538 CHAPTER 13 Airway Management and Ventilation

Patho Pearls

Back to Basics Always try basic airway maneuvers before resorting to advancedones.

■ Figure 13-22 Personalprotective equipment.

\In the absence of cervicalspinal trauma, the head-tilt/chin-lift is the best techniquefor opening the airway in anunresponsive patient who isnot protecting his own airway.

BASIC AIRWAY MANAGEMENT

Deciding if a patient has a patent airway is the most important step in the initial as-sessment. Airway management is one of the few prehospital interventions that isknown to improve patient survival rates. Once you have determined that interventionis needed, you must use simple manual airway maneuvers and equipment before pro-ceeding with more advanced techniques such as endotracheal intubation or place-ment of the CombiTube. Always provide supplemental oxygen to all patients forwhom it is indicated; never withhold it even from the COPD patient. Be sure to al-ways wear protective eyewear and gloves to avoid contact with the patient’s body flu-ids (Figure 13-22 ■). If you suspect cervical spine injury, perform modified airwaytechniques in conjunction with appropriate cervical spine stabilization. Once youhave secured the airway, frequently reassessing for an adequate airway and ventilationis critical to the patient’s survival.

MANUAL AIRWAY MANEUVERSManual maneuvers are the simplest airway management techniques. They require nospecialized equipment, are safe, and are noninvasive. They are highly effective but oftenneglected in prehospital care. In the patient who is unconscious or has a decreased levelof consciousness, posterior displacement of the tongue is often the cause of airway ob-struction. The head-tilt/chin-lift and the jaw-thrust are safe and dependable maneuversfor relieving this obstruction. You should perform one of these techniques on all uncon-scious patients; do not perform them on responsive patients. If you suspect cervical spineinjury, perform the modified jaw-thrust with in-line stabilization of the cervical spine.

Head-Tilt/Chin-LiftIn the absence of cervical spine trauma, the head-tilt/chin-lift is the best technique foropening the airway in an unresponsive patient who is not protecting his own airway

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