AIRWAY

MANAGEMENT
Lesson Three

MSTC, FT LEWIS WA
Airway Management: Conscious
Patient
► No attempt at airway intervention if the
patient is conscious and breathing well on
his own.

► Ifthe casualty is talking or yelling he has an

open airway
 Airway Management:
Unconscious Patient

► Without airway obstruction:

 Chin lift or jaw thrust maneuver
 Nasopharyngeal airway
 If facial trauma present, position to let
gravity drain and maintain airway
(recovery position)
 Airway Management:
Unconscious Patient

► With airway obstruction:

 Chin lift or jaw thrust maneuver
 Observe for debris and remove if possible
►Loose teeth, facial bone, vomitus, etc…..
►No blind sweeps with your fingers

 Place NPA
 Open the Casualty’s Airway

► Thetongue is the most common cause of

an airway obstruction

► When a casualty is unconscious, muscles

relax. This relaxation may cause the tongue
to slip to the back of the mouth and block
the airway
Anatomy – Upper Airway

Tongue

Noisy ventilations =
obstructed airway

Gurgling, snoring,
stridor and wheezing
Anatomy – Upper Airway
 Manual Maneuvers
► Head-Tilt/Chin-Lift
 No suspected neck or spinal injury
► Trauma Jaw Thrust
 If neck or spinal injury is suspected, use the
Jaw Thrust method
► Trauma Chin Lift
Open the Casualty’s Airway
(Head-Tilt/Chin-Lift)
Open the Casualty’s Airway
(Trauma Jaw Thrust)
Open the Casualty’s Airway
(Trauma Chin Lift)
 Rescue Breathing
► Maintain head-tilt/chin-lift or jaw thrust

► Pinch nostrils closed and administer two full breaths (2

seconds)

► Check carotid pulse

► If pulse is present, administer mouth-to-mouth ventilations

at 1 per 5 seconds

► Check for breathing and pulse after one minute

 Airway Adjuncts
► Oro-pharyngeal Airway (OPA)

► Naso-pharyngeal Airway (NPA)

 Oropharyngeal Airway
(J-Tube)
► Identify when to use

► Determine the size

► Insertion of the airway

► Monitor the casualty

 Oropharyngeal Airway
(J-Tube)
► When to use:
 Unconscious patients

 Help to maintain an airway

 What about trauma?

 Oropharyngeal Airway
(J-Tube)
► How to size:
 Place the tip of the airway along the
outside of the casualty's jaw with the tip
touching the ear lobe.

 Close the casualty's mouth and place the

other end to the corner of the mouth
Oropharyngeal Airway
(J-Tube)
Oropharyngeal Airway
(J-Tube)
 Oropharyngeal Airway
(J-Tube)
► Monitor The Casualty:
 Check Respirations

 Check Placement

 What if the patient becomes conscious?

Oropharyngeal Airway
(J-Tube)
Not indicated if gag
reflex present

Best used temporarily

Does not protect the

trachea
 Nasopharyngeal Airway
(Nasal Trumpet)
► Identify when to use

► Determine the size

► Insertion of the airway

► Monitor the casualty

 Nasopharyngeal Airway
(Nasal Trumpet)
► When to use:
 Conscious, semi-conscious, or has a gag reflex

 Respiration rate less than normal (less than two

in 15 seconds)

 Snoring and gurgling sounds

 Airway of choice in tactical environment

 Nasopharyngeal Airway
(Nasal Trumpet)

► How to size:
 Size the airway by measuring from the tip
of the nose to the casualty’s earlobe

 Coat the tip with a water-soluble lubricant

 Nasopharyngeal Airway
(Nasal Trumpet)
► How to insert:
 Place the casualty on his back
 Remove airway and lubricant
 Lubricate the tube
 Expose the opening of the casualty’s nostril (pig
nose)
 Insert the tip of the airway into right nostril with
bevel facing septum
 Advance until flange rest against the nostril
Nasopharyngeal Airway
(Nasal Trumpet)
Nasopharyngeal Airway
(Nasal Trumpet)
Nasopharyngeal Airway
(Nasal Trumpet)
Nasopharyngeal Airway
(Nasal Trumpet)
Nasopharyngeal Airway
(Nasal Trumpet)
Nasopharyngeal Airway
(Nasal Trumpet)
 Nasopharyngeal Airway
(Nasal Trumpet)

► DO NOT continue if resistance is met

► Stop, remove adjunct, relubricate and try
other nostril
► If resistance is still met, check proper size or
use alternate artificial airway method
► To remove, pull out with steady motion
along curvature of nasal cavity
Nasopharyngeal Airway
(Nasal Trumpet)
Do not use the
nasopharyngeal
airway if the roof of
the casualty’s mouth
is fractured or brain
matter is exposed

Do not use the

nasopharyngeal airway if
there is clear fluid coming
from the ears or nose

Leaking cerebrospinal fluid

Nasopharyngeal Airway
(Nasal Trumpet)
 Position the Casualty
► Gravity is not just a good idea it’s the law
 Recovery Position, transport face down

► Casualty with facial trauma should be placed

in the recovery position (see below)
Questions????