When providing rescue breaths to an unresponsive individual, the immediate lack of chest movement signals that air is not entering the lungs. This situation requires prompt and precise troubleshooting to ensure the person receives the necessary oxygenation. The failure of the chest to inflate suggests a problem with either the technique being used, the positioning of the airway, or a physical obstruction. Addressing this issue quickly is paramount.
Correcting Airway Position and Seal
The most frequent reason air fails to enter the lungs is misalignment of the airway, often caused by the tongue falling back and obstructing the upper airway when consciousness is lost. This anatomical blockage is corrected by performing the head-tilt/chin-lift maneuver. The rescuer places one hand on the forehead and gently tilts the head backward while the fingers of the other hand lift the chin upward. If a spinal injury is suspected, a jaw-thrust maneuver is used instead to open the airway without moving the neck. After properly repositioning the head, the rescuer must ensure an airtight seal before reattempting the two rescue breaths.
Identifying and Clearing Airway Obstruction
If the chest still fails to rise after repositioning the airway and reattempting the breaths, the problem is likely a foreign-body airway obstruction (FBAO). The immediate priority shifts to relieving the obstruction within the established cardiopulmonary resuscitation (CPR) cycle. The sequence of actions involves alternating chest compressions with a check for the foreign body.
The rescuer should immediately begin cycles of 30 chest compressions, delivered at a rate of 100 to 120 per minute and to a depth of at least two inches (five centimeters). These compressions function not only to circulate blood but also to increase pressure within the chest cavity, potentially forcing the lodged object out. After completing the 30 compressions, the rescuer should open the airway again using the head-tilt/chin-lift.
Before attempting the next rescue breath, the rescuer must visually inspect the person’s mouth for any visible foreign material. If an object is seen and can be easily grasped, remove it with a finger sweep. Avoid a blind finger sweep, as this may push the object further down the throat and worsen the obstruction. If no object is seen or removed, attempt the two rescue breaths again, observing closely for chest rise. If the chest still does not inflate, immediately proceed to the next cycle of 30 chest compressions, repeating the sequence of compressions, mouth check, and attempted ventilation.
Prioritizing Chest Compressions
Regardless of whether the airway issue is resolved, the highest priority in resuscitation is maintaining circulation through continuous chest compressions. The brain and heart require a constant supply of oxygenated blood, and compressions provide this life-sustaining flow. The chest compressions should continue without interruption except for the brief pauses necessary to deliver the two rescue breaths and check the mouth. Even if only minimal air is entering the lungs, the act of forcefully compressing the chest helps to achieve some gas exchange and maintain blood flow. The rescuer should maintain a compression rate of at least 100 per minute to maximize perfusion. These cycles of compressions and attempted ventilations must continue without cessation until professional medical help arrives and takes over the effort.