Opening and Managing a Opening and Managing a Casualty’s AirwayCasualty’s Airway

Module 3Module 3Objective:Objective:

Open the airway of an unconscious Open the airway of an unconscious casualty, and how it can be casualty, and how it can be

maintained. maintained.

Airway Adjuncts: what are they?Airway Adjuncts: what are they?

The Question of CPRThe Question of CPR

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

If the casualty responds to your question If the casualty responds to your question ”Hey, hey, are you Ok?” then after your ”Hey, hey, are you Ok?” then after your treatment, place the casualty on his side, treatment, place the casualty on his side, with his arm tucked under his head. (This with his arm tucked under his head. (This is called the is called the Recovery Recovery position ) position )

If Casualty is not alert, consider inserting If Casualty is not alert, consider inserting a nasopharyngeal airway from casualties a nasopharyngeal airway from casualties IFAK packIFAK pack

No Airway = No PatientNo Airway = No Patient

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

Determine their Responsiveness levelDetermine their Responsiveness level AA

Casualty is Alert and is aware of Place, Casualty is Alert and is aware of Place, time, and events.time, and events.

VV Casualty is not alert, but responds to verbal Casualty is not alert, but responds to verbal

stimulistimuli PP

Casualty’s body responds to painful Casualty’s body responds to painful stimulus, like Sternal rub, ear lobe pinch, stimulus, like Sternal rub, ear lobe pinch, etc…etc…

UU There is no response whatever from the There is no response whatever from the

CasualtyCasualty

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

Open airway of unconscious patientOpen airway of unconscious patient

Unconscious patients will relax muscles, Unconscious patients will relax muscles, so this causes the tongue to fall back, so this causes the tongue to fall back, blocking the airway.blocking the airway.

The Tongue is the most common form of The Tongue is the most common form of obstruction in an unconscious patient. obstruction in an unconscious patient.

Use the Use the Head-TiltHead-Tilt / / Chin-LiftChin-Lift method to method to open their airway. Secure by inserting an open their airway. Secure by inserting an NPA.NPA.

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

Head-Tilt / Chin-Lift MethodHead-Tilt / Chin-Lift Method One hand against forehead, one One hand against forehead, one

hand grasping chin lightly, and hand grasping chin lightly, and open the airway.open the airway.

This method allows you to move This method allows you to move to the next patient, and provide to the next patient, and provide care, while not having to care, while not having to maintain “hands on” to keep maintain “hands on” to keep airway open.airway open.

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

Less than 1% of all battlefield casualties have Less than 1% of all battlefield casualties have neck or spinal injuryneck or spinal injury

Only suspect neck or spinal injury in Only suspect neck or spinal injury in casualtiescasualties

Falls from 15 feet or higherFalls from 15 feet or higher Fast rope or Airborne operationsFast rope or Airborne operations

Motor vehicle / Military vehicle accidentsMotor vehicle / Military vehicle accidents If Spinal injury suspected—INSERT AN If Spinal injury suspected—INSERT AN

NPANPA(if no head injury is suspected)(if no head injury is suspected)

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

Airway AdjunctsAirway Adjuncts

Keeps Casualty’s airway open in case Keeps Casualty’s airway open in case they get worsethey get worse

IFAK Pack has a Nasopharyngeal IFAK Pack has a Nasopharyngeal Airway in each one. Airway should be Airway in each one. Airway should be pre-measured to specific soldierpre-measured to specific soldier

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

Insertion of a Nasopharyngeal AirwayInsertion of a Nasopharyngeal Airway

DO NOT INSERT IFDO NOT INSERT IF Roof of mouth is fractured, and/or brain Roof of mouth is fractured, and/or brain

matter is exposed, or severe facial matter is exposed, or severe facial traumatrauma

Clear fluid is observed coming from ears Clear fluid is observed coming from ears or nose ( This could be Cerebrospinal or nose ( This could be Cerebrospinal fluid indicating a skull fracture)fluid indicating a skull fracture)

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

Place casualty on backPlace casualty on back Lubricate the NPALubricate the NPA Insert with the bevel (Shallow opening Insert with the bevel (Shallow opening

side of tube) facing the Septum side of tube) facing the Septum ( middle of the nose ) ( middle of the nose )

Insert on the right side.Insert on the right side. Allow it to turn if it begins too– it Allow it to turn if it begins too– it

probably will. probably will. Insert until the Flange rests against Insert until the Flange rests against

the nostrils.the nostrils.

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

CPR?CPR? If a victim of a blast or penetrating If a victim of a blast or penetrating

injury is found without a pulse, injury is found without a pulse, respirations, or other signs of life,respirations, or other signs of life,

DoDo NotNot attempt CPR attempt CPR Three instances where CPR may be Three instances where CPR may be

beneficialbeneficial Near drowningNear drowning ElectrocutionElectrocution HypothermiaHypothermia

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

138 trauma patients with pre-hospital 138 trauma patients with pre-hospital cardiac arrest in whom resuscitation was cardiac arrest in whom resuscitation was attemptedattempted

No survivors!!!No survivors!!!

Authors recommended Authors recommended No CPRNo CPR in cardiac in cardiac arrest due to traumaarrest due to trauma

Rosemurgy et al.Rosemurgy et al. J Trauma 1993J Trauma 1993

TRAUMA DEAD IS TRAUMA DEAD IS DEAD!DEAD!

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

CPR performers may get killedCPR performers may get killed

Mission gets delayedMission gets delayed

Casualty stays deadCasualty stays dead

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

Rescue breathingRescue breathing If casualty has a pulse, but is not If casualty has a pulse, but is not

breathing you may assist in rescue breathsbreathing you may assist in rescue breaths

Ventilate Casualty at a rate of 1 breath Ventilate Casualty at a rate of 1 breath every 5 seconds.every 5 seconds.

Re-evaluate after several minutes. Re-evaluate after several minutes. Revaluate need to rescue breathe based on Revaluate need to rescue breathe based on mission. mission.

Opening and Managing a Opening and Managing a Casualty’s Airway (Cont’d)Casualty’s Airway (Cont’d)

TRIAGE NoteTRIAGE Note If you have multiple casualties, If you have multiple casualties,

open airways of patients, insert open airways of patients, insert NPA, and move on to the next NPA, and move on to the next one. one.

NO RESCUE BREATHING in NO RESCUE BREATHING in MASS CASUALTY situations.MASS CASUALTY situations.

QUESTIONS?QUESTIONS?