CASE 1

On 2nd July 1979 n emergency home visit called because of an asthmatic attack found a 16 year old girl supporting herself with both hands at the kitchen sink.  She was making occasional short high-pitched noises like a faint hiccup sound trying to breathe.  At this point she collapsed unconscious with complete cessation of the sounds and respiration.  Mouth to mouth resuscitation failed even with the head lifted slightly and a clear airway.  The patient was turned over on her face in an attempt to use the Schafer method of artificial respiration. Two hands were placed flat over the lower chest, the thumbs over the spine and the fingers around each side of the lower chest using the operators body weight to compress the chest against the floor.  There was an immediate satisfying and prolonged escape of air from the lungs suggesting that the reason the mouth to mouth respiration had failed was that the lungs were already over inflated and the chest wall at maximal extension.  Following 4 or 5 compression manoeuvres the patient started to breathe on her own oxygen was administered by face mask and by the time the ambulance arrived three quarters of an hour later she was regaining consciousness.