Wood considers "forced respiration" the most valuable plan. He employs a pair of bellows which are connected with a tracheal tube by India-rubber tubing; a face-mask is also required.
cases in whicii, an the iisnal resusci tative measures having failed, complete inversion and suspension by the bent knees over the operator's shoulders re suited in recovery. Prince (Then Gaz., Jan., '93).
Rapid and violent artifieial respiration and overvigorons efforts in the direction of inversion, etc., may. if the heart is already deeply chloroformed, lead to a fatal distension of that organ. Leonard Hill and Barnard (Brit. :Med. Jour.. Nov. 20, '97).
Complete inversion—i.e., suspending the patient by the feet or bent knees— is sometimes rapidly effective. Dudley Buxton regards Nelaton's inversion method as the best procedure in cardiac failure when no pulmonary or venous engorgement. In his opinion, artificial respiration stands facile princeps for cases of failure of respiration when due to narcotism of medullary centres.
Kelly recommends the following plan, which combines inversion and artificial respiration in an especially-effective manner: "On the first indication of failing respiration the administration of the amnsthetic should be instantly suspended and the wound protected by a fold of gauze. An assistant steps npon the table and takes one of the patient's knees under each arm and thus raises the body from the table until it rests upon the shoulders. The anms thetizer in the meanwhile has brought the head to the edge of the table, where it hangs extended and slightly inclined forward. The patient's clothing is pulled down under the armpits, completely baring the abdomen and chest. The op erator, standing at the head, institutes respiratory movements as follows: III spiration, by placing the open hands on each side of the chest posteriorly over the lower ribs, and drawing the chest well forward and outward, holding it thns for about two seconds; expiration, reversing the movement by replacing the hands on the front of the chest over the lower ribs and pushing backward and in ward, at the same time compressing the chest. The success of the manoeuvre
should be demonstrated by the audible rush of the air in and out of the chest." The following plan of resuscitation was pursued by Maas, and, after over an hour, in each case successfully: The mouth was opened, the tongue drawn forward, and the epiglottis raised. The prFecordial region was then compressed thirty or forty times a minute (the fre quency of respiration). Whenever tbis was stopped, syncopal symptoms again appeared. Subsequently tracheotomy was performed, as it was difficult to keep the air-passages free; but this did not assist the circulation. The respirations becoming almost imperceptible, Sylves ter's method of artificial respiration was adopted, and more vigorous pressure made over the breast. A similar course was adopted in the second case. The manceuvre is thus performed: The op erator stands -upon the left side of the patient, and presses, with quick, strong movements, deep down in the region of the heart with the fingers of the right hand, while the ball of the thumb is placed above the left clavicle. The nnm ber of compressions is one hundred and twenty or more per minute. The left hand should seize the patient upon the rit,dit side of the thorax.
C'ase in it child, apparently dead. in which the Kiinig-Maits method—rapid compression (about 120 per minute) of the prrecordium—followed by ultimate recovery. Seven minutes had elapsed during which neither heart-beat nor respiratory effort could be detected. Leedham Green (Birmingham Med. Rev., Feb., '95).
A method recommended by Prus is warranted when other means of resusci tation have failed. This consists in ex posing the pericardium by making an opening through the chest-Avalls — a trap-door flap of skin, muscles, and ex sected ribs—and grasping the heart and pericardium. The firmness of the grasp is then increased every second—simu lating its own normal action. Cases re cently reported have shown that the heart, even in doomed subjects, may be brought to react, at least for a time.