Chapter 3 - Airway Management

AIRWAY MANAGEMEN T Lesson Three MSTC, FT LEWIS WA

Airway Management: Conscious Patient ► No

attempt at airway intervention if the patient is conscious and breathing well on his own.

► If

the casualty is talking or yelling he has an open airway

Airway Management: Unconscious Patient ► Without

airway obstruction:  Chin lift or jaw thrust maneuver  Nasopharyngeal airway  If facial trauma present, position to let gravity drain and maintain airway (recovery position)

Airway Management: Unconscious Patient ► With

airway obstruction:

 Chin lift or jaw thrust maneuver  Observe for debris and remove if possible ►Loose

teeth, facial bone, vomitus, etc….. ►No blind sweeps with your fingers

 Place NPA

Open the Casualty’s Airway ► The

tongue is the most common cause of an airway obstruction

► When

a casualty is unconscious, muscles relax. This relaxation may cause the tongue to slip to the back of the mouth and block the airway

Anatomy – Upper Airway Tongue Noisy ventilations = obstructed airway Gurgling, snoring, stridor and wheezing

Anatomy – Upper Airway

Manual Maneuvers ► Head-Tilt/Chin-Lift

 No suspected neck or spinal injury ► Trauma

Jaw Thrust

 If neck or spinal injury is suspected, use the Jaw Thrust method ► Trauma

Chin Lift

Open the Casualty’s Airway (Head-Tilt/Chin-Lift)

Open the Casualty’s Airway (Trauma Jaw Thrust)

Open the Casualty’s Airway (Trauma Chin Lift)

Rescue Breathing ►

Maintain head-tilt/chin-lift or jaw thrust

►

Pinch nostrils closed and administer two full breaths (2 seconds)

►

Check carotid pulse

►

If pulse is present, administer mouth-to-mouth ventilations at 1 per 5 seconds

►

Check for breathing and pulse after one minute

Airway Adjuncts ► Oro-pharyngeal

Airway (OPA)

► Naso-pharyngeal

Airway (NPA)

Oropharyngeal Airway (J-Tube) ► Identify

when to use

►

Determine the size

►

Insertion of the airway

►

Monitor the casualty

Oropharyngeal Airway (J-Tube) ► When

to use:

 Unconscious patients  Help to maintain an airway  What about trauma?

Oropharyngeal Airway (J-Tube) ► How

to size:

 Place the tip of the airway along the outside of the casualty's jaw with the tip touching the ear lobe.  Close the casualty's mouth and place the other end to the corner of the mouth

Oropharyngeal Airway (J-Tube)

Oropharyngeal Airway (J-Tube)

Oropharyngeal Airway (J-Tube) ► Monitor

The Casualty:

 Check Respirations  Check Placement  What if the patient becomes conscious?

Oropharyngeal Airway (J-Tube) Not indicated if gag reflex present Best used temporarily Does not protect the trachea

Nasopharyngeal Airway (Nasal Trumpet) ► Identify

when to use

►

Determine the size

►

Insertion of the airway

►

Monitor the casualty

Nasopharyngeal Airway (Nasal Trumpet) ► When

to use:

 Conscious, semi-conscious, or has a gag reflex  Respiration rate less than normal (less than two in 15 seconds)  Snoring and gurgling sounds  Airway of choice in tactical environment

Nasopharyngeal Airway (Nasal Trumpet) ► How

to size:

 Size the airway by measuring from the tip of the nose to the casualty’s earlobe  Coat the tip with a water-soluble lubricant

Nasopharyngeal Airway (Nasal Trumpet) ► How

to insert:

Place the casualty on his back Remove airway and lubricant Lubricate the tube Expose the opening of the casualty’s nostril (pig nose)  Insert the tip of the airway into right nostril with bevel facing septum  Advance until flange rest against the nostril    

Nasopharyngeal Airway (Nasal Trumpet)

Nasopharyngeal Airway (Nasal Trumpet)

Nasopharyngeal Airway (Nasal Trumpet)

Nasopharyngeal Airway (Nasal Trumpet)

Nasopharyngeal Airway (Nasal Trumpet)

Nasopharyngeal Airway (Nasal Trumpet)

Nasopharyngeal Airway (Nasal Trumpet) ► DO

NOT continue if resistance is met ► Stop, remove adjunct, relubricate and try other nostril ► If resistance is still met, check proper size or use alternate artificial airway method ► To remove, pull out with steady motion along curvature of nasal cavity

Nasopharyngeal Airway (Nasal Trumpet) Do not use the nasopharyngeal airway if the roof of the casualty’s mouth is fractured or brain matter is exposed Do not use the nasopharyngeal airway if there is clear fluid coming from the ears or nose Leaking cerebrospinal fluid

Nasopharyngeal Airway (Nasal Trumpet)

Position the Casualty ► Gravity

law

is not just a good idea it’s the

 Recovery Position, transport face down ► Casualty

with facial trauma should be placed in the recovery position (see below)

Questions????