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Airway Management

Airway Management

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  • Airway Management

    meRefer to lesson 3 in your book (pg. 3-1)

  • IntroductionOne of the most critical skills for the soldier medicWithout proper airway management the casualty may dieFunction of respiratory systemExchange of oxygen and carbon dioxideSupplies cells which in turn supply major organs

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  • TerminologyNPABevelSeptumPerfusionCricothyroid membraneTidal Volume

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  • Lesson OutlineBrief A&P of the respiratory systemRespiratory processIdentifying adequate respirationSigns of inadequate respirationEvaluating the casualtyInserting a NPABrief emergency cricothyrotomyRecovery position

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  • The Respiratory System

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  • Respiratory System: A&P

    mePharynxStructureNasopharynxOropharynxLaryngeal pharynxTrachea

    Tube that extends from lower edge of larynx to upper part of chest above the heartBronchi and BronchiolesTrachea branches off into two bronchi Enter the lungsRight bronchus considerably larger and straighter Left bronchus goes off at a greater anglePassageways to bring air to alveoli

  • Respiratory System: A&PThoracic cavityLungs occupy considerable portion of thoracic cavitySeparated from abdominal cavity by diaphragmPleura Mediastinum- region between lungs

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  • Respiratory System: A&P

    FYI Right lung has three lobes Left Lung has two lobes Respiratory system is divided into Conducting zone Respiratory zone

    meConducting zone includesTracheaBronchiBronchiolesTerminal bronchioles Respiratory zoneRespiratory bronchiolesAlveolar ductsAlveoli

  • Respiratory ProcessThe process of exchanging O2 and CO2Inhalation Initiated by contracting of respiratory system musclesDiaphragm flattens and drops downExhalationRespiratory muscles relaxDiaphragm moves upNormal breathing should be effortless

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  • Respiratory System: Air ExchangeExhalationInhalation

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  • Respiratory System: Air Exchange

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  • Adequate RespirationNormal breathing should be effortless

    * Breathing and heart beat are so dependent on each other that if breathing stops first the heart beat will stop very soon or if the heart beat stops first breathing will stop almost at onceUnusual respiratory rate or difficulty in breathing indicates that the casualty has a problem requiring attention

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  • Adequate RespirationAverage respiratory rate for an adult is 12-20 respirations per minuteNormal tidal volume Does not require accessory muscles

    meAccessory muscles includeNeck muscles (sternocleidomastoid, scalene)Abdominal musclesExternal intercostal musclesLike child crying

  • Inadequate RespirationShallow breathingslight movement of chest or abdomenLabored breathing increased respiratory effort, use of accessory muscles, and gaspingNoisy breathing (obstructed airway) may include snoring, wheezing, gurgling (fluid in airway) on expiration, and crowing.

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  • Sources of Airway ObstructionTongueNumber one airway obstructionForeign bodiesBroken teethFacial bonesAspirationSevere edema

    meIndications of partial airway obstructions may include:Poor air exchangeHigh-pitched noises while inhalingCyanosisIncreased difficulty breathingComplete obstructionInability to speakNo airflowCasualty becomes unconscious quickly

  • Signs of Inadequate Respirations

    Nasal flaringExcessive useof accessorymusclesChest TightnessCyanosisNumbness, tingling inhands & feet

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  • Evaluating the CasualtyMove the casualty for safetyCheck for responsivenessAre you okay?AVPUCasualty should be supineIf casualty is not supine, turn him or her

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  • Opening the Casualtys AirwayWhen casualty is unconscious, muscles relaxThis causes the tongue to slip back into the pharynxCombat lifesavers goal is to maintain a patent airway

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  • Opening the Casualtys AirwayTwo methods are employed to open the airway

    Head-tilt/chin-liftJaw-thrust maneuver * Note: even if the casualty is breathing, position the airway to allow him or her to breathe easier

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  • Head-Tilt/Chin-LiftDo not compressSoft tissues under jawNot recommended for patients with suspected head, neck, or spine injury

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  • Head-Tilt/Chin-Lift

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  • Jaw-Thrust Maneuver

    Elbows onsame surfaceUse on unconscious patients or where head, neck, or spine injury is suspected

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  • Jaw-Thrust Maneuver

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  • Checking the Casualtys BreathingWhile maintaining an open airwayLook, listen, feelLook for signs of inadequate breathing or obstruction

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  • Rescue BreathingIf the casualty is not breathing, insert NPA and begin rescue breathingRescue breathing

    1. Maintain an open airway 2. Pinch the casualtys nostrils shut

    meMake sure air does not escape.

  • Rescue Breathing3. Administer two full breaths Ventilations should last from 2 to 3 seconds Watch for the casualtys chest to rise

    4. If the air does not go inReposition the head and reattempt

    5. If air does go in, check pulse after administering 2 breaths

    meAs you blow, observe the casualtys chestAdministering the two ventilations should take 2 to 3 seconds.Quickly break the seal, take another breath and release his nosewill allow the casualtys body to exhaleDiaphragm will expel air automaticallyCheck pulse after administering 2 breathsShould check pulse at the carotid arteryCheck pulse on the side closest to you

  • Rescue Breathing6. If casualty does not have a carotid pulse begin CPR *ONLY IF CERTIFIED* 7. Do not perform CPR in a combat environmentMove on to the next casualty

    8. If casualty resumed breathing, count the number of respirations for 15 seconds

    meCPR delivers only 25%- 33% of normal oxygen and nutrients throughout the bodyTo an already depleted system

  • Nasopharyngeal Airway* Airway of choice for the field environment

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  • Nasopharyngeal AirwayIndicationsConscious, semi-conscious, unconscious Gag reflex does not affect placementContraindications Open or closed skull fracturesOther signs of head injuriesMajor maxillofacial traumaComplicationsNasal trauma

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  • Nasopharyngeal Airway:InsertionMeasure the NPA for appropriate sizeTip of the nose to the earlobe

    Use sterile, water-soluble lubricantInsert NPA in the right nostril or largest nostrilBevel toward the septum

    * This is the bevel

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  • Nasopharyngeal Airway:InsertionIf resistance is met, try other nostrilIf NPA will not go into either nostril, place the casualty in the recovery position and seek advanced medical aid

    * Never force NPA into casualtys nostril

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  • Choose the correct size

    Measure from the nostril to the earlobe or angle of jaw

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  • Lubricate With Water Soluble Lubricant* What are your alternatives if conventional lubricant is unavailable?* Do not use petroleum jelly or any non-water-based lubricant

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  • Expose the opening in the nostril* Pig nose

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  • Insert the tip of NPA into the nostril* Bevel toward the septum* Do not continue if resistance is met

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  • NPA in place* Flange is resting flush against the nostril

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  • Inserted NPA* Tongue as an airway obstruction is no longer a concern

    meTo remove, pull out with steady motion along curvature of nasal cavity

  • What if you cannot insert a NPA?* Everything after this point is supplementary information

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  • Brief Anatomy of the Trachea

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  • Cricoid CartilageCricothyroidMembraneThyroidCartilageBrief Anatomy of the Trachea

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  • Emergency CricothyrotomyProcedure:Identify and palpate the cricothyroid membraneMake a 1 -inch vertical incision in the midline using a #15 or #10 scalpel blade

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  • Emergency CricothyrotomyProcedure:Stabilize the larynx with one hand; using a scalpel or hemostat, cut or poke through the cricothyroid membrane

    A rush of air may be felt through the opening

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  • Emergency CricothyrotomyCheck for air exchange and tube placement:

    Listen and feel for air passing in and out of tubeLook for bilateral rise and fall of the chestAscultate the abdomen and both lung fields

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  • Recovery Position

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  • SummaryBrief A&P of the respiratory systemRespiratory processIdentifying adequate respirationSigns of inadequate respirationEvaluating the casualtyInserting a NPABrief emergency cricothyrotomyRecovery position

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  • Questions?

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    Refer to lesson 3 in your book (pg. 3-1)

    PharynxStructureNasopharynxOropharynxLaryngeal pharynxTrachea

    Tube that extends from lower edge of larynx to upper part of chest above the heartBronchi and BronchiolesTrachea branches off into two bronchi Enter the lungsRight bronchus considerably larger and straighter Left bronchus goes off at a greater anglePassageways to bring air to alveoli

    Conducting zone includesTracheaBronchiBronchiolesTerminal bronchioles Respiratory zoneRespiratory bronchiolesAlveolar ductsAlveoli

    Accessory muscles includeNeck muscles (sternocleidomastoid, scalene)Abdominal musclesExternal intercostal musclesLike child crying

    Indications of partial airway obstructions may include:Poor air exchangeHigh-pitched noises while inhalingCyanosisIncreased difficulty breathingComplete obstructionInability to speakNo airflowCasualty becomes unconscious quickly

    Make sure air does not escape.

    As you blow, observe the casualtys chestAdministering the two ventilations should take 2 to 3 seconds.Quickly break the seal, take another breath and release his nosewill allow the casualtys body to exhaleDiaphragm will expel air automaticallyCheck pulse after administering 2 breathsShould check pulse at the carotid arteryCheck pulse on the side closest to you

    CPR delivers only 25%- 33% of normal oxygen and nutrients throughout the bodyTo an already depleted system

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