Airway Management
Introduction
• One of the most critical skills for the soldier medic
• Without proper airway management the casualty may die
• Function of respiratory system– Exchange of oxygen and carbon dioxide
• Supplies cells which in turn supply major organs
Terminology
• NPA• Bevel• Septum• Perfusion• Cricothyroid membrane• Tidal Volume
Lesson Outline
• Brief A&P of the respiratory system• Respiratory process• Identifying adequate respiration• Signs of inadequate respiration• Evaluating the casualty• Inserting a NPA• Brief emergency cricothyrotomy• Recovery position
Respiratory System: A&P
NasopharynxOropharynx
Right m ain bronchus
Pharynx
Thyroid cartilageCricoid cartilage
Epiglo ttis
Lungs
Larynx
Bronchiole
Diaphragm
Trachea
Left m ain bronchus
Respiratory System: A&P
• Thoracic cavity– Lungs occupy
considerable portion of thoracic cavity
– Separated from abdominal cavity by diaphragm
– Pleura – Mediastinum- region
between lungs
Respiratory System: A&P
FYI Right lung has
three lobes Left Lung has two
lobes Respiratory
system is divided into
Conducting zone Respiratory zone
Respiratory Process
• The process of exchanging O2 and CO2
• Inhalation – Initiated by contracting of respiratory
system muscles– Diaphragm flattens and drops down
• Exhalation– Respiratory muscles relax– Diaphragm moves up
• Normal breathing should be effortless
Respiratory System: Air Exchange
ExhalationExhalationInhalationInhalation
Respiratory System: Air Exchange
Adequate Respiration
• Normal 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 once
• Unusual respiratory rate or difficulty in breathing indicates that the casualty has a problem requiring attention
Adequate Respiration
• Average respiratory rate for an adult is 12-20 respirations per minute
• Normal tidal volume • Does not require
accessory muscles
Inadequate Respiration
• Shallow breathing– slight movement of chest or abdomen
• Labored breathing – increased respiratory effort, use of accessory
muscles, and gasping• Noisy breathing (obstructed airway)
– may include snoring, wheezing, gurgling (fluid in airway) on expiration, and crowing.
Sources of Airway Obstruction
• Tongue– Number one airway obstruction
• Foreign bodies• Broken teeth• Facial bones• Aspiration• Severe edema
Nasal flaringNasal flaring
Excessive Excessive useuseof accessoryof accessorymusclesmuscles
Chest Chest TightnessTightness
CyanosisCyanosis
Numbness, Numbness, tingling intingling inhands & feethands & feet
Pursed lipsPursed lips
Coughing, high-Coughing, high-pitched barkpitched bark
Respiratory Respiratory noise noise crowing,crowing, • wheezingwheezing• rattlingrattlingImpaired mental Impaired mental statuesstatues• unconsciousnessunconsciousness• dizziness/faintingdizziness/fainting• restlessnessrestlessness• anxietyanxiety• confusionconfusion• combativenesscombativeness
Signs of Inadequate Respirations
Evaluating the Casualty• Move the casualty for safety
• Check for responsiveness– “Are you okay?”– AVPU
• Casualty should be supine– If casualty is not supine, turn him or her
Opening the Casualty’s Airway
• When casualty is unconscious, muscles relax– This causes the tongue to slip back into the
pharynx
• Combat lifesaver’s goal is to maintain a patent airway
Opening the Casualty’s Airway
• Two methods are employed to open the airway
1. Head-tilt/chin-lift2. Jaw-thrust
maneuver
* Note: even if the casualty is breathing, position the airway to allow him or her to breathe easier
Head-Tilt/Chin-Lift
Do not compressSoft tissues under jaw
Not recommended
for patients with suspected head, neck, or spine injury
Head-Tilt/Chin-Lift
Jaw-Thrust Maneuver
Elbows onsame surface
Use on unconscious patients or where
head, neck, or spine injury is
suspected
Jaw-Thrust Maneuver
Checking the Casualty’s Breathing
• While maintaining an open airway– Look, listen, feel
• Look for signs of inadequate breathing or obstruction
Rescue Breathing• If the casualty is not
breathing, insert NPA and begin rescue breathing
• Rescue breathing 1. Maintain an open
airway 2. Pinch the
casualty’s nostrils shut
Rescue Breathing
3. Administer two full breaths – Ventilations should last from 2 to 3
seconds– Watch for the casualty’s chest to rise
4. If the air does not go in– Reposition the head and reattempt
5. If air does go in, check pulse after administering 2 breaths
Rescue Breathing
6. If casualty does not have a carotid pulse begin CPR *ONLY IF CERTIFIED*
7. Do not perform CPR in a combat environment
– Move on to the next casualty 8. If casualty resumed breathing,
count the number of respirations for 15 seconds
Nasopharyngeal Airway
* Airway of choice for the field environment
Nasopharyngeal Airway• Indications
– Conscious, semi-conscious, unconscious
– Gag reflex does not affect placement
• Contraindications – Open or closed skull
fractures– Other signs of head
injuries– Major maxillofacial
trauma• Complications
– Nasal trauma
Nasopharyngeal Airway:Insertion
1. Measure the NPA for appropriate size
• Tip of the nose to the earlobe2. Use sterile, water-soluble lubricant3. Insert NPA in the right nostril or
largest nostril• Bevel toward the septum
* This is the bevel
Nasopharyngeal Airway:Insertion
• If resistance is met, try other nostril• If NPA will not go into either nostril, place
the casualty in the recovery position and seek advanced medical aid
* Never force NPA into casualty’s nostril
Measure from the nostril to the earlobe or angle of jaw
Choose the correct size
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
Expose the opening in the nostril
* Pig nose
Insert the tip of NPA into the nostril
* Bevel toward the septum
* Do not continue if resistance is met
NPA in place* Flange is resting flush against the nostril
Inserted NPA
* Tongue as an airway obstruction is no longer a concern
What if you cannot insert a NPA?* Everything after this point is supplementary information…
Brief Anatomy of the Trachea
Cricoid Cartilage
CricothyroidMembrane
ThyroidCartilage
Brief Anatomy of the Trachea
Emergency Cricothyrotomy
• Procedure:– Identify and palpate
the cricothyroid membrane
– Make a 1 ½-inch vertical incision in the midline using a #15 or #10 scalpel blade
Emergency Cricothyrotomy Procedure:– 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
Emergency Cricothyrotomy
Check for air exchange and tube placement:
– Listen and feel for air passing in and out of tube
– Look for bilateral rise and fall of the chest– Ascultate the abdomen and both lung fields
Recovery Position
Summary• Brief A&P of the respiratory system• Respiratory process• Identifying adequate respiration• Signs of inadequate respiration• Evaluating the casualty• Inserting a NPA• Brief emergency cricothyrotomy• Recovery position
Questions?
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