chapter 3 - airway management

MSTC, FT LEWIS WAMSTC, FT LEWIS WA

AIRWAY AIRWAY MANAGEMENMANAGEMEN

TT

Lesson ThreeLesson Three

Airway Management: Airway Management: Conscious PatientConscious Patient

►No attempt at airway intervention if No attempt at airway intervention if the patient is conscious and breathing the patient is conscious and breathing well on his own.well on his own.

► If the casualty is talking or yelling he If the casualty is talking or yelling he has an open airwayhas an open airway

Airway Management: Airway Management: Unconscious PatientUnconscious Patient

►WithoutWithout airway obstruction: airway obstruction: Chin lift or jaw thrust maneuverChin lift or jaw thrust maneuver Nasopharyngeal airwayNasopharyngeal airway If facial trauma present, position to If facial trauma present, position to

let gravity drain and maintain airway let gravity drain and maintain airway (recovery position)(recovery position)

Airway Management: Airway Management: Unconscious PatientUnconscious Patient

►WithWith airway obstruction: airway obstruction: Chin lift or jaw thrust maneuverChin lift or jaw thrust maneuver Observe for debris and remove if possibleObserve for debris and remove if possible

►Loose teeth, facial bone, vomitus, etc…..Loose teeth, facial bone, vomitus, etc…..►NoNo blind sweeps with your fingers blind sweeps with your fingers

Place NPAPlace NPA

Open the Casualty’s Open the Casualty’s AirwayAirway

►The tongue is the most common cause The tongue is the most common cause of an airway obstructionof an airway obstruction

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

Anatomy – Upper AirwayAnatomy – Upper Airway

TongueTongue

Noisy ventilations = Noisy ventilations = obstructed airwayobstructed airway

Gurgling, snoring, Gurgling, snoring, stridor and wheezingstridor and wheezing

Anatomy – Upper AirwayAnatomy – Upper Airway

Manual ManeuversManual Maneuvers

►Head-Tilt/Chin-LiftHead-Tilt/Chin-Lift No suspected neck or spinal injuryNo suspected neck or spinal injury

►Trauma Jaw ThrustTrauma Jaw Thrust If neck or spinal injury is suspected, use If neck or spinal injury is suspected, use

the Jaw Thrust methodthe Jaw Thrust method

►Trauma Chin LiftTrauma Chin Lift

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

Open the Casualty’s AirwayOpen the Casualty’s Airway(Trauma Jaw Thrust)(Trauma Jaw Thrust)

Open the Casualty’s AirwayOpen the Casualty’s Airway(Trauma Chin Lift)(Trauma Chin Lift)

Rescue BreathingRescue Breathing

► Maintain head-tilt/chin-lift or jaw thrustMaintain head-tilt/chin-lift or jaw thrust

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

► Check carotid pulseCheck carotid pulse

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

► Check for breathing and pulse after one minuteCheck for breathing and pulse after one minute

Airway AdjunctsAirway Adjuncts

►Oro-pOro-pharyngeal Airway (OPA)haryngeal Airway (OPA)

►Naso-pharyngeal Airway (NPA)Naso-pharyngeal Airway (NPA)

Oropharyngeal AirwayOropharyngeal Airway(J-Tube)(J-Tube)

►Identify when to useIdentify when to use

► Determine the sizeDetermine the size

► Insertion of the airwayInsertion of the airway

► Monitor the casualtyMonitor the casualty

Oropharyngeal AirwayOropharyngeal Airway(J-Tube)(J-Tube)

►When to use:When to use: Unconscious patientsUnconscious patients

Help to maintain an airwayHelp to maintain an airway

What about trauma?What about trauma?

Oropharyngeal AirwayOropharyngeal Airway(J-Tube)(J-Tube)

►How to size:How to size: Place the tip of the airway along the Place the tip of the airway along the

outside of the casualty's jaw with the outside of the casualty's jaw with the tip touching the ear lobe.tip touching the ear lobe.

Close the casualty's mouth and place Close the casualty's mouth and place the other end to the corner of the the other end to the corner of the mouthmouth

Oropharyngeal AirwayOropharyngeal Airway(J-Tube)(J-Tube)

Oropharyngeal AirwayOropharyngeal Airway(J-Tube)(J-Tube)

Oropharyngeal AirwayOropharyngeal Airway(J-Tube)(J-Tube)

►Monitor The Casualty:Monitor The Casualty: Check RespirationsCheck Respirations

Check PlacementCheck Placement

What if the patient becomes What if the patient becomes conscious?conscious?

Oropharyngeal AirwayOropharyngeal Airway(J-Tube)(J-Tube)

Not indicated if gag Not indicated if gag reflex presentreflex present

Best used temporarilyBest used temporarily

Does not protect the Does not protect the tracheatrachea

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

►Identify when to useIdentify when to use

► Determine the sizeDetermine the size

► Insertion of the airwayInsertion of the airway

► Monitor the casualtyMonitor the casualty

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

►When to use:When to use: Conscious, semi-conscious, or has a gag Conscious, semi-conscious, or has a gag

reflexreflex

Respiration rate less than normal (less Respiration rate less than normal (less than two in 15 seconds)than two in 15 seconds)

Snoring and gurgling soundsSnoring and gurgling sounds

Airway of choice in tactical environmentAirway of choice in tactical environment

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

►How to size:How to size: Size the airway by measuring from Size the airway by measuring from

the tip of the nose to the casualty’s the tip of the nose to the casualty’s earlobeearlobe

Coat the tip with a water-soluble Coat the tip with a water-soluble lubricantlubricant

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

►How to insert:How to insert: Place the casualty on his backPlace the casualty on his back Remove airway and lubricantRemove airway and lubricant Lubricate the tubeLubricate the tube Expose the opening of the casualty’s Expose the opening of the casualty’s

nostril (pig nose)nostril (pig nose) Insert the tip of the airway into right Insert the tip of the airway into right

nostril with bevel facing septumnostril with bevel facing septum Advance until flange rest against the Advance until flange rest against the

nostrilnostril

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

►DO NOTDO NOT continue if resistance is met continue if resistance is met►Stop, remove adjunct, relubricate and Stop, remove adjunct, relubricate and

try other nostriltry other nostril► If resistance is still met, check proper If resistance is still met, check proper

size or use alternate artificial airway size or use alternate artificial airway methodmethod

►To remove, pull out with steady To remove, pull out with steady motion along curvature of nasal cavitymotion along curvature of nasal cavity

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

Do notDo not use the use the nasopharyngeal nasopharyngeal airway if the roof of airway if the roof of the casualty’s mouth the casualty’s mouth is fractured or brain is fractured or brain matter is exposedmatter is exposed

Do notDo not use the use the nasopharyngeal airway if nasopharyngeal airway if there is clear fluid coming there is clear fluid coming from the ears or nosefrom the ears or nose

Leaking cerebrospinal fluid Leaking cerebrospinal fluid may indicate a skull fracturemay indicate a skull fracture

Nasopharyngeal AirwayNasopharyngeal Airway(Nasal Trumpet)(Nasal Trumpet)

Position the CasualtyPosition the Casualty

►Gravity is not just a good idea it’s the Gravity is not just a good idea it’s the lawlaw Recovery Position, transport face downRecovery Position, transport face down

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

Questions????Questions????