unsuccessful and the object is blocking the airway. If vomiting occurs, turn the person on his or her side and sweep out the mouth with two fingers. Do not place your finger in the mouth if the person is rigid or is having a seizure. Tilt the head back slightly to open the airway. Put upward pressure on the jaw to pull it forward.
Pinch the nostrils closed with thumb and index finger. Use a mouthpiece if one is available. Release the nostrils. If the person does not start breathing on his or her own, repeat the procedure. As a service to our readers, Harvard Health Publishing provides access to our library of archived content.
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We've all been taught to make sure the patient had an airway first, and if the patient was not breathing, to breathe air into the patient with mouth-to-mouth.
Only then, if the patient did not have a pulse or signs of circulation, we were taught to compress the chest to pump blood through the body. That thinking was flawed. Airway and breathing are vital, there's no question about that. The proof is in the brain. Our brains' most basic needs are centered in our brain stems, and the most basic of all is the need to breathe.
Even as the rest of the brain is damaged from illness or injury, one of the absolute last functions to go will be the drive to breathe. Even the structures that support breathing are built to be protected.
Nerves that move the diaphragm, a muscle in the base of the chest used for breathing, are found at the very top of the spinal cord so they'll be the last nerves damaged if the spinal cord is injured. Those are the nerves the late Christopher Reeve damaged when he fell off a horse, leaving him on a ventilator for the rest of his life. Our focus on airway is not misguided; we took our cue from the body itself. Unfortunately, we missed a major point. While breathing is the most important item on the brain's to-do list, pumping blood isn't even up to the brain to remember.
Pumping blood is a function of the heart, and the heart does it without even being told. Our heart muscle is the only muscle tissue in the body that doesn't require an outside stimulus to contract. It happens automatically. The heart can pump blood even as the brain is trying to focus on breathing. When the brain loses the ability to direct breathing, the heart will still be pumping blood until it completely runs out of energy. So the brain keeps air going in and out while the heart keeps blood going around and around.
They work together, but they're independent. If the brain stops working, the heart can continue. On the other hand, if the heart stops, so does the brain. The circulatory system heart and blood vessels and respiratory system lungs and airways work together like a supply chain, moving oxygen to body tissues and removing carbon dioxide.
The bloodstream is the highway, with main arteries and a network of side streets, all with one-way traffic. The lungs are like a giant loading dock where oxygen is dropped off and carbon dioxide is collected. Imagine a truck on a highway. That truck's goal is to always be full and on the road. Moving cargo is his way of making money.
He has just left the dock with a load of oxygen on his way to a bunch of factories that need it for fuel. He'll drive through the biggest interchange in the whole system--the heart--and then take the aorta freeway.
Just past the turnpike, he'll take the carotid artery exit heading to the brain.
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