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Rescue Breathing and Barrier Devices

Rescue breaths have become controversial in the paradigm of BLS and CPR.  The American Heart Association has now come out with guidelines for hands only CPR that seems to negate the use of rescue breaths at all.  However, if you are a professional or in a situation of prolonged out of hospital CPR, you are probably going to need to use rescue breaths at some point.  This brings up the idea of barrier devices and how to protect yourself while still giving your patient the best chance at recovery.

A rescue breath may not help your patient, but in prolonged CPR, you will need to get perfusion of oxygen to the head.  As the guidelines now read, rescue breaths or mouth to mouth are only used in extremes.  Even paramedics use bag-valve-mask devices or mouth to mask devices to give breaths when they arrive on scene.  The cultural taboo against mouths touching keeps many away from rescue breaths, but the idea of infection control is just as powerful.  If you decide to do rescue breaths, you either need a barrier device or need to improvise one to avoid contamination.  Here’s a look at what you can carry and what you can use for breaths.

Deciding to Give Rescue Breaths

It is a very difficult decision to decide to do rescue breaths.  For some providers, they feel like they are letting down their patient if they don’t do them.  They feel as if they aren’t going to save the patient if they do not do rescue breaths.  The consensus of most researchers is that rescue breaths aren’t necessary, particularly if paramedics are nearby or an AED is on hand.  If you know that you will be doing CPR for an extended period, you may want to consider rescue breaths with a barrier.

Another reason for doing rescue breaths is if you are part of a two person CPR set up.  If someone else is doing compressions, then you may feel like you should at least be giving rescue breaths.  Culturally, there is a taboo against putting your mouth on another’s unless they are an intimate friend.  In addition, you may find the act repulsive, especially with the possibility of vomiting occurring while you give breaths.  For this reason, you should not perform rescue breaths unless you have a barrier device.  Many professionals and those trained in CPR carry them, or they can be improvised.

Barrier Devices

Barrier devices come in all sorts of shapes and sizes.  Some are as small as a keychain while others can easily fit into a purse.  You have to decide what sort of barrier device would be most convenient for you to carry around and would be accessible in a time of emergency.  A facemask with one-way valve is probably the best barrier device, though it can be bulky and doesn’t fit well into a pocket.  With this device, you would be able to provide a good seal, and you would not run the risk of contamination or infection.

Devices that come on key chains are a bit more problematic.  They are generally a sheet of plastic that acts as a guard between you and the patient.  Some of them have small valves, but most of them simply provide a place for you to seal your lips onto the plastic instead of the patient’s mouth.  One caveat with these devices is that they go bad quickly.  You can have a device for several years, but if you take it out to use it, it may crumble in your hands.  For this reason, it is good to get a newer device every few years to keep the plastic from getting too old.

Improvised Barrier Devices

What do you do if you need to give rescue breaths but don’t have a barrier device?  Actually, there are no official ways to improvise a barrier, but many bystanders in the field have been creative in their attempts to give rescue breaths when they were standard practice.  Some have pulled their t-shirts over their mouths to give breaths through the fabric.  It isn’t ideal, but it can act as a barrier against regurgitation and other bodily fluids.

Since most barrier devices are plastic, you could easily use available plastic around the victim as an improvised device.  A shopping bag would be good for this.  You will need to make a hole in the plastic, though, to get the air through and into the lungs.  Be careful not to make the hole too big as you will not have enough protection.  Too small and the patient will get no air.  Again, these methods are only to be used in extreme circumstances, and it is much preferable to do hands only CPR while waiting for the paramedics.  If you find yourself in need of rescue breaths and help is far away, you can use these ideas to help your victim get some much needed oxygen.