Artificial Respiration, forcing of air into and out of the lungs of one person by another person or by mechanical means. It is usually employed during suspension of natural respiration caused by disease, such as poliomyelitis or cardiac failure; by electric shock; by an overdose of depressive drugs such as morphine, barbiturates, or alcohol; or by suffocation resulting from drowning, breathing noxious gases, or blockage of the respiratory tract. If the brain is deprived of oxygen for five minutes, it may be permanently damaged; slightly longer periods without oxygen usually result in death. The exception is drowning in very cold water, in which the body's oxygen demand is greatly reduced; people have been revived after being submerged for one-half hour in cold water.
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Because of the danger to the brain of even short periods without oxygen, artificial respiration should always be started immediately. The mouth-to-mouth method, shown to be superior to the back-pressure and arm-lift procedure, is now recommended by the American Red Cross. In the mouth-to-mouth method the unconscious person is laid face up with the head tilted as far back as possible to prevent the tongue from blocking the air passages. The victim's nose is then pinched shut, and with the reviver's mouth tightly covering the victim's, the reviver gives four quick, deep breaths. If breathing does not resume, the reviver proceeds to give one breath each five seconds, allowing the air to come out of the victim's lungs between breaths. This is continued until the victim resumes breathing or until trained help arrives. If the unconscious person is a baby or small child, both the mouth and nose are covered with the reviver's mouth, and small puffs of air are breathed out to the victim at the rate of one every three seconds. To restore breathing to a person who is choking, a rescuer gives four quick blows between the victim's shoulder blades with the heel of the hand. If this does not dislodge the obstruction, the rescuer uses the stomach thrust, popularly called the Heimlich maneuver after its developer, the American physician Henry Jay Heimlich. The rescuer places the side of the fist against the victim's stomach, below the ribs and above the navel. Then, using the other hand, the rescuer thrusts the fist up into the victim's stomach forcefully four times. With children, a rescuer first turns the child head-down and slaps the child's back. In applying the Heimlich maneuver to children, the rescuer uses only the first hand, and not the second. A type of respiratory first aid that requires special training is called cardiopulmonary resuscitation (CPR). In this procedure, which is used for a person who has had a heart attack, the reviver alternately breathes for the victim and performs external massage on the person's chest to keep blood moving through the body. This technique is more easily done by two trained people, one performing each maneuver. See also First Aid.
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Mechanical devices for the administration of artificial respiration include a portable resuscitator used by police and fire departments and the heart-lung machine used to maintain oxygen saturation in the blood during open-heart surgery. Severe breathing difficulties may require help from a mechanical ventilator, which forces air into the lungs by way of a tube inserted into the upper airway through the nose, mouth, or a slit in the trachea. Comatose patients dependent on such a ventilator for a prolonged period may not resume spontaneous breathing. In the much-publicized case of Karen Anne Quinlan in 1976, the New Jersey Supreme Court ruled that a mechanical ventilator could be disconnected under certain conditions so that the comatose patient could "die with dignity." Normal breathing resumed, and the patient lived; nevertheless a precedent was established for the removal of life-support ventilators in the absence of electrical activity in the brain cortex.
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