FEATURES OF GENERAL PATIENT CARE 21

clear. If there is risk of the patient vomiting, his head should be turned to
one side.
The vomiting patient is in danger of inhaling his own vomit. In the
X-ray department this risk can be removed if the patient is put on a tilting
table and tipped a few degrees head downwards. A tilting table is the best
one for an unconscious patient. If he is not on a tilting table and he starts
to vomit, his head should be turned to one side and the shoulders tilted
sideways so that the head is really well turned. It should be ascertained
that the airway is clear.
An advantageous position for the patient is one giving postural drain
age. That is a semi-prone position, half-way between lying on his side and
lying face downwards. The arm of the side on which he is lying should
be placed behind him (not underneath him). His head is turned on one
side with the face rotated slightly downwards.
The patient's colour should be observed for cyanosis. The term cyanosis
means that the patient is beginning to turn blue, and this will be observed
in the face. It is a sign that the blood is lacking in oxygen. The blueness
will show first in the tips of the ears and the nose, and immediate action
should be taken. It should be made certain that the airway is clear, oxygen
should be given by mask Chapter XV) and medical advice sought.
(see
If the patient stops breathing a method of artificial respiration which
can be instantly and easily applied is one which is described as 'direct
artificial respiration'.
The patient is put supine and his head is tilted fully back and to one side,
once it has been ascertained that there is no foreign matter visible in his
mouth or throat to obstruct the airway. This must be cleared first. With
his head back, the jaw is lifted up to keep the tongue forward as already
explained. The operator inhales a deep breath. Then, with mouth applied
closely against the patient's (the patient's nostrils being closed with the
fingers of one hand), the breath is exhaled directly into the patient's
mouth.
If this manoeuvreis correctly done (and experience has shown that it is
not difficult to do this), the patient's chest will be seen to rise; as the patient
is unconscious and in a state of muscular relaxation it is much easier to
inflate the chest than the inexperienced might suppose. The blowing into
the patient's mouth should be repeated once every 3 to 4 seconds.
This procedure should be maintained until the patient starts breathing
or other means of resuscitation can be applied. It is important that the
operator's inhalations should be deep, as the oxygen content of expired
air is somewhat lower than that of atmospheric air, being 14-18 per cent