This section is about providing care for someone who has taken a fall or sustained a physical injury that may appear to include the spine, and how you should proceed in these situations. Before we get into the jaw thrust CPR technique, there are some other things to keep in mind first.
When you encounter a victim who appears to be immobile and in pain, you want to minimize their movement as much as possible, as you inquire more about what happened, how the patient is feeling, and whether or not you need to activate EMS.
If the victim is conscious, let them know who you are and that you're there to help. Instruct the patient to not move and avoid nodding, and to answer your questions verbally, as you continue to assess his or her condition.
Look specifically for head wounds and bleeding – from the head, nose, and ears. Check to see if the person has any broken teeth and if their pupils are responsive to light.
Pro Tip #1: To check for responsiveness to light, simply place one hand over the patient's eyes and then remove it. Do the pupils react? If not, the victim could have a possible concussion and swelling of the brain. If you suspect this to be the case, call 911 immediately.
Otherwise, if the victim is conscious, has a heartbeat, and is breathing normally, you may not have to call 911, at least while you continue to assess the situation. Some questions you should ask include:
- Do you remember what happened?
- Did you hit your head?
- Can you tell me what hurts?
- Can you move your arms, legs, fingers, toes?
- Do you know what day it is?
- Do you know what year it is?
Should the victim answer one of those last two questions incorrectly, you may be dealing with someone who may have an altered mental state, likely due to a head injury. Remember, if you suspect a head injury at any point during your evaluation, call 911 immediately.
Warning: If the patient is showing signs of paralysis, this could potentially lead to spinal shock. You may recall learning about the signs of shock in the bleeding control course material – pale, cold, sweaty, etc. If the patient does go into shock, this could lead to the patient becoming unresponsive and requiring CPR.
Pro Tip #2: If you see signs of shock, cover the patient with a blanket or coat. It's important to keep them warm while you continue to reassess for airway or circulation problems.
Should the patient become unresponsive or begin having trouble breathing normally, or go into full cardiac arrest, proceed with CPR using the jaw thrust technique to avoid any potential and/or further spinal injuries.
How to Provide Care
As always, the first thing you want to do is make sure the scene is safe and that your gloves are on. Make sure you have your rescue mask with a one-way valve handy and begin calling out to the victim to assess whether or not he or she is responsive.
Are you OK? Can you hear me?
If you don't get an initial response, place your hand on the patient's forehead and tap on his or her collarbone, while also reminding yourself not to move the neck or head. If you still do not get a response, proceed with CPR as you normally would.
- Call 911 and activate EMS or call in a code if you're in a healthcare setting. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc. In the event that you do not know how to proceed, call 911 on your cell phone, put it on speaker, and follow their instructions.
- Continue to assess the victim's responsiveness and vital signs – signs of breathing normally, signs of a pulse, etc.
- Check for the carotid pulse (or brachial pulse in infants), located between the trachea and sternocleidomastoid muscle, in the valley between these two structures. Use the flat parts of your index and middle fingers and press with moderate force in that valley. Spend no more than 10 seconds looking for a pulse.
- If you've determined at this point that the victim is unresponsive, not breathing normally, and has no pulse, continue immediately with CPR.
Jaw thrust Technique when Performing CPR
The purpose of the jaw thrust technique is to minimize cervical spine movement. It requires two responders. One should be positioned at the head of the patient, while the other begins chest compressions as you normally would.
When you get to the point of delivering two breaths into the rescue mask, proceed with the following steps:
- Place the apex of your rescue mask over the bridge of the victim's nose.
- Seal the bell part of the mask just below the patient's bottom lip and above the chin.
- Place both of your thumbs on top of the mask, as your fingers fan out and over the sides of the patient's face.
- As you push down on the mask with your thumbs, use your fingers to grab the mandible, or jaw, and pull it up into the mask.
Pro Tip #3: The jaw line goes down then hooks at the back of the jaw, providing the leverage points you'll be using to pull the jaw upward, into the mask.
Warning: Remember that you do not want to perform a normal head tilt, chin lift on a patient who you suspect may have a spinal injury. The only scenario when you would use the normal maneuver is if you are the lone responder and you have no choice.
- As you pull the jaw up into the mask, give one rescue breath, wait for the chest to rise and fall, and give one more rescue breath in the same manner.
- Continue with CPR – chest compressions followed by jaw thrust rescue breaths – until help arrives, an AED arrives, or the patient is responsive and breathing normally.
A Word About Two-Responder CPR
When two responders are available, responder one should size up the scene and make sure it's safe, begin the primary patient assessment, and then begin chest compressions.
Responder two should call for help, get/find an AED, or prepare its readiness if you have one, while responder one continues with 30 chest compressions followed by two rescue breaths.
Continue this way until responder two is ready to jump in and take over or until the AED is ready to use.
When the AED is ready, responder one should move to the patient's head while responder two gets into a hovering position to perform chest compressions. Switch positions when the responder performing chest compressions becomes fatigued.
Pro Tip #4: The best time to switch positions is while the AED is analyzing the patient. Use an agreed upon term like switch, and make sure the responder doing the chest compressions is counting out loud so the other responder can anticipate the switch.